So I struggled with moderate cystic acne from age...
So I struggled with moderate cystic acne from age 13 to age 38 (always bad enough for antibiotics and retin-a but never quite bad enough for accutane). I know there is a genetic component to my acne since my mom had severe acne, my grandpa had acne and oily skin until he died at 76, and my brother had the worst acne I'd ever seen (did accutane in high school and then it never came back). I thought it was wonderful when I neared age 40 and things seemed to FINALLY clear up a bit. I had what I would consider normal skin issues (occasional pimple here and there - but nothing major). It was wonderful, and I got used to not wearing much makeup (which had always been the dream).
And then about a year ago the other shoe dropped. Around the same time my periods starting become irregular with what I'm assuming is the onset of menopause, I started having issues with cystic/nodular acne again. My skin is oily, pores are huge and I always seem to have at least two painful, nasty zits going at any given time. What's worse, is now that I am older dealing with this I notice that every pimple seems to take longer to clear and inevitably leaves a purple or indented scar afterwards (even if I don't pick at them). I initially went to the derm and they prescribed minocycline short term along with spirolactonone and retin-a (been on that forever). It seemed to help -but not cure the acne- for about the first 3 months. Then everything came back and I'm even more pimply and oily than I was before.
So earlier in December I sprouted a very prominent, monstrous zit on my cheek and I went in for my first acne cortisone injection (which I think is fantastic - although not exactly the overnight remedy I had read about). While in the derm's office I was venting my frustration about having to go through acne YET AGAIN and how the scarring is getting worse. I told her I even try to work from home and avoid interacting with people when it is bad, because it makes me so self-conscious. She mentioned that because I had tried all the other available options without success, that accutane would be something she would be willing to prescribe.
Now I know that my skin is not as bad as what some have to deal with, but I feel like I'm once again living my life as a hostage to my breakouts. My whole day hinges on how many and how bad my pimples are (bad breakout =crappy day). I'm hoping that I can at least get a little breather between breakouts so my husband and I can have a date night out where I don't have to struggle for an hour with concealer and powder just to keep from looking oozy and inflamed (and my two youngest kids who are 7 and 9 are always looking at me and saying "mommy do you know you have a big pimple on your cheek"...).
But I also saw my brother go through accutane and have read the reviews here on RS, so I know it will not be as simple as just popping a pill every day to get rid of the pimples. I already have a lot of dry skin spots and my lips are always chapped and cracked in the winter without accutane. I'm terrified of the initial breakout and just how much worse it can get before it starts to get better. I am an avid weightlifter/gym enthusiast and I have a lot of aches and joint pain already so I am a bit anxious about the potential for that to get worse (and I have this vision of stinging sweat on dry, cracked skin during workouts at the gym). Retin-a makes my skin bright pink for about the first hour after application - will I look sunburned for the duration I'm on the isotretinoin ? I just wish there was more info available about the impact on women my age.
And... Not least, is my concern about how much this will end up costing since I have a high deductible health plan and have had to fight for acne treatments in the past to be considered covered because of my AGE (retin a was a bunch of additional paperwork with my insurer - and all just so they would post the cost to my never-to-be-met deductible).
So my journey starts 1/18 when I complete my one month after being entered in iPledge. I'll post more then.
Just started Accutane!
Today is my second pill of the Claravis. I'm just on 40mg a day to start - not sure what the doc will up the dosage to later. Of course when I picked up the prescription yesterday I was having a (what I'm sure will be short-lived) reprieve in my normal acne so I was thinking some sort of alarm would go off and the pharmacist would identify me as an imposter who does not have acne bad enough to warrant isotretinoin.
I was also expecting side effects to start immediately (headache, joint pain), but the first pill didn't cause any noticeable effects. I did drink 5 liters of water yesterday so I'm hoping that helps.
Also, as a side note to those that may be concerned about pricing like I was. I shopped around on price before dropping off my prescription (since with my high deductible plan the expense of the medication will all be out of pocket). I found that the Walmart pharmacy had the best pricing and even had a coupon! I don't normally use their pharmacy (and we don't have one near our home so I don't ever shop there either) - but it ended up being about $100 less than the lowest price I had seen elsewhere ($156 with my insurance and the coupon).
I'll post more once I start noticing some side effects. I'm excited to finally be starting the journey to clear skin!
Isotretinoin Day 5 - the start of side of side effects
Today I noticed the start of some side effects. My lips and the skin around my mouth is a bit dry and a little flaky. I'm not sure if the initial breakout is starting but I have 4 new pimples (two of them look like they might get bad). I have a pain/soreness in my back that is unusual as well - it feels a bit like the pain you get when you swallow an ice cube and you can feel it in your esophagus. I've seen other people mention this, but I've also been having vivid crazy dreams...maybe it just affects sleep and I just have more wakeful periods in the night? That would make sense since I feel a bit more tired/fatigued than usual.
My overall skin is still oily so I haven't switched cleansers yet. I'm still using neutrogenia liquid cleanser or glycerin bar soap. I have some cetaphil but haven't felt a need to start using it yet. I'm looking forward to drying out!
I'm interested to see how the new pimples do with the isotretinoin - I'm hoping they clear faster than they would normally. I'll post more as things progress.
So, I've not really noticed any of the drastic side effects I was expecting - or worried about. My lips are really chapped, but it's winter so it's not really that different from what I would normally be going through. I've been using Aquaphor during the day and I put neosporin ointment on them at night and that makes it bearable.
The skin on my face seems to be slightly less oily than before but I still haven't had to change up my cleansing routine (liquid neutrogena acne cleanser). I still have the knot of one cyst near my ear. It is no longer sore, but it is still raised and visible. I developed a new pimple on my cheek that is radiating out that ugly purplish hue and doesn't want to be covered by make-up, but it is not painful. I'm hoping that it heals soon. The other pimples that had formed after starting the Claravis are flat but still red.
I have two large craters where my last round of recurring cysts were (I have had cysts in the exact same two spots about every three months for the last year and a half). I'm wondering if the isotretinoin will keep them from blooming into cysts again. I can always tell when they've have not gone away for good since they have that weird texture and NOTHING will cover them up (not even the heavy duty dermablend). They are still like that, so I'm crossing my fingers.
I'm not sure what they will increase my dosage to after month 1, but my next appointment is 2/15. Looking forward to the improvements to start happening!
New pimples - ugh!
So just when I thought my initial breakout would consist of the four pimples I got in my first week, I sprouted 3 more on my forehead. They are those knobby lumpy under-the-skin cysts so now I have the Frankenstein brow ridge. I know I'm on the path to having clear skin but it's so discouraging to be my age with a face full of pimples (and of course I got these right before I have a big meeting with my management team at work tomorrow).
I suppose on the up side - although they look bad, the new pimples don't really hurt like they would in the past. I'm just hoping by some miracle I wake up tomorrow and they are no longer noticeable.
Day 16 and more new pimples
So the the line of lumpy forehead cysts are starting to dissipate a bit but I now have a huge sore cyst on my right cheekbone, a wide red cyst below my lip (like a raised red patch the size of a cheerio). I also have a new cyst on my lower left cheek.
In addition I had a whitehead on my upper lip that I squeezed. It's scabbed over but red.
I still have several cysts near my ears too
I feel like I'm a mess just given how many pimples there are and how they are distributed all over my face.
Really really hoping they at least start to heal quickly like I've been reading they do for other RS accutane users.
Waiting for these to heal
I have an appointment Monday to get cortisone injections in the new cysts. The cysts hurt and two of them are painful without even touching them. Since this seems to be the start of the initial breakout, I'm hoping it doesn't get too much worse.
Day 19 - no luck getting cortisone shots, but got a new prescription
I was hoping the derm would be able to inject the big pimples that still have yet to flatten out (they look almost as bad when I try to cover them up with makeup). She said she couldn't do it because it could potentially cause scarring. Oh well... They also told me no fillers or Botox (for several months afterward??) so I'm dreading to see how bad I'm going to look at the end of of this treatment. I'll have clear skin but it will be wrinkly and saggy. ????
On the upside, the nurse checked iPledge and it appears I could just have my monthly follow up this morning when I went in - rather than waiting until next week. My dosage was upped to 60mg. So in 11 days I will start up with 20mg more per day. I have been wondering if this might mean I can wrap up early since I have read isotretinoin is based on a cumulative dosage based on weight. I calculated based on my weight and the 40mg/day would have gotten me to the 150mg/kg of weight at right around 24 weeks. I guess I would love to not be on the entire summer (since I can handle winter chapped lips but they seem harder to deal with in hot weather). I'll have to ask when I'm in again since I forgot to bring it up after the disappointment at not being able to have these lumpy red marks injected.
There must be a per pill charge!
Ouch - so I went to pick up my new 60 mg prescription yesterday (2 30mg capsules daily) and it was $375. The pharmacy tech asked me twice if I wanted it ("you know how much this is, right?") and then seemed surprised when I paid for it. I'm going to have to research if there is a cheaper option. I had a coupon but I'm not exactly sure how much of a discount I got as a result.
I'm committed though (despite the exorbitant price) and these monsters I sprouted with the initial breakout finally seem to be residing a bit. It's true what they say about not picking, because once you do they DO NOT want to heal.
Finally had to switch cleansers too. Using cetaphil now and cera ve lotion. I have scaliness on my chin right in the marionette line area. Neosporin on my lips at night has been a lifesaver, because my lips are so chapped right now there is a constant feeling of burning.
Almost to my one month mark, looking forward to having the zits clear completely because the texture of my skin has really improved (no pores visible!).
Day 4 on 60mg
So I'm not sure if I'm just imagining it, or if the side effects could change up a bit after just 4 days on the higher dose. Right away my skin became dryer and flaky near my mouth and chin. The chapped lip situation is about the same. Annoying but tolerable. The absolute weirdest thing for me is not being greasy anymore. I can go all day and there is no shine - my makeup stays put and looks fresh. And (gasp) I can even put lotion or moisturizer on my face without breaking out. It's really nice. I was probably 8 years old the last time my skin had this little oil.
No new breakouts - but that stubborn spot I picked (again, don't do it!!) is still hanging in there. It actually looks like it might become one of those ugly keloid type scars since it is raised and red. Other than that, my skin looks pretty good. It's impossible with the flakiness to wear foundation or powder so I've just been going with a little blush and eye makeup. I can't really express how it feels to not have to worry about wearing makeup. Before even in those few years where my skin was "good" I was greasy and would usually have a smaller pimple here or there. This is amazing - to not have to worry and agonize about my skin. I just hope this lasts after my course of Claravis is done. Or at least until I get through full blown menopause and can deal with normal older woman skin issues. :-) (assuming that the acne would finally stop then!)
1 month 12 days into my accutane journey
Not too much to report. I'm just about 2 weeks into my 60 mg dosage. Things have stayed clear but pretty dry and flaky. I have some red spots left from previous blemishes. Some of the really deep scarring actually seems to be looking quite a bit better. However, the one cyst I tried to pop STILL refuses to go away. I've been experimenting with different lip balms to see what works best. Neosporin at night seems to help and then I use this Shea butter balm I got at my local coop. As long as I have something on my lips they seem ok.
I tried to deflake my skin with a gentle non-scrubby exfoliant but I just seemed to end up with even more dry scaly patches. Does anyone have a good method for sloughing off the dead skin? I've tried a warm washcloth, but I haven't had much luck there either (I'm scared to rub too vigorously). If I could just get rid of the flaky skin it would be awesome. My skin has been so clear lately it is amazing. I haven't been troubled with any hair loss or unusual joint or muscle pain. I do have dry eyes, so my symptoms at this point just seem to be chapped lips, dry eyes, and dry flaky skin. Definitely worth it to be pimple-free!
Almost through month 3
29 Mar 2016
2 months post
So it has been awhile since I posted since things sort of seem to normalize. I'm used to dry eyes and chapped lips. I'm sure it will be weird once this is over, when I don't always have to always make sure I have lip balm with me. I still haven't had any of the really negative side effects (hair loss, muscle or joint pain), and I'm really enjoying not having to fight with oily skin. I've had a couple of pimples here and there, but nothing major. The skin healing seems to be more normal these days too.
I even went in for Botox (I could not wait until end of summer-I felt like my face was melting) and there were no marks. I was a little worried because my derm for the accutane would not inject me because they said it was a keloid scar risk. I read all the reviews and posts from patients and doctors here on RS and decided to go ahead with it. I'm glad I did.
I put together a before and after of my skin when I started and my skin now. Still not perfect, but much better as far as pore size and active acne. I feel like I'm in the home stretch and I'm so happy I started treatment!
Ready to start my 5th Month
17 May 2016
4 months post
I made it through most of month four without much issue. I did get two pimples - one near the corner of my mouth that went away on the 3rd day and another on my cheek that is still lingering. Because of the slowness to heal it's been more difficult to cover with makeup. But overall I'm still pleased with my results.
I have noticed some hair loss but nothing terrible at this point. The more irritating side effect I've had this past month is the joint pain. If I sit anywhere for more than 15 minutes I struggle like an old woman to get up (which is rough since I work at a computer all day). I've even noticed joint achiness in my feet. I had been attributing much of this to the fact I work out a lot, but I'm pretty sure this is due to the Claravis. My eyes have been dry and red - between allergies and taking this medication, I am needing to use eye drops a few times a day. I also have scaliness on my arms. It gets better with lotion, but it almost looks like eczema. I also feel like the dryness makes me look older - I moisturize my skin but there is still a subtle difference (could be that I am overdue for fillers too).
My doctor said I will complete 6 months of the drug - so two more to go! It's strange seeing my skin so pale these days. I had often gone tanning as a means to lessen the visible effects of the acne (terrible, I know). Now that I need to avoid getting tan/burnt my skin seems so ghostly white to me. This summer will be a challenge since I am outside a lot.
Even with the new and not so pleasant sides - I'm still glad I've done this. In the past, even when my skin was "good" there were always little pimples at my hairline, or behind my ear, and I was so oily in my t-zone! Not always having to worry that a little bump or red spot is going to sprout into a gigantic cyst is truly wonderful. I'm just hoping that I stay clear once I've stopped the medication.
3 months post and acne seems to be coming back
16 Sep 2016
8 months post
I'm so discouraged right now. This past week I developed a cluster of new pimples in one of the spots where I always had recurring breakouts (so I'm sure this will result in even deeper ice pick scarring in that area). Two of them are cysts. I'm not sure what to do since I know I can't go back on zenatane or Claravis for another 3 or 4 months. I also was hoping I wouldn't have to given how expensive it is. I'm 48 years old, I can't believe I'm still having to deal with this. I just want to crawl under a rock. Worst thing is that I had an internal job interview at my company yesterday and I had a huge cyst with a white head on it. This just kills my confidence.