Any dermatologists out there? Accutane question

My gf is having a hard time getting accutane prescribed to her. Her acne is not that bad but she is almost 30 and she doesn't want to deal with the topical medication any more. I was on accutane twice and it was a cinch to get a Dr. to prescribe it to me. My acne at the time was similar to hers

Is there something that happened recently that makes it more difficult to get accutane prescribed to patients?

 

Isn't that the stuff that causes deep depression in some cases?

 

i guess in some cases it has been known to cause depression. When I was on it I had to buy fancy cars to make me happy. jk, I was fine.

 

Isn't Accutane a short term solution prescribed mainly to teens?

 

I don't know about depression, but when I was on it, I had to go for monthly blood tests.

I had the unfortunate side effect of severe bloody noses while on it. I used to always carry a handkerchief with me because I would start gushing blood for no apparent reason. Accutane worked so well though that I learned to live with the nose bleeds for 5 months.

I thought it was a more permanent solution, not a temporary one...? I've not had acne (other than the occasional pimple) since taking it almost 10 years ago. I think we were told that Accutane is supposed to be pretty permanent, though some people might need one more round of it.

 

I took accutane about 15 years ago - its a miracle drug. I went from severe acne to skin as clear as a babys bum in a year. I did two 'cycles' of accutane. I had to get monthly blood tests, stay away from fat/cholesterol, and use a lot of lip balm, but it worked beautifully.

I think there are complications maybe with women taking it. it said all over the bottle NOT to get pregnant for women while taking it, so maybe thats the deal.

I told my doc ( Noe) I wanted accutane, I tried lots of topical stuff with little success, and he prescribed it, no problem. Worked a charm.

 

it causes severe birth defects, so women who take it must also take birth control pills simultaneously. this is even true for non-sexually active women

 

I have heard of kids killing themselves while on accutane...remember that FL kid wo flew a Cessna into an apartment building? On the bright side...clear skin!

 

Jesus--there is some bad info around about this drug.

1) While depression is listed as a potentail side effect, the quality of that science is debated hotly. Think about it--teenager, horrible scarring acne, depression--makes sense with no drug involved. Does Accutane accentuate this--maybe in rare cases.

2) These are simplified stats, but if you take 5 folks with bad scarring acne and give them an appropriate course of accutane (and this is a key point), 2 of 5 are cured (forever, or at least for as long as the drug has been out), 2 or 5 have permanent significant improvement (they may still have some acne, but it is responsive to other treatmetns), and 1 of 5 will eventually need a repeat course of Accutane. And so on.

3) The companies that make Accutane (it is now generic) have instituted the iPledge program. It was this or pulling the drug off of the market (mostly because of the birth defect issue). This program has made it SO DIFFICULT for Dermatologists to precribe the drug that some are not doing it. Our office had to designate a full time person to work it out. The point is that there are incredibly strict qualification guidelines to get the drug, and it is very hard to get around it.

To answer the question at hand, if your GF does not have nodulocystic scarring acne (aka pizza face acne) it is likely she won't be able to get the drug. Thank you F.D.A.

I'd be happy to answer further specific questions.

Cheers--Scott (The FChat Dermatologist)

 

hey scotty you have a pm

 

Warrenn--no PM yet???

 

I think my dermatologist told me once about some sort of new cocktail they were developing...like low dose accutane plus some other stuff. He said that it seemed to be working out just as well as accutane without the side effects, and no monthly blood tests. Have you heard anything about that?

 

oh I think I emailed you instead of pm-ing you. Did you get it?

 

warrenn--got the e-mail, but when I replied it bounced back?

mbmike--low dose Accutane can work very well, however I don't see how it could be given with the current program

 

tetracyclin works for me...i do still get a few pimples though

 

Interesting development...........I used it when I was 25 (20 years ago) and it worked perfectly with no side effects at all.

 

Acutane works by shrinking the oil glands. The P-acnes (Propionibacterium acnes) bacteria that causes acne feed on the sebum (oil). So by eliminating the sebum the bacteria can't multiply. The oil glands once off of Acutane will resume oil production but, not at the same rate as before. This drying is what cases the bloody noses and chapped lips. If you're on it you need to moisturize your face with a non cogmetic moisturizer.

I've been on it 3 times. I had very oily skin when I was younger. So oily that when I'd wash my face I could look in the mirror after washing and actually see the oil begin to come out of my pores within a minute or two. Surprisingly though I rarely got bad acne at the time. A couple of pimples here and there but that was about it. I did use topical treatments to help keep any breakouts small.

Then when I turned 30 and my body changed into a different cycle (as all ours do) I began to get cystic acne. So, my dermatologist put me on antibiotics. They had no real effect. Then he put me on a low dose of Accutane as a last resort. Cleared up my skin within a month. It was amazing. For the first time in my life I would find myself in a bathroom and not really looking in the mirror at my skin. I had to stop drinking alcohol as everyone does (Accutane can effect the liver) and do the blood work. Oh, and I didn't have insurance at the time so I paid out of pocket. That's some expensive stuff! But worth every penny.

Got off of it and was clear for a year after that. Then it came back, but not as bad. Back on, and the results were the same. Insurance paid for this round.

Then two years after that it came back, not as bad as the second time and a new dermatologist prescribed it to me. She did it with some retinace. I cleared up again. Now a few years after that and at 39 I'm still getting some acne but I find if I follow a good diet, exercise, drink lots of water it helps a lot. I'm also using Proactive and that's helped keep me clear.

So, if I had such oily skin when I was younger why didn't I break out more? Well, my dermatologist just figured that my oil production was so fast that my pores never really had a chance to clog up. It just constantly pumped out the oil. Ok, sure I had oily skin through my teens and well into my twenties but the upside of that is I look a lot younger than my age. Most people I've met that find out my age all initially thought I was in my late twenties, maybe early thirties. I have almost no wrinkles or laugh lines. Any that I do have were developed after that first treatment of Acutane.

I don’t want to sound like a commercial but if your GF hasn’t tried Proactive I’d recommend it. It’s certainly worth a try.

 

The proactiv wasn't working. Man, that is some oily skin you had there as a teen. I wonder if oily skin really does have anything to do with aging. Does that mean that people on accutane tend to wrinkle more? I've never heard of this.

Scotty, thanks for the email. Good news, my gf got a second opinion and this time around the Dr said she was definitely a candidate, I think the first dr didn't want to deal with the ipledge thing, her current dr. told her a lot of offices aren't prescribing accutane for this reason. Scotty, you also mentioned this.

I thought it was going to be difficult because her skin looks pretty good, but unfortunately in her profession looks matter a lot so it's important for her skin to be near flawless. We'll see how it goes.

 

Accutane is a pretty heavy duty drug and because of all of the negative side effects, many dermatologists shy away from prescribing it. The birth defects it can cause are absolutely horrific - so are the potential side effects to the patient. This, and perhaps potential law suits, are why some (many?) physicians stay away from prescribing it. Consider carefully.

 

Yes it was! But, looking back it didn't seem so bad.

Make sure she doesn't drink while she's on it! The doctor will fill her in. Or at least he should.

I'm going to make an assumption here, seeing that your profile say's your here in LA and that you've stated her profession requires good skin I'm going to say she's an actress. Currently working or not, if she is one, she can deduct the expense of the Accutane as a work expense.

 

senna21--Accutane has a myriad of effects, you mention one. The perhaps more important one has to do with epidermal corneocyte cohesion. Under the same hormonal influence that increase oil production surface skin cells stick together more--this results in the "pore clog" (technically a microcomedone) that initiates an acne lesion.

While the reduction of oil is both true and important, it is not necessarily the pharmacologically most important effect of Accutane.

FWIW--Scott

 

I have moderate acne, but what I really want is no acne. My doctor gave me Doryx (tetracycline), I've been on it a month and its done a little, but not all the way gone. If still want to go ahead with accutane in a month, then the doc will let me, he says. But he also said that it might not take my acne away completely, say 5 acne lesions down to 3. So he doens't know if it is worth it. But I dont care, I'm gonna try it.

 

Sigh, acne sucks..mine isnt "severe" enought to get accutane.

 

This is another FWIW comment. Rarely is monotherapy (i.e. one drug) successful in the treatment of acne. If you are on an antibiotic, you should be on a topical comedolytic (pore unclogger) as well. Optimal non-Accutane acne treatment involves 2 (but usually 3 or more) prescription agents. Pro-active can be one of these elements. (I could talk for a long time on this, but I'll defer that.)

 

My doctor says Pro-active doesnt do a thing, and tha6t the whole program is just amazing marketing. He has me on Doryx right now (time-released tetracycline), and 2 different topical cremes. They don't seem to be doing much though.