Started low dose accutane \ isotretinoin for rosacea

[flying_er]

I've started low dose isotretinoin for rosacea so I thought I'd start a thread to track results. Feel free to comment, give advice, share knowledge etc.

Background -
46 y\o white male, starting having mild breakouts on forehead and scalp a couple years ago. I was able to contain this by using cetaphil cleanser and moisturizer and witch hazel toner. At the time I did not know I had rosacea, just some acne and this method contained it for 2 years. As I understand now, the witch hazel probably made things worse in the long run.

April 2009, breakouts on forehead and scalp got worse, skin got red rashy\sore\hot.

May 2009, went to dermatologist, diagnosed with rosacea, given metrogel. I used metrogel for 2 months, it did not help at all, my condition worsened.

July 2009, derm added low dose doxy to the mix, 40mgs per day in addition to the metrogel. This combo did nothing to help me, conditions continued to get worse.

Aug 2009, derm upped doxy to 100mg per day and switched topical to finacea. I talked to derm about low dose accutane\isotretinoin, he thought it might be a good idea if the doxy did not work.
The combo of doxy\finacea helped a bit but problems persisted. It seemed to me like the finacea helped a bit but the doxy did nothing.

Sep 24, 2009, started low dose isotretinoin, 20mg every other day. The first week was interesting, had some lower back pain, achy legs, trouble sleeping one night, slightly dry lips and eyes. At first it seemed like iso was immediately helping my condition, less inflamation, less heat on skin, fewer P&P's. But in the second week I have started to breakout a bit, nothing horrible yet, but noticeable new P&P's on forehead. Maybe this is the start of the dreaded Initial Breakout that iso is famous for, time will tell.

**Also of note, I've embarked on a "cleaner" diet. Lots of fruits and veggies and less gluten. I've heard gluten and or wheat can be a problem for some so I'm going low gluten. I'm eating gluten free bread\cereal\cookies\pasta etc. I'm not on a gluten free diet, just a low gluten diet. I'm also reducing sugar\coke\candy etc and drinking lots of water.

[Yvette]

Hi Dave!

Looking forward to reading your log! Congratulations on starting low dose Accutane!! In a short time, you will see a noticeable improvement in your acne (eliminated) and your face clear and smooth.

I've given you some tips and things to watch for... Mainly... Just stay low dose and do moisterise! This not only includes your skin (face and body) but also be watchful and lube your eyes, nose, lips, and even "down there" if you need to! Too much information I know, but really, the dryness sneaks up quick. Putting eye drops in a few times a day or more, using Aquaphor for your lips, and Polysporin or Vaseline for inside your nose if it gets dry, will help. Supplements per your Derm. I took probiotics, calcium, biotin, grape seed, and hair supplements. And you bet, eating good and exercising, will combat some of the aches/pains you may feel on Accutane. Lots of water and fluids too.

Routing for ya! Will check up on you and feel free to ask any questions. Take care.
Yvette

[flying_er]

Thanks for your support Yvette. I hope you are correct, acne free sounds good to me. I really enjoyed reading your log, it helped me make the decision to try accutane. Hopefully this log will be of help to others.

[Yvette]

Hey Dave,

Accutane is really the only closest thing to a cure for acne.... It's the only medicine that really cleared and smoothed my face like no other. Here are some more tid bits, atleast from my experience.

I don't have much other underlying skin conditions, maybe a little seborrhea on my forehead, so my face (and overall) did very well on low dose Accutane. Sometimes, if your skin is super sensitive, you have other skin issues and/or your dose is too high for your skin/body, your skin may regress or you may have moderate versus mild side effects on Accutane. For example, if you have dry eyes, be very careful that you lube them or you will have problems as Accutane will dry them further. Accutane is great for acne/pustules/papules and the inflammation associated with it, however, I've read posts of those with clearer skin taking Accutane only to find their flushing worsens (ie. drug too strong for their skin and condition). Periodic flushing is okay, which clears quickly, but lasting and frequent flushing is not. If my skin for some reason was red/dry (had a few experiences in the mid-latter part of my treatment) I would just skip a day or so taking the medicine. Ask your Derm. about this. I kinda altered my treatment slightly to fit "my needs" often reducing the dose. This was fine with my Derm. My Derm. was very supportive of clearing my acne without exacerbating my Rosacea. From what you tell me, your Derm. sounds really cool and is an advocate in helping you achieve your best skin! :0)

I hope this information is helpful. Some of it may sound a little scary, but overall, my ride was pretty smooth. The "not knowing what to expect factor" is high in the beginning but as you go along you will see the results and the few minor sides. Were here to give you support and listen. I'm hoping things go smooth for you also.

Cheers,
Yvette

[flying_er]

Thanks for the info Yvette. I've been lubing eyes, nose, skin, so far no real problems with over dryness. And I no longer have the achy back or legs so that's a good thing. But I am breaking out pretty bad, not too happy about that. I knew the initial breakout was a possibility. What I don't know is how long it will last and how bad it will get, I'll just have to wait it out and see.

I'd like to hear from other accutane users, an informal poll if you will.

- Did you get an Initial breakout?
- How long did it last?
- How bad did it get?

[Yvette]

You're welcome Dave - anytime.

I remember I was really scared/freaked to start Accutane and having the IB. Each day, getting up wondering if a new pimple would arise or something. Did your Derm. suggest anything you can do or use on the few breakouts? My Derm. said a mild salicylic acid gel would be fine on the spots. If your spots are bothersome, ask you Derm. for suggestions. And if the urge is there to pick - don't. Just let them be, they will dry out and wash away soon... You will have your day soon where you'll be spotless!

There are others here who've been or are on Accutane. A few come to mind: Lauren (recently finished), Valby (still on very low dose), Steve95301. Surely, there are others too. By chance, have you visited acne.org? This is a good site to read posts/experiences. Folks on antibiotics, holistic regimens, Accutane, etc. Though keep in mind most folks there are on regular dose Accutane and not low dose. Good posts and before/after pictures.

Hang in there.

Yvette

[Sonic999]

I used to take 10mg, 3 days a week, and it quickly (1 week) dealt with my seb derm (each and every one of my pores has this white gunk, whiteheads, which if removed, come back the next day), but the redness never went away... I don't think accutane can clear rosacea, correct me if I'm wrong (I'm no dermatologist).

[Snegovik]

flying_er, yvette and others that have experience with low dose accutane. My derm said that he prefer a high dose of accutane for acne, because the final result is better then. With a low dose, the risk is high that the problems return. How ever, the low dose treatment can last longer so that the cumulative dose is reached. He also said he would never give a high dose to anyone with ocular rosacea or flushing problems.

What do you guys think about that? Could it be that 6-12 months on a low dose is simply to short? And that we would benefit more on staying on accutane until the cumulative dose is reached?

I wonder if that is why "googoo" here on the forum, and others that have been on the meds for a long time, report that their rosacea/seb derm returned, but less severe than before accutane? Because the sebacous glands are less in numbers, and smaller, so that even if we still have the disease, the symptoms will be less?

[flying_er]

Thanks for the replies.

Yvette - I do try to keep my hands off my face, it's tough at times but I'm pretty good about it. I have a funny routine I follow. When I look at my face in the mirror I make sure my hands are behind my back so I don't instantly start touching my skin. As for spot treating my acne, my derm said I could continue to use a bit of Finacea as long as I don't find it too drying.

Sonic999 - I think you are correct, accutane will not generally clear rosacea on a permanent basis. My derm typically uses long term low dose therapy for rosacea, but did say that many people can come off the accutane at some point and still do well. Others do not stay clear and may need to use topicals\doxy or again use accutane.

Snegovik - From what I have read, higher doses do generally yield better long term results for acne. The problem with skin that has both rosacea and acne is that the high dose may inflame the rosacea symptoms. I think it requires a bit of trial and error to find the right dose for an individual. My derm suffers from rosacea and has been on low dose accutane for many years with good results.

[flying_er]

Week 3 update:

I've been on this program for 3 weeks now, taking 20mg every other day. The sore back and legs are not much of an issue at this point, and the dry skin, eyes, lips are very manageable. I think my body has gotten more comfortable with the medication. My breakouts got worse around day 10 and I'm still breaking out but not as bad as last week. Hopefully the breakouts will slow down over the next few weeks. My skin is feeling a bit softer and seems to be getting smoother. I wish I could roll the clock ahead and see what the future holds but I guess I'll just have to wait. That's it for now.