Should I be on accutane

[advisememf]

Hello,

I want to know if I should be on accutane, as I feel that I probably should. Honestly, the idea of taking pills and topical meds until I "outgrow" acne is starting to wear really thin with me. I feel that I've had this whole thing mismanged.

I'm a male, 27 yrs. old, caucasian, somewhat oily skin, 185 lbs, and have had acne since I was about 14 or so. It seems to have evolved from whiteheads and pimples early on to large cysts (about 2-5 per week) on back, shoulders and forehead/nose/neck. I started getting large deep cysts starting in about 1999. I have some scarring on my shoulders and a little bit on my back from them.

I've been on many meds including (in approx. chronological order)...benzoyl peroxide, clindamycin, tetracycline and, possibly, erethromycin (can't remember for sure), retin-a, doxycycline and now, minocycline (100 mg 2X daily). I was on doxy from '99 to '03 and I've been on mino since then. I also started using differin a few weeks ago.

My prescription for minocycline just expired and after not taking it for about 10 days now, I'm starting to get about 1-2 cysts per week on my face and 2-4 on my shoulders. They aren't huge cysts (like back from a few years ago) and so long as I don't try to lance them, they will go away by themselves in about 1-2 weeks. When I'm on minocycline, I still get cysts, but perhaps only 2 or so every three weeks on my face. Minocycline does almost nothing to help my shoulders, although its my face that I'm most concerned about, naturally. I have no confidance that the differin I'm taking will ever do anything as no topical med. has ever helped me in the least.

I also have keratosis pilaris (I figured that out by myself) and have plugs/ingrown hairs on the back of my arms, thighs and buttocks. Not sure what that means in terms of acne though. I guess I'm predisposed to getting plugged pores/follicles. I was also going to be put on accutane about 10 years ago, but a blood test showed to many RBC's. Another test was more normal and they said it was pseudopolycythemiavera. I ended up never going on it. Things must change. I know my body and have no sense that I will "outgrow" this anytime soon. At the rate my acne has improved over the yrs., I'll probably outgrow it by age 35. I don't have sever cystic acne like in the worst of the pics of people (but I'd say I was somewhat close to that a few years back before the antibiotics). I just have this ultra-stubbord form of the condition. I'm absolutely sick and tired of having zits on my shoulders and all the scarring and I'm fed up with even occasional cysts on my face. I want to absolutely insist on being put on accutane at a dosage that will clear me up for good after 4-5 months of therapy. I'm just extremely tired of dealing with this. If my current derm. doesn't give me accutane I'll see as many derms. as it takes to get it. What's your opinion on this? Should I see you if my derm resists my request for accutane?

Regards,
maf

[DrAtNIH]

I just log on this forum today, and didn't realize that acne make people so suffering, I already make post on this website, check the message:
http://www.medhelp.org/perl6/dermatology/messages/34092.html
I would like to share my experience with you if you are interesting.
***@****

[clearaway]

I am a 38 year old mother of two and whi has been suffering from cysts since 18 years old.  I thought by now I should not have to worry about them and it has actually escalated to a point  where I am experiencing extreme anxiety.  My dermatologist knows that I am desperate for a cure and suggested accutane last year and I was hesitant and refused at the time.  I am now considering it but very fearful of the side effect of depression because of my mental state.

I am on doxycycline twice a day and have been taking Diane 35 for a little over a year.  I did seem to help with the cysts occurring only once every few months but just recently in the last month I had a pretty painful one on my chin.  I had a cortisone injection and it seemed to go away in about a week...three weeks later it feels like its coming back.  I'm think maybe because the cyst never excreted the puss.  

My self-esteem is nil and I have had to seek therapy to work out my anxiety that I am suffering.  I have had many hours of crying, feeling sorry for myself and asking why me.  I see my family, friends and co-workers who complain about a little pimple and with a little topical cream it is gone in a couple of days.

I am tired of feeling so helpless and feel that I will be living and fighting with these cysts for the rest of my life.

[Alan Rockoff, MD]

Although of course I can't tell for sure from your note whether you are a candidate for Accutane, it sounds as though that drug would be a reasonable option.  I agree that topical therapy is not likely to help much.  That, plus the failure of oral antibiotics to bring sustained improvement make Accutane worth considering, and I think you should discuss this with your dermatologist.

I don't know what to make of your having too many red blood cells 10 years ago, or why that should make any difference to your taking Accutane, then or now.  That too is something to talk about with your doctor (assuming it's even still present.)

Take care.

Dr. Rockoff