Acne Treatment

Parent Cafe
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<p>My son, with cystic acne, went for almost 2 years trying everything the dermatologist had. She was ready to put him on Accutane after 1 year, but he was resistant. He started with proactive, then agreed to the dermatologist. He used oral antibiotics, several different creams, antibiotic and otherwise (one that was $130/month) and nothing worked. He finally agreed to try Accutance. His acne was on face, back and chest and was painful.</p>

<p>He took a lower dose than normal, and because of the lower dose was on it for an extra month. He did get very dry skin and lips, but he said it was less painful than the acne. Not only did his acne clear up, but his scars healed. The dermatologist said it might help with his scars, but we weren’t expecting all of them to fade. His skin looks like it did when he was a baby.</p>

<p>He’s been off of Accutane for almost 5 years and has no outbreaks. The first couple of years he got a pimple once in a while, but hasn’t had any the last 3 years. He uses chap-stik, but thinks it’s more of a habit than a necessity. </p>

<p>I agree about staying out of the sun, or at least using high spf sunscreen while you’re on it. My son is pale anyway, so he’s always used sunscreen and doesn’t spend a lot of time in the sun. Good luck.</p>

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<p>My concern about Accutane’s longterm effects is stunted growth (height).</p>

<p>Has anyone heard about that?</p>

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<p>I don’t remember it in the tome we had to read and sign.</p>

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<p>I have read about hair loss as a side effect of Accutane.</p>

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<p>The OP’s son is 17. How much more would he grow anyway?</p>

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<p>Accutane can cause severe hair loss/thinning–my D lost at least 1/3 of her hair if not more. Then after 6 months of being off the accutane, she began breaking out again and she’s back where she started. Have tried everything. Now trying Oracea, which is given to rosacea patients. Her lips actually never were severely chapped, due to using Dr. Dan’s cortibalm lip balm. Very dry, but never swollen, bleeding, etc. It is amazing–just ask your pharmicist for it. You can google it for more info. If we had it to do over again, we would not do the accutane. All the side effects weren’t worth 1 year of clear skin. Another round of it and she might have hardly any hair left.</p>

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<p>Accutane was wonderful for S2. I wouldn’t do it for S1, because I was concerned about the side effects. Now I wish we had. He’s 22 now and still has occasional outbreaks. It’s not severe on his face at all but his back is kind of bad sometimes.</p>

<p>S2’s acne was much worse. I initially resisted the Accutane again, due to the depression/suicide link. The Dr. said, “Look, I have used this on hundreds of kids and I’ve never seen a case of depression. I did have to take 2 kids off it because their liver enzymes went up.” That sold me. S2 did one course. He looked bad while he was going through it, with the red peely skin and his lips were miserable. But now, 2 years later, his skin is like a baby’s behind. He was 17, so the height thing wasn’t a concern.</p>

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<p>I just finished my first course of Accutane last month, and I’m really glad I did it. Before I had tried a few combinations of antibiotics and topical creams that worked until we played with my dosage, after which it stopped working.</p>

<p>My doctor wasn’t concerned about the depression link, but he still had to ask me if I had mood changes at my monthly appointments. My mom was initially very concerned about the depression/suicide link and mentioned it at my very first appointment, but was told by the dermatologist that it was overblown by the media and she wouldn’t be starting me off on Accutane anyway.</p>

<p>I only needed three blood tests – before I started, a month after I started, and a month after we changed the dosage. If my doctor had messed with the dosage more frequently, I would have needed more blood tests. Of course, there was also a pregnancy test every month.</p>

<p>I waited until after I graduated before starting – it had been suggested as something to try when I was still in college, but I didn’t want to mess with finding a new dermatologist. </p>

<p>The side-effect I experienced was dryness around my lips, but this is very common. I used vaseline, and it really helped me. I was definitely not concerned about stunted growth, as I finished growing in middle school, about 9 years ago, but I don’t remember seeing that in my big book of things to know.</p>

<p>My sister tried Accutane when she was in high school and it worked pretty well for her. Hopefully I won’t need another series of Accutane, but I’m aware that many people do go on it more than once.</p>

<p>My acne wasn’t horrible, but it didn’t go away and stay away after trying a few other treatment combinations. I haven’t had a bad breakout since about month three/four on Accutane, and hopefully I’ll just have the occasional zit to deal with in the future. I liked that Accutane changed my treatment from special wash/antibiotic/topical cream to one pill a day and wash my face like normal. </p>

<p>Proactive also didn’t work for me.</p>

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<p>My daughter’s were both on similar regimens to the OP with wonderful results. D2, now a college freshman, is no longer on the minocycline. She washes her face with the Cetaphil morning and night and uses Benzaclin and Tazorac (one in the morning and the other at night). The Duac was too drying for my daughters skin and the derm switched her to the Benzaclin with wonderful results. I am not sure what D1 is doing these days (she is 21 and currently abroad) but her skin still looks great. I remember D1 started with Proactive before we broke down and went the dermatologist route but the Proactive never helped her. She does like the proactive face mask that they sell though. These meds are absurdly expensive but we have found them to be worth it. </p>

<p>I would think long and hard about using Accutane. My child’s acne would have to be really bad for me to consider its use.</p>

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<p>It’s a rather aggressive treatment for moderate acne. I think the derm prescribed too many drugs. This is a more permissible treatment for severe acne, not moderate.
Your derm has been brain washed by the pharma reps. He prescribed Solodyn, a completely worthless drug. He should have prescribed minocycline. Solodyn came about because minocycline went generic. Solodyn is extended release minocycline. With minocycline, you take it twice a day compared to once a day for solodyn. Minocycline is a cheap drug compared to Solodyn.
He will have facial redness and dryness. The acne might potentially be worse for the first month of treatment. The redness will go away within 1-2 weeks but the dryness probably will not go away. Make sure he wears sunscreen when he goes out. He will be at high risk for sun burn.
Accutane is a last line drug for acne treatment.
If cost is an issue, instead of Tazorac choose generic tretinoin cream/gel. You can also switch out the Duac CS to generic benzoyl peroxide/erythromycin cream. You can switch out solodyn for minocycline. Derms are the worst when it comes to prescribing generics. Many of them refuse to prescribe them because they believe generics are less efficacious than brands.</p>

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<p>My son was on a similar regimen as the OP’s doc prescribed, and it helped a lot. It got my son over the hump, so to speak, and his hormones evened out after sophomore year, so he didn’t really need anything after that.</p>

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<p>^^^Nova10, I completely agree with your assessment of (some) doctors and pharmaceutical reps and generics. </p>

<p>Also, it amazes me that there is so much selective caution in accepting medical treatment. Accutane is the “last line drug of acne treatment” for good reasons. Yet, it sounds like some people are clamoring for it. At the same time, some parents agonize over vaccinations for their kids. Not saying it’s the same parents, but it doesn’t make sense to me. (and I DO understand the cost of acne to self confidence among other things, I had it myself.)</p>

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<p>Nova10 -
excellent post.<br>
Some acne meds are unnecessarily, ridiculously expensive. After the samples run out you are left with several expensive prescriptions.
My daughter has seen a dermatologist since she was 4 and he, like so many others, refuse to prescribe generics. Something about the inactive ingredients are different and that makes generics inferior.
I don’t buy it though - I think they get kickbacks from the drug companies.
She starts a new dermatolgist in July - so we’ll see.</p>

<p>What my daughter has found is that after a year or so some medicine will no longer work since she becomes resistant to them. She has to keep switching around.</p>

<p>IMO - Accutane is a very effective medicine for “cystic” or “nodule” acne. It is not the first line of defense for “moderate” acne. It should be used as last resort - there is no point in risking serious side effects (including liver disease), you don’t need a bomb when a bullet will do.</p>

<p>mousegray - good analogy on vaccinations ;)</p>

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I don’t know about unnecessarily, but the prescription receipt for the Solodyn showed an insurance cost of over $636 for a thirty day supply. None of these drugs are covered by our insurance, so the dermatologist gave H a “rebate” card that brought the cost down to $10 for each of three thirty day supplies. What a racket.</p>

<p>In addition to suggesting accutane for future treatment, the dermatologist tried to sell H on a “phototherapy” treatment called Blue-Light: six treatments, once or twice a week. Didn’t get the full story on this treatment (or the cost) because H discounted it right away as a money-maker for the dr.</p>

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<p>Thanks goodness there are now various pharmaceutical treatments for acne.</p>

<p>I had a fairly minimal case of facial acne while in high school in the late 60s, early 70s. I went to the dermatologist once a week to get my face “worked over” by his nurse - she lanced and cleaned each “blemish.” The doc would then come in, examine my face and make a few incomprehensible comments to the nurse. I also had to wash my face morning and night with some sort of liquid soap (sulphur based?), that dried my face like the Sahara.</p>

<p>I got even with them once when I passed out post-treatment in the outer lobby while waiting at the window for my next week’s appointment card, went ass over tea cup and smashed a coffee table (loaded with 10 year old magazines) to smithereens.</p>

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<p>A month’s supply of regular Minocycline is probably going to run you no more than $20 without insurance.</p>

<p>You don’t see a lot of sulfur cream nowadays. Most commonly you see retinoid creams (Retin-A, Tazaroc, etc).</p>

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<p>Speaking of rackets and derms, if you get a retinoid cream formulated for acne, it’s covered under our insurance plan (and I’m not sure what the uninsured price is), but if you want the wrinkle version (for getting rid of), it’s not covered and costs over $100.</p>

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<p>I’m a bit alarmed to see Accutane being recommended by so many. Patients who take it need to have their blood and liver function tested regularly while on it. I don’t know why someone wouldn’t try everything else first before wanting it.</p>

<p>Luckily, there are other options now that also shrink the glands that produce oil.</p>

<p>My son did a course of PDT (photodynamic light therapy) followed by a daily routine of antibacterial face wash in the morning with a thin layer of 2% Salicylic acid. Spot treatment with 5% Salicylic acid. He still breaks out a bit but it’s much, much better.</p>

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<p>Accutane is way too serious for moderate acne.</p>

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<p>Accutane is a wonderful treatment. When I was about 40, I took it for acne that was not severe but just would not, would not, would not, go away despite years of all sorts of tries of other topical and antibiotic treatments. </p>

<p>The chapped lips and all of the blood tests were annoying, but it was just, what, six months or so?, and it made my acne completely go away. And after Accutane, my hair isn’t oily anymore either. I wish I had gone on it five years sooner. My dermatologist had often said, well, we could try Accutane, but I didn’t try it until I met a woman dermatologist socially and she mentioned that Accutane would put my acne “into remission.” My (male) dermatologist hadn’t used those words. That was enough to make me give it a try. It was nearly miraculous.</p>