accutane, fordyce spots, injection

[brian22]

Dr. Rockoff,

I just want to say what a great source of comfort you are to so many of us accessing this website with our embarrassing dermatologic conditions. Thank you!

1) I am 24 years old. I have a variety of cystic acne that only causes flare ups on my chin/jowls area. I am now on adoxa 100mg's 2X daily, persagel BP 10% at night, and neutrogena on the spot BP 2% + Cetaphil moisterizer applied ten minutes later in the morning.

My chin is generally dry and RED from the treatment. I tend to attempt to cover-up the redness with concealer, which has garnered a few unappreciated downward glances from several people. My method is inconvenient and obtrusive. I have never tried accutane, I fear hair loss. I know you have not seen this too much in your practice, but my fear pervades nonetheless. I have to say, though, having been on antibiotics on and off for ten years now, I am sick and tired of rubbing these medications on my face. Should I just switch to Retin-A Micro once a day? Comments? Observations?

2) I received an injections for a cyst on my chin in August. Something went wrong with the injection whereas the blood vessels broke. Four months later, redness still exists where the blood vessels burst. Will this ever go away? Is it ever permanent?

3) I have had Fordyce's spots on my penis my whole life basically. (I know, I'm a very lucky guy!!) I had some success with a very low dose retin-a preparation applied on the penis. However, it is extremely annoying to apply. Is the low dose Retin-A applied on the penis a safe method? Is it safe to apply tretinoin to a penis?

4) Do you know if Accutane clears up the Fordyce's spots during treatment? Is it like acne where a large percentage of people may complete their course of Accutane, and then never have the Fordyce's Spots again?

Thank you so much in advance,
Brian

[Alan Rockoff, MD]

1.  Retin-A is OK, but may dry you out.  Try it first.  The medication you are now using that may be the source of dryness is the Persagel (benzoyl peroxide.)  Ask about using a non-benzoyl peroxide product.
2.  If the vessels are still visible, they probably won't go away unless you laser them away, a minor and safe procedure.
3. There's no way to get rid of what you're calling Fordyce spots (cysts) on the penis.  Retin-A will not work.  You should make up your mind to consider yourself normal, which you almost certainly are.
4.  No, Accutane will not clear these up.

I don't know whether Accutane will clear up your acne permanently, but even if it doesn't, it should give you a long remission.  I haven't seen a case of severe or permanent case of hair loss from this drug in 22 years of use.  You should at least consider it, I think.

Please talk to your doctor about all these things.

Take care.

Dr. Rockoff

[DarkDryad]

Sorry to bump this thread. But I have been using Accutane and I must say that after 5 months of treatment, my acne has improved a lot. There are, however, some side effects. Skin dryness being one of them, the skin in the face on arms legs or on tummy. It's pretty irritating, but by applying some cream it's a bit better. The biggest side effect the one that bothers me really is being exhausted. I used to be able to run like hell, but now since I began the treatment I have quite severe exhaustion, I can barely go up the stairs one level without being a bit exhausted which I had no problem before. About the hair loss, well I wouldn't call it hair loss in my case, but I do realize that if I'm not careful when I wash or comb my hair that it can be pulled out kind of easily, but it's nothing to worry about. I tried so many creams and pills and nothing worked, so I tried accutane and it improved, so it's your decision.

[Alan Rockoff, MD]

The dryness will go away when you stop.  The exhaustion is not from Accutane--you need to look into other causes (not sleeping enough being the most likely.)

Dr. Rockoff

[DarkDryad]

Are you sure about that? Because I did not have that kind of exhaustion before I started treatment. I don't have much sleep (about 5 to 6 hours), but I have been doing that for over 3 years. I,ll have to check it out then.

[Alan Rockoff, MD]

Good idea for you to look into it.  In any case, you'll be off it soon.

Dr. Rockoff

[DarkDryad]

Well I have not extended it to one more month. I wanted to know, is it ok if I take alcohol during the treatment? I have taken one or two beers now and then since the treatment, but this weekend is going to be my 18th birthday and I just wanted to know if it could do any damage if I took about 5-6 beers?

[Alan Rockoff, MD]

Check with your prescribing doctor.  I usually permit my Accutane patients modest alcohol intake.

Dr. Rockoff

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