Accutane, then retinoid. Is this a good route?

Question

hi,currently i suffer from moderately severe acne.because accutane is so expensive in mu country,my derm recommended with a 3months of 10-20mg of accutane,and then a maintenance course with topical retinoid.is this a good route?

Raffy Karamanoukian, MD, FACS · Answer

Accutane is a go-to medication for patients with recalcitrant cystic acne. It can reduce pore size and also reduce sebum production in your skin, making it less oily; and in turn, dryer. Accutane can be used to control acne, but patients receiving the medication should be carefully monitored. In terms of skincare, always wear an appropriate sunscreen and reduce direct sun exposure. In my patients, I recommend a good ceramide moisturizer such as Elevase whenever they are on Accutane. This will keep the skin hydrated and reduce the oiliness of the skin that is associated with oil-based moisturizers.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Alim R. Devani, MD, FRCPC · Answer

Accutane is an oral form of vitamin A. It reduces the amount
of oil released by oil glands in your skin, and helps your skin renew itself
more quickly. Accutane is used to treat severe nodular acne. It is usually
given after other acne medicines or antibiotics have been tried without
successful treatment of symptoms. Because it can cause severe, life-threatening
birth defects, many doctors are hesistant to use it. Never use Accutane if you
are pregnant or planning pregnancy. Women of child-bearing potential must agree
in writing to use two specific forms of birth control and have regular
pregnancy tests before, during, and after taking isotretinoin. Since their has
been some links to depression, crohns disease, liver disease and other rare
effects, many lawsuits have arisen in the USA which is another reason it is
very difficult to give. Accutane is available only under a special program
called iPLEDGE in the USA. Overall, in the right hands, it is a great
medication and if used properly, it will clear acne for life in 90-95% of
cases.

Susan Goodlerner, MD (retired) · Answer

Accutane , which is a retinoid is used for more severe cystic acne. It often will put acne into remission when taken for 5 months at a dose of 0.5-1 mg/kg. Low dose Accutane will work while you are taking it , but in the long run , the acne is likely to recur. If you are female another alternative is an oral contreceptive that is approved for acne, sometimes combined with Spironolactone, which blocks female testosterone. This can also be combined with a topical retinoid.

Accutane, then retinoid. Is this a good route?

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