accutane

[lyter]

hello. My background info:

2 years ago at the age of 21 i took a cumulative dose of 187 mg/kg over a period of 5 months for moderate acne. Even though my acne cleared up completely by the third month still my doc pushed me for as high a dose as 2 mg/kg/day for the last month. When i asked why he said  "your numbers ( blood test) are A+ ".  
While on the drug i had the dryness issues but no joint pain, just weakness.
About 4-5 months post accutane my joints became very noisy and soon enough painful. Since then the pain has gotten a lot worse. I have painful tmjs, shoulder, knees, wrists and hips. Plus stiffness and severe crepitus. However there is no sign of inflammation in my blood tests. auto-immune diseases, gout and thyroid disorders have been ruled out. My internist says accutane does not do this. While my rheumotologist does a verbal dance to dodge my questions regarding accutane.

I have neither any sport injuries nor any family/personal history of joint problems.

my questions:

1. How often have you seen in your practice arthritis or pseudo-arthritis ( arthritic manifestations in absence of inflammation, sorry dont know what to call it) percipated by accutane? I am not talking about acute cases but long-term chronic ones.

2. Is it just me or was my derm too liberal when it came to dosing? do you doctors usually stick to FDA guidlines regarding dosing ( 120 mg/kg typical, 150 mg/kg max, 14-20 weeks, can be discontinued when 70% improvement...) or do you regard them as overly conservative guidlines.

3. why is this gap between what FDA says ( muscoskeletal conditions have been linked to accutane and may persist after discontinuation of drug) and what doctors say ( my derm flatly refuted a link between arthritis and accutane even though it
is listed)

thank you

[sam ivan]

Hi there. I suffer from whiteheads. I dont know how to treat them. I have no probems on my forhead, neck or any other part of my body. I have no cysts only these little whiteheads. Any suggestions how i can stop them from coming? I had them burnt out before but i cannot keep doing this? Is Minicycline the answer? I have very sensitive skin and any cream, gel or lotion makes my face red? what can I do?

[Alan Rockoff, MD]

1. How often have you seen in your practice arthritis or pseudo-arthritis ( arthritic manifestations in absence of inflammation, sorry don't know what to call it) percipated by accutane? I am not talking about acute cases but long-term chronic ones.
Never, in 25 years.

2. Is it just me or was my derm too liberal when it came to dosing? do you doctors usually stick to FDA guidlines regarding dosing ( 120 mg/kg typical, 150 mg/kg max, 14-20 weeks, can be discontinued when 70% improvement...) or do you regard them as overly conservative guidlines.
Dosage can vary from the guidelines, depending on the severity of the acne.

3. why is this gap between what FDA says ( muscoskeletal conditions have been linked to accutane and may persist after discontinuation of drug) and what doctors say ( my derm flatly refuted a link between arthritis and accutane even though it
is listed)
I too am not aware of such a link.  One thing I've done in the past when patients developed something strange that I couldn't definitely associate with Accutane has been to contact the medical department of Hoffman-LaRoche, who fist developed the drug, to see whether they have such cases on file.  Of course, even if they do, it hardly proves cause and effect.  But if you want to chase this down further, that's where I go.  I should tell you, though, that you're not going to get any absolute certainty in a circumstance so rare.  Again, this is a complication I have neither seen nor read about....

Best.

Dr. Rockoff