proactive/accutane/doryx - didn't work for me

[Lukalala]

I am a 33 years old female. For a while I have had minor but persistent break outs and some white heads and very little internal bumps around the chin and nose area which would only get better temporarily, never disappear.  I bought Proactive to have a complete system to clean my face.  Within 3 days ended up with dark blemishes and red irritated spots all over my face along with a bad break out yet horribly dry skin, like I had never seen my face before.

Several months and medications later I was on an Accutane treatment.  The results were not entirely satisfactory.  My face looked good for a couple of DAYS at the end of the 6th month of Accutane [December 2003].  I started tri-luma as well which cleared my blemishes perfectly within 2 weeks.  

However the blemishes are back and won’t clear completely now, they stay as yellowish-tone spots, along with lighter skin areas and light pink-like ones as if slightly irritated.  I still have minor break outs and white heads just like before and during Accutane. I am currently on Doryxx 75mg for 3 months to then go on a second round of Accutane.  I have been on medications [pills, gels, creams] for a long time and having another treatment of Accutane to look forward to after 3 months of Doryx is really frustrating.   My dermatologist is absolutely great but I would like to hear your opinion.  

I keep brainstorming: “I put on my sun block every morning ~ I don’t have oily skin ~ I have a healthy diet ~ work out but hardly sweat ~ my family has good skin ~ I clean the phones and wash the pillow cases ~ birth control is the jasmin pill ”.  Could any of that change your opinion/advice?  Could it be that I don’t sweat much?, I only break out on my face.

Currently I don’t even use moisturizer [directed by my doctor].  My face looks really dry and “lifeless” kind of “blahh” [if that makes sense] but when I wash it or touch it doesn’t feel dry.  If I go to get facials they tell me I need to hydrate and moisturize my skin [so I don’t get the facial], the dermatologist tells me to not moisturize it, my previous dermatologist mention some dermabrassion but then said my face didn’t need it.  It seems to me like I am right in the middle of everything and nothing.

I look forward to your response,  
Thank very much for your time and help.

[Alan Rockoff, MD]

As far as I can tell from your description, you have not severe acne but rather the kind of minor irregularities of skin tone and texture which respond poorly to any acne treatment.  If you started having them a mere couple of days after stopping Accutane, then I wouldn't bother taking it again.  I doubt that topical or oral antibiotics will do much for you either.  The patients I see with similar complaints I direct to an esthetician for facials, microdermabrasion, and other esthetic treatments.  I don't understand why the estheticians' admonition to moisturize makes you "not get the facial."  As to the disagreement over whether to moisturize or not, I think that's not a medical issue but one of personal judgment--if it makes your skin look and feel better, do it, and it not don't--up to you.

Eating well is good overall but hasn't much relevance to skin appearance.  Cleaning phones of bacteria feels hygienic but is not necessary.

A useful thing for skin that looks "lifeless" is makeup.  Worth considering, along with esthetic treatment.

Best.

Dr. Rockoff

[Lukalala]

I wish the doctors would have said that from the very beginning.  Thank you very much, those are GREAT news and make all the sense in the world.  Medications seem to come and go and my face is just oblivious to them.  No matter what medication I am on I break out the same.  It is not too much just bothersome however combined with the pigmentation irregularities adds up to where it hampers my job which is closely tied to my appearance.  It has been professionally and personally frustrating.

The dermatologist told me to stay away from moisturizers while on Accutane because they would not help the treatment.  Once the treatment was over and my face kept breaking out she advised me to stay clear of any type of creams, lotions, ect for a while so I am just following directions.  I went “facial-shopping” to see what was new out there and also to have a place to go once I was done with all the pills and the tri-luma.  I have only washed my face with netrogena soap and have used cetaphil lotion occasionally for the last 7 months.

Once again I really appreciate your advice, it answers a lot of questions and makes me feel more secure about what to do next. You are incredible!

[Alan Rockoff, MD]

You're welcome.  I appreciate your response very much.  

Good luck.

Dr. Rockoff

[queenka]

can you put non oil free lotion on while using accutane?  also, i use foundation that is not oil free. is that okay as well?

[Alan Rockoff, MD]

Sure, no problem.

Dr. Rockoff

[deoxyribose]

A related discussion, What to do when Accutane doesn't work was started.