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  • accutane and sebaceous hyperplasia

    i've been on accutane 20mg/day for about 2.5 months now and have seen a striking improvement in my general acne (face, trunk). my rosacea, however, has not yet exhibited a comparable improvement. the redness has not really subsided and the bumpy and uneven texture of my nose still remains, though my nose appears less swollen. i understand this may take some time, but what should i expect?

    will accutane help with the fibrosis and sebaceous hyperplasia, and the large pores (orange peel-like skin)? i noticed that some bumps have hardened over the course of treatment. some have said that this is a normal occurence. what is happening here?

    my derm initially prescribed a 5 month course, which means i'm halfway through it. should i continue to take accutane? what dosage should i use to shrink and smooth out my nose?

    about me:
    22 year old male
    about 140 lbs, 5'10"
    normal lab on accutane

    thanks, everyone, and happy holidays!

  • #2
    Re: accutane and sebaceous hyperplasia

    Originally posted by dreamz
    i've been on accutane 20mg/day for about 2.5 months now and have seen a striking improvement in my general acne (face, trunk). my rosacea, however, has not yet exhibited a comparable improvement. the redness has not really subsided and the bumpy and uneven texture of my nose still remains, though my nose appears less swollen. i understand this may take some time, but what should i expect?

    will accutane help with the fibrosis and sebaceous hyperplasia, and the large pores (orange peel-like skin)? i noticed that some bumps have hardened over the course of treatment. some have said that this is a normal occurence. what is happening here?

    my derm initially prescribed a 5 month course, which means i'm halfway through it. should i continue to take accutane? what dosage should i use to shrink and smooth out my nose?

    about me:
    22 year old male
    about 140 lbs, 5'10"
    normal lab on accutane

    thanks, everyone, and happy holidays!

    Hi Dreamz,

    Please give it time and talk to your doctor about extension of the low dose regimen. It should definitely have an effect on superfiical fibrosis, sebaceous gland hyperplasia and pore size. Remember that all of these symptoms are dependent on the cumlative dose -- so clearance and maintenance of clearance will depend on how long you take this low dose.

    Comment


    • #3
      Dr Nase,
      When you say cumulative dose, should we be aiming for 120mg/kg (similar to teenage acne)?

      At that pace, I will be on accutane for nearly 3 years. That might be tough to convince my derm to do...

      Thanks in advance for you help!!!

      Hope you are feeling well.

      Best,
      Trey

      Comment


      • #4
        Originally posted by clsykes00
        Dr Nase,
        When you say cumulative dose, should we be aiming for 120mg/kg (similar to teenage acne)?

        At that pace, I will be on accutane for nearly 3 years. That might be tough to convince my derm to do...

        Thanks in advance for you help!!!

        Hope you are feeling well.

        Best,
        Trey

        Hi Trey,,

        Very good question. The 120 mg/kg was set to be the standard for treating severe cystic acne, so in mild to moderate acne or rosacea, that should be cut in half at least.

        The cumulative dose for rosacea sufferers of Type I and Type II works out to be 10 mgs every day for approximately 1 year based on the reports from experts in the field.

        If you have rhinophyma or considerable sebaceous gland involvement they may alter the regiment slightly to get a higher cumulative dose:

        1. 10 mgs everyday for one year and then 10 mgs 3 times per week for another 4 to 6 months (under tight guidance by your physician)

        2. Alternating 10 mgs and 20 mgs for up to a year.

        Sebaceous gland hyperplasias can be treated and clearance maintained for years or they may come back within 6 to 8 months. No one can predict.

        Comment


        • #5
          Originally posted by drnase
          Originally posted by clsykes00
          Dr Nase,
          When you say cumulative dose, should we be aiming for 120mg/kg (similar to teenage acne)?

          At that pace, I will be on accutane for nearly 3 years. That might be tough to convince my derm to do...

          Thanks in advance for you help!!!

          Hope you are feeling well.

          Best,
          Trey

          Hi Trey,,

          Very good question. The 120 mg/kg was set to be the standard for treating severe cystic acne, so in mild to moderate acne or rosacea, that should be cut in half at least.

          The cumulative dose for rosacea sufferers of Type I and Type II works out to be 10 mgs every day for approximately 1 year based on the reports from experts in the field.

          If you have rhinophyma or considerable sebaceous gland involvement they may alter the regiment slightly to get a higher cumulative dose:

          1. 10 mgs everyday for one year and then 10 mgs 3 times per week for another 4 to 6 months (under tight guidance by your physician)

          2. Alternating 10 mgs and 20 mgs for up to a year.

          Sebaceous gland hyperplasias can be treated and clearance maintained for years or they may come back within 6 to 8 months. No one can predict.
          Dr.Nase:

          I'm slightly confused. I was thinking of starting accutane a 10mgs 3 times a week for my rosacea --flushing/p&p/burning/hot skin/ no perm. redness. Would this dosage be too low to start with? Is 10mgs everyday for a year going to result in better clearance?
          I don't want to live with it. I refuse to.

          Comment


          • #6
            Originally posted by clsykes00
            Dr Nase,
            At that pace, I will be on accutane for nearly 3 years. That might be tough to convince my derm to do...
            it's also extremely costly to do. plus, i'm a little concerned about the long-run effects of such a long treatment period.

            The cumulative dose for rosacea sufferers of Type I and Type II works out to be 10 mgs every day for approximately 1 year based on the reports from experts in the field.

            If you have rhinophyma or considerable sebaceous gland involvement they may alter the regiment slightly to get a higher cumulative dose:

            1. 10 mgs everyday for one year and then 10 mgs 3 times per week for another 4 to 6 months (under tight guidance by your physician)

            2. Alternating 10 mgs and 20 mgs for up to a year.

            Sebaceous gland hyperplasias can be treated and clearance maintained for years or they may come back within 6 to 8 months. No one can predict.
            it looks like i'll need to continue taking this drug then, but i could probably lower the dosage to 10-20mg every other day.

            since we're talking about cumulative dose, what would be the key differences between taking a low dose vs. a high one, beyond side effects?

            what are some milestones or key markers we should be conscious of while taking the drug?

            should we use anything in conjunction with accutane, e.g. topical ointments?

            cheers,
            dreamz

            Comment


            • #7
              Originally posted by lafittevillage
              Originally posted by drnase
              Originally posted by clsykes00
              Dr Nase,
              When you say cumulative dose, should we be aiming for 120mg/kg (similar to teenage acne)?

              At that pace, I will be on accutane for nearly 3 years. That might be tough to convince my derm to do...

              Thanks in advance for you help!!!

              Hope you are feeling well.

              Best,
              Trey

              Hi Trey,,

              Very good question. The 120 mg/kg was set to be the standard for treating severe cystic acne, so in mild to moderate acne or rosacea, that should be cut in half at least.

              The cumulative dose for rosacea sufferers of Type I and Type II works out to be 10 mgs every day for approximately 1 year based on the reports from experts in the field.

              If you have rhinophyma or considerable sebaceous gland involvement they may alter the regiment slightly to get a higher cumulative dose:

              1. 10 mgs everyday for one year and then 10 mgs 3 times per week for another 4 to 6 months (under tight guidance by your physician)

              2. Alternating 10 mgs and 20 mgs for up to a year.

              Sebaceous gland hyperplasias can be treated and clearance maintained for years or they may come back within 6 to 8 months. No one can predict.
              Dr.Nase:

              I'm slightly confused. I was thinking of starting accutane a 10mgs 3 times a week for my rosacea --flushing/p&p/burning/hot skin/ no perm. redness. Would this dosage be too low to start with? Is 10mgs everyday for a year going to result in better clearance?

              Hi,

              For skin inflammation, flushing, redness and burning, 10 mg 3x a week works for some. Try it out for 3 months and then decide whether to up it. If you also have papules and pustules, probably better to take it every day.

              Comment


              • #8
                Originally posted by dreamz
                Originally posted by clsykes00
                Dr Nase,
                At that pace, I will be on accutane for nearly 3 years. That might be tough to convince my derm to do...
                it's also extremely costly to do. plus, i'm a little concerned about the long-run effects of such a long treatment period.

                The cumulative dose for rosacea sufferers of Type I and Type II works out to be 10 mgs every day for approximately 1 year based on the reports from experts in the field.

                If you have rhinophyma or considerable sebaceous gland involvement they may alter the regiment slightly to get a higher cumulative dose:

                1. 10 mgs everyday for one year and then 10 mgs 3 times per week for another 4 to 6 months (under tight guidance by your physician)

                2. Alternating 10 mgs and 20 mgs for up to a year.

                Sebaceous gland hyperplasias can be treated and clearance maintained for years or they may come back within 6 to 8 months. No one can predict.
                it looks like i'll need to continue taking this drug then, but i could probably lower the dosage to 10-20mg every other day.

                since we're talking about cumulative dose, what would be the key differences between taking a low dose vs. a high one, beyond side effects?

                what are some milestones or key markers we should be conscious of while taking the drug?

                should we use anything in conjunction with accutane, e.g. topical ointments?

                cheers,
                dreamz

                Hi Dreamz,

                Definitely your decision on lenght f treatment. Some go right back to their former state if not treated long enough and then need a second treatment schedule. It is better to stay on one for a little longer if this is the case.

                Higher dose shrinks sebaceous glands more -- thats the main difference.

                Milestones -- once the symptom is gone and stays gone, the rule of thumb is to treat another 3 months at least -- dont stop right when symtpoms diminish.

                Just be extra gentle to your skin. Even cut down washing it and just soak it with spring water some days.

                Comment


                • #9
                  Thanks Dr Nase,

                  With your informative posts I have decided to up the dose to 20 mgs a day alternating once in a while back to 10mg a day to see how my skin responds. After 5 months I haven't seen the improvements in base redness as much as I want to.

                  Comment


                  • #10
                    Originally posted by drnase
                    Hi Dreamz,

                    Definitely your decision on lenght f treatment. Some go right back to their former state if not treated long enough and then need a second treatment schedule. It is better to stay on one for a little longer if this is the case.

                    Higher dose shrinks sebaceous glands more -- thats the main difference.

                    Milestones -- once the symptom is gone and stays gone, the rule of thumb is to treat another 3 months at least -- dont stop right when symtpoms diminish.

                    Just be extra gentle to your skin. Even cut down washing it and just soak it with spring water some days.
                    thanks for the tips. i'm going to see if i can continue with accutane.

                    it seems one bump on my nose has become harder. is this normal? i thought accutane was supposed to shrink oil glands.

                    also, i'm waiting to get some more pills. i'm assuming there shouldn't be too much of an issue with missing 4-5 doses, right?

                    Comment

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