Spironolactone & Accutane going on 4 months now and still breaking out? (Photo)

Question

I've been on spironolactone for years and years; it was keeping my skin under control, but I did not want to have to rely on this drug for many more years to keep my acne under control. I was put on accutane Nov. 2015 at 60mg a day; in January I was upped to 80mg due to no dryness at all. I'm now experiencing very little dryness of the eyes, nose and lips; I have had nose bleeds though. I'm also still breaking out horribly; is this normal? Shouldn't the use of the combined drugs be enough?

Marla M. Klein, MD · Answer

It is pretty unusual to not be dry from isotretinoin at 80 mg/day.  The biggest reason why this would occur is because of poor absorption.  Isotretinoin, is a derivative of Vitamin A, and vitamin A is fat soluble, which means that if you aren't taking the medication at the same time as a meal with fat in it, you won't absorb it properly... and you won't get dried out.  When my sons took it, they would take it after dinner with their dessert, usually a bowl of ice cream.There is one version of isotretinon, called Absorica, where the fatty meal isn't as important for its absorption.  In my experience I use this particular brand when I'm dealing with thin young women who aren't probably eating as much fat as the average individual.That being said, even a course of Accutane won't guarantee that you won't be stuck with spironolactone to control hormonal acne for more years to come.   In my 20 years of experience with treating acne, the mostly likely patient to re-break out after a full course of Accutane is the female with hormonal acne.  I wish you the best, Marla Klein MD

Morris Westfried, MD · Answer

Accutane needs to be used for 5 months and reach a cumulative dose of 150 mg per kilogram. If you weigh 110 pounds or 50 kilograms you should receive 2250 mg total over the course of treatment. At 80 mg per day you are receiving 2400 mg per month and this will almost always work. Another option would be to subsidize 5 mg of prednisone for the aldactone while you are on accutane .

Spironolactone & Accutane going on 4 months now and still breaking out? (Photo)

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Spironolactone & Accutane going on 4 months now and still breaking out? (Photo)

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Everything you need to know about Spironolactone For Acne

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