3

votes

Fed up with acne - starting a very low dose (i.e. 10mg a week) accutane treatment

Answered on September 12, 2014
Created August 05, 2012 at 2:50 PM

After 6ish years of trying everything and anything to stop my cystic acne, I decided to resort to a very low dose accutane treatment in an attempt to keep my acne at bay while minimizing the common side effects of accutane.

I am going to start off with 10mg per week and see how that works for a while and adjust from there. Fortunately I have a dermatologist who is willing to let me try the low dose regimen...I've read some dermatologist won't allow it.

I hate having to resort to this drug, but at 29 I really can't continue to deal with acne.

EDIT (to be a question): Has anyone else tried a low dose regimen? What was your experience?

Is anyone is interesting in hearing about how it's working/etc? If so let me know and I'll update this post periodically.

Week 1 (8/5/12 to 8/11/12)
I took 10mg on Sunday and Wednesday. Nothing particularly noticeable. My skin may have been slightly drier than usual, but I normally have dry skin and often have chapped lips to begin with, so it's hard to tell if it's from the accutane or just my usual self. A few new cysts came up during the week, but also nothing more than my usual breakout rate. I do notice faster healing/more drying out but at this point it's too early to chalk that up to the accutane.

Week 2 (8/12/12 to 8/18/12)
I took 10mg on Sunday and Wednesday again. I haven't gotten a new cyst since I started taking the accutane, which is huge because I normally don't go a week without getting a new one as a previous one heals. I do get what feels like a pimple coming up, but it never surfaces and the next day it's gone. My skin is less inflamed/red throughout the day and particularly after I shower. Still no side effects I can complain about, except that my molars are randomly sore (the same feeling you get when you have your braces tightened) which is very weird. No dry skin or dry lips, at least no more than normal.

Week 3 (8/19/12 to 8/25/12)
10mg Sun/Wed again. Still no new cysts and old marks are healing. My skin texture is much smoother than it has been. Skin and hair are a little dryer than usual, and I actually don't need to wash my hair everyday and it doesn't get oily. I was in the sun all weekend and although I felt like I was burning, I didn't end up getting burned at all (was not wearing sun screen). Still no impact on my bowels or mood. I've also been eating more foods that I grew to suspect caused acne, with absolutely no negative impact on my skin.

Week 4 (8/26/12 to 9/01/12)
10mg Sun/Wed again. Skin continues to heal and I am still not experiencing any noticeable side effects aside from dry hair. My lips do get a little dry so I always carry around chapstick, but my lips are ALWAYS dry so I can deal with that and it's nothing like I've read about where people's lips crack. Once all of my old red marks heal I may scale down to 10mg a week instead of 20mg to see how I do.

Week 5 (9/02/12 to 9/08/12)
10mg Sunday but skipped Wednesday. On Sunday I developed a cyst above my right eyebrow but it never came to a head and was completely gone by Friday without me doing anything to it. Not sure if it's a coincidence but I strayed pretty heavily from Paleo all weekend (gf/df corn bread, gf/df banana bread, gf/df cookies, baked beans, processed ketchup) and my digestion sucked and I got that new cyst. My hair is starting to get really dry but I've found that washing every other day and using shampoo meant for dry/damaged hair helps. Skipping Wednesday actually helped a lot with making my hair less dry. Still sticking with it so will continue the updates, but aside from that new cyst all is clear and healing.

Week 6 (9/09/12 to 9/15/12)
10mg Sunday/Wed. Not a good week and ended up with one cyst on my forehead, a smaller cyst on my temple, and three minor pimples (the kind that go away in 2 days and leave no mark). There are a few variables at play here; stress and Vegas. I had an extremely stressful work week and then I was in Vegas from Thurs to Sun. I had a hard time finding guaranteed gluten free meals (I'm Celiac, so this is important) so it's very probably I got glutened often. I was also drinking all day and low on sleep (i.e. 4 hours a night for 3 nights) so it was very likely my skin wouldn't be happy. Will see how quickly my skin bounces back.

Week 7 (9/16/12 to 9/22/12)
I got back from Vegas and my skin started to get worse, likely because of the heavy drinking and crappy food, but who knows. So I decided to try taking 10mg of accutane every day this week. I took 10mg on Tues/Wed/Thurs/Fri and my digestion was a WRECK. Every time I ate I felt a little nauseous, I had incredibly loose stool, and generally felt run down. It's possible my digestion was wrecked from Vegas, but I have to think the accutane didn't help. I stopped taking it Sat/Sun and my digestion improved. The good part is my skin stopped breaking out and I'm back to a point where I have no new pimples, and the several cysts are healing. I'll go back to 10mg on Sun/Wed again after my digestion is fully back to normal. One other thing I'm starting to notice is that my hair is thinning out. I never used to my any attention to my hair, but it's definitely thinner in the front and I can see more of my scalp than I ever could. My girlfriend also pointed out a lot of hair shedding on the pillow/sheets.

Medium avatar

(39831)

on March 09, 2013
at 05:46 PM

Have you considered just taking vitamin A?

0859683443aff4a9d341606dbd326d32

(137)

on October 05, 2012
at 01:38 PM

I'm severely allergic to eggs, and then moderately allergic to dairy and gluten. Basically I NEVER eat eggs, it's instant cystic acne and other symptoms, but I can have gluten and/or dairy once every few weeks and it's not too bad. My naturopath took a tiny sample of my blood for IgG food intolerance testing. It was fairly expensive, but so worth it. The acne side effect of food allergies is bad enough, but you're doing so much other damage to your body eating those foods unknowingly too. So I definitely think it's worth it.

91882203467f64f68f25f58f1caeee68

(1017)

on September 27, 2012
at 12:49 AM

What foods did you turn out to be allergic to and which test did you take?

Eecc48184707bc26bce631485b5b7e34

(4764)

on September 10, 2012
at 11:49 PM

Hey Shawn, consider dropping your D down to 2000-3000 IU per day. At 23 ng/ml, 2000 IU per day will bump you up probably up to the mid 40s. 3000 IU per day may get you to the high 40s or 50s. You really don't want to be higher than that. Also consider that the thorne K2 (mk4) and some MK7 (carlson I think has one) may be better options than the thorn k2/d3 combo. mk4 k2 has a very, very short half life so we need higher doses more...mk7 has a longer half life but may have slightly different effects - which is why I take both.

Eecc48184707bc26bce631485b5b7e34

(4764)

on September 10, 2012
at 11:43 PM

Korion, oral vitamin A is helpful for a lot of ppl (ditto for oral zinc) but not for everyone. Accutane is a great drug for carefully chosen people in specific situations. The mood and other side effects can probably be largely mitigated by having a sufficiency of other fat soluble vitamins on board.

Eecc48184707bc26bce631485b5b7e34

(4764)

on September 10, 2012
at 11:41 PM

Assuming you've tried tretinoin gel and tazorac gel, the latter being my favorite. Having said that, I think you're a good candidate for accutane and wouldn't worry about it too much.

1da74185531d6d4c7182fb9ee417f97f

(10904)

on September 06, 2012
at 04:01 AM

10ml is two of the syringe-fulls that come with the bottles

1da74185531d6d4c7182fb9ee417f97f

(10904)

on September 06, 2012
at 04:00 AM

I take 10ml of the fclo which is about 18k iu of vitamin A and 4500iu of vitamin D. I am, however, breastfeeding so you could Probably get away with the Weston price dose of 5ml or maybe a bit more. Good luck!

91882203467f64f68f25f58f1caeee68

(1017)

on September 06, 2012
at 01:18 AM

I tried 30iu a day of vitamin A in pill form, the source was cod liver. I also went through 2 bottles of high vitamin butter oil/cod liver oil from green pastures with little success. Maybe I needed to take way more. I'll check out the dermodex thing, never heard of it before.

91882203467f64f68f25f58f1caeee68

(1017)

on September 06, 2012
at 01:16 AM

will keep up the updates as long as i continue the regimen

91882203467f64f68f25f58f1caeee68

(1017)

on September 05, 2012
at 12:25 AM

I actually tested for low vitamin D. In Oct it was around 23 nl/mg, and around April (i think, can't remember the month) it was around 43 ml/mg. I started taking 5,000 to 8,000 per day (i take the D3/K2 drops from Thorne). I'll continue to take that while taking accutane, and will get my levels tested again soon.

79fc447191de75e7c178951594a43f13

(448)

on September 04, 2012
at 12:51 PM

low carb is the way to go.

D4d83e7981ca572aaaa19fc620bb54f1

(467)

on September 04, 2012
at 08:13 AM

Sorry, I don't remember what dosage it was, since it was a long time ago. After 1.5 months, I had a blood test that showed my triglycerides were absurdly high, so the doctor said I had to stop taking accutane immediately. I just remembered another thing, the zinc/copper level may be important too. Make sure you don't have too much copper (no unfiltered water from copper pipes, for example). For showering, it may be better to avoid too hot water, since the copper pipes are normally used for hot water. I too try everything for my skin, and have even had my amalgam fillings removed. ;)

91882203467f64f68f25f58f1caeee68

(1017)

on September 03, 2012
at 09:16 PM

Will do. So far I am pleased but we'll see what happens over time.

91882203467f64f68f25f58f1caeee68

(1017)

on September 03, 2012
at 09:16 PM

Thanks for the suggestions. I've tried nightshade free (I was following auto-immune protocol for a while) and it helped but never stopped my acne. Also tried very low omega 6 and it didn't stop it either. What was your accutane dosage?

91882203467f64f68f25f58f1caeee68

(1017)

on August 28, 2012
at 11:34 PM

How low of a dose? My diet is pretty strict paleo all the time, and always gluten/diary free.

91882203467f64f68f25f58f1caeee68

(1017)

on August 13, 2012
at 11:41 AM

I'm not sure how accurate these stats are, but according to my dermatologist with a high dose there's a 10% chance it comes back, and with a low dose there's a 50% chance. Any reason you wouldn't do a second low dose round if there were minimal side effects?

0a9ad4e577fe24a6b8aafa1dd7a50c79

(5150)

on August 06, 2012
at 04:59 PM

Iodine supplementation is also a good idea.

0a9ad4e577fe24a6b8aafa1dd7a50c79

(5150)

on August 06, 2012
at 04:57 PM

You have a linoleic acid deficiency and it's causing your sebum to be formed by oleic acid instead of linoleic acid. Have you tried topical application of high LA oils along with consumption of said oils? Evening Primrose, Safflower and Borage are the only 3 I would recommend.

B0fe7b5a9a197cd293978150cbd9055f

(8938)

on August 06, 2012
at 07:29 AM

Okay, please update if you try accutane!

Medium avatar

(19469)

on August 05, 2012
at 11:01 PM

Bill doesn't use a computer to go on Paleo Hacks. Grok wouldn't approve.

Medium avatar

(19469)

on August 05, 2012
at 11:00 PM

I would imagine that with lower doses, the side effects would have been lessened (all things remaining equal of course, I cannot speak for your own individual response). I was an angry teenager at the time (17-18) and I continued to be angry for some years after discontinuing my use of Accutane, so I can't attribute my generally shitty attitude at that time to the medication.

F5a0ddffcf9ef5beca864050f090a790

(15515)

on August 05, 2012
at 10:46 PM

OMG... Can you find a good naturopath or take some professional strength probiotics for a long time? With different strands, too. Gosh, you might need something very powerful. Sauerkraut alone won't help.

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 10:46 PM

Any sign of mood changes or other bad side effects and I plan to stop using it. What were your mood changes?

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 10:45 PM

That's why I'm trying a very low dose, I am afraid of the side effects that come along with the normal and higher doses. My cousin has Crohns and I have Celiac, so maybe I'm at a high risk for developing Crohns using accutane and it's a stupid move...

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 10:42 PM

VB - Oral. I was clueless and had no idea how bad it was, so I was rotated through various antibiotics and was taking an antibiotic pretty much every day over 5 years (minocycline, doxycycline, amoxycylin, septra, zythromax, etc). They never helped for more than a few months so they kept switching them.

F5a0ddffcf9ef5beca864050f090a790

(15515)

on August 05, 2012
at 10:25 PM

Shawn, after 5 years of antibiotics I bet every single bacteria was killed off. I hope they were topical...

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 10:00 PM

Totally agree with you on it exerting a huge emotional, psychological, and physical toll. It's led to some pretty severe depression and social withdraw that's not healthy. I feel like I've missed out on a bit of my 20s because I skipped a lot of evens specifically because my face was a mess. Did 160mg lead to more severe side effects while on it?

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 09:57 PM

Good point, I'll be continuing to take D/K2 drops from Thorne daily.

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 09:57 PM

It can wear on you after a while, and is so crippling when you get your skin to clear up for a few weeks and wake up with a bunch of cysts. It quickly brings your spirits from a high to very low.

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 09:55 PM

I tried retinol and it wasn't helping noticeably, and anything above 30iu a day was giving me strange side effects I wasn't comfortable dealing with (specifically numbing limbs/feet).

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 09:55 PM

Sounds like you had a positive experience with it. Thanks for sharing.

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 09:54 PM

I've had my hormones and thyroid checked three times in the last year. Everything came out within a normal range each time.

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 09:54 PM

VB - I've only tried probiotics for the last 10 months or so, with gradual improvement but nothing significant.

B0fe7b5a9a197cd293978150cbd9055f

(8938)

on August 05, 2012
at 09:35 PM

I wonder if retinol would have done the same thing... No mood changes while using it?

B0fe7b5a9a197cd293978150cbd9055f

(8938)

on August 05, 2012
at 08:10 PM

Bill what's your point, the guy has tried tons of diets his acne obviously needs something more. Not all of us are that lucky, so if pharmacology is needed, so be it.

Ce41c230e8c2a4295db31aec3ef4b2ab

(32556)

on August 05, 2012
at 07:56 PM

Did you have a question, Shawn? Please read the FAQs.

1c67bc28f4e44bbb8770b86df0463df3

(6719)

on August 05, 2012
at 07:54 PM

good for you, better living through pharmacology. grok would be proud

4ef079c57d2140bba4dbf4e30240a645

(4413)

on August 05, 2012
at 06:28 PM

WHY Jason? What are you thinking specifically. They are probably fine and then what...?

1296f5fecd084f101d7c5fbe013f07eb

(1213)

on August 05, 2012
at 05:22 PM

I tried Accutane and I'd never do it again. Mine is hormonal and it came back, albeit not as vigorously (it's mild and all over my face, but no big spots). My sister is in the same boat, except she did three courses . Got rid of her cystic acne, but she still struggles with it. I consider us blessed to have so far escaped the nasty side effects. Be careful, and good luck.

F5a0ddffcf9ef5beca864050f090a790

(15515)

on August 05, 2012
at 05:08 PM

I would like to see updates. Oh, and can you also have some professional-strength probiotics just to see if it helps?

F5a0ddffcf9ef5beca864050f090a790

(15515)

on August 05, 2012
at 05:07 PM

5 years of antibiotics????? How many years have you tried probiotics (and I hope after antibiotics)? I bet your gut is totally messed up.

Medium avatar

(2923)

on August 05, 2012
at 04:59 PM

I assume you've already tried the standard Paleo answer of cutting out all dairy?

Medium avatar

(3024)

on August 05, 2012
at 03:12 PM

+ 1 for perseverence!

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 03:02 PM

Not the full two years, but I've tried GAPS, candida cleansing/diet (20 weeks), laser therapy, acupuncture, paleo, auto-immune paleo, 5 or so years of antibiotics, creams/lotions, caveman regiment, colon hydrotherapy, liver supplements, FCLO/BO, vitamins A/D/K/E, mega dosing vitamin B5, zinc, gluten/dairy free for years, probiotics,...name it and I've probably tried it.

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26 Answers

5
0d3873eb2dd0447baf06139e75c10252

(600)

on August 06, 2012
at 03:38 AM

Hi Shawn, I come from a family where horrifying cystic acne is the norm for females on my mother's side. She struggled with it all her life and still does at 55, so when my sister and I developed it as teens she took us straight to a dermatologist. Like you, we tried everything, including scary long antibiotic regimens, because we were petrified of the terrible reported side effects of Accutane. Finally though we were desperate enough to give it a go.

We were on a pretty strict diet with no alcohol allowed and a high vitamin d dose to mitigate some of the damage. Make sure you stay up on your regular blood work to make sure everything is in order with your liver.

This is the critical part- after about 4 months, our acne seemed to be worse. Much worse. And the skin cysts HURT all of a sudden, not to mention horrible skin dryness, cracked lips and hands, and sensitivity to sunlight. My mom could not deal with the side effects and figured like everything else this drug did not help. My sister and I decided to stick it out. After 6 months, we turned a corner and our skin started clearing up. Even the side effects seemed to diminish (although that could just be the joy of seeing the treatment working.) While my mothers still struggles with her skin, I'm happy to say both my sister and I have clear skin now with only very minimal scarring. I get the occasional little pimple now but it's hardly anything to worry about, and it's been 5 years since the treatment. The only lasting side effect is that I don't tan very evenly in the sun anymore- but it's probably nothing you would notice until I pointed it out.

So basically I'm saying, have patience. Sometimes it gets worse before it gets better. I wish you all the best of luck! Check in and let us know how it's going.

4
Medium avatar

(19469)

on August 05, 2012
at 06:08 PM

Both my sister and I used Accutane as teenagers to treat cystic acne that was not responding to other treatments (oral/topical antibiotics, retin-A cream, etc.)

After a few months of extremely dry skin, chapped lips, etc. (and actually worsening acne) my skin started to clear and since then I have had ZERO problems with my skin. My sister had the same experience as well.

If I had it to do all over again, I would do it in a heartbeat.

Years of failed treatment exert a huge emotional, psychological, and physical toll and IMHO it is worth taking Accutane as long as you are properly educated with regards to the risks and things that you can do to emeliorate them (i.e. avoiding anything that can tax your liver such as alcohol, having regular blood work to detecte elevated liver enzymes, etc.)

Note: My doctor accidentally prescribed me a double dose of Accutane so I was on 160mg/day during the course of my treatment. Despite this, I have no persistent side effects. The typical dosage is in the neighborhood of 40-80mg/day.

B0fe7b5a9a197cd293978150cbd9055f

(8938)

on August 05, 2012
at 09:35 PM

I wonder if retinol would have done the same thing... No mood changes while using it?

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 10:00 PM

Totally agree with you on it exerting a huge emotional, psychological, and physical toll. It's led to some pretty severe depression and social withdraw that's not healthy. I feel like I've missed out on a bit of my 20s because I skipped a lot of evens specifically because my face was a mess. Did 160mg lead to more severe side effects while on it?

Medium avatar

(19469)

on August 05, 2012
at 11:00 PM

I would imagine that with lower doses, the side effects would have been lessened (all things remaining equal of course, I cannot speak for your own individual response). I was an angry teenager at the time (17-18) and I continued to be angry for some years after discontinuing my use of Accutane, so I can't attribute my generally shitty attitude at that time to the medication.

Eecc48184707bc26bce631485b5b7e34

(4764)

on September 10, 2012
at 11:43 PM

Korion, oral vitamin A is helpful for a lot of ppl (ditto for oral zinc) but not for everyone. Accutane is a great drug for carefully chosen people in specific situations. The mood and other side effects can probably be largely mitigated by having a sufficiency of other fat soluble vitamins on board.

3
Cacf3bd2d5606b83dd32057537577b68

on August 05, 2012
at 07:00 PM

I got cystic acne in my late 20's too, and pretty much cured it using dietary changes. Basically i saw an acupuncturist/Chinese med doctor, and he gave me a list of foods to to eat and avoid, based on my personal diagnosis. Generally speaking (and assuming you are currently paleo)- nothing spicy, nothing fried, no caffeine, no sugar (small amounts of fruit), eating cooling foods: cucumbers, watermelon, dandelion greens. In addition, keep stress levels low and get adequate sleep. According to Chinese medicine, I suffered from "damp heat".

I tried Accutane in college too, and the first thing I noticed was mood changes, and I immediately quit using it.

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 10:46 PM

Any sign of mood changes or other bad side effects and I plan to stop using it. What were your mood changes?

3
53d4bdc70b99e4c14fd17b40c45f76a8

(30)

on August 05, 2012
at 06:36 PM

Accutane was also the only thing that worked for me in my 20s, after trying everything else. It took 2 rounds for me. The first time I had a very conservative derm who would only prescribe me 40 mgs. My skin cleared up, but only temporarily. 2 years later I was breaking out with cysts again and went to another derm and got back on Accutane, this time going up to 100 - 120 mgs/day, which was at the high end of the spectrum for my weight. But it did the trick. Clear skin for 8 years now, unless I have too much dairy. I'm not sure that 10 mgs/day is going to be enough to keep your acne away long term. My only lasting side effect from such a high dose is dry lips. Not to the same extent that they were on Accutane, and nothing that a little Aquaphor doesn't take care of. For me, it's a trade off that was well worth it.

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 09:55 PM

Sounds like you had a positive experience with it. Thanks for sharing.

3
Eecc48184707bc26bce631485b5b7e34

on August 05, 2012
at 03:27 PM

Getting ideal amounts of D and K can probably minimize (dramatically) the negative effects of accutane.

All the best to you!

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 09:57 PM

Good point, I'll be continuing to take D/K2 drops from Thorne daily.

2
Efa701fa5dbaec9c9f048ee0134f3f9a

on August 28, 2012
at 05:05 PM

I did a low dose of accutane for 2 years on my dermatologists recommendation. That was a few years ago and my acne just ended up coming back again and again. The only thing thats worked for my has been a carb intake below 100 grams a day. Cutting out chocolate, and eating organic where I can. I am 28 and for the first time since i was 13 I don't have acne anymore...not sure what your diet is like, but it took about 3 months of super clean eating to clean up my skin..but it did clear up. I just wash my face with regular soap now and thats it. Accutane really does just cover up an underlying problem, and can really cause more problems then it solves. But on the other hand, it definitely is easy and does clear up the acne.

79fc447191de75e7c178951594a43f13

(448)

on September 04, 2012
at 12:51 PM

low carb is the way to go.

91882203467f64f68f25f58f1caeee68

(1017)

on August 28, 2012
at 11:34 PM

How low of a dose? My diet is pretty strict paleo all the time, and always gluten/diary free.

2
B0fe7b5a9a197cd293978150cbd9055f

(8938)

on August 05, 2012
at 05:17 PM

I don't see why you'd use accutane instead of just retinol. I noticed you asked a question about retinol in the past, so maybe you already tried that, just wanted to make sure.

If the retinol doesn't work though, I doubt the accutane will. I remember seeing someone taking accutane and while it did clear his skin of acne it was peeling and inflamed and he had swollen, dry lips so there was no aesthetic improvement.

But if nothing else works, it's worth a try.

B0fe7b5a9a197cd293978150cbd9055f

(8938)

on August 06, 2012
at 07:29 AM

Okay, please update if you try accutane!

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 09:55 PM

I tried retinol and it wasn't helping noticeably, and anything above 30iu a day was giving me strange side effects I wasn't comfortable dealing with (specifically numbing limbs/feet).

Eecc48184707bc26bce631485b5b7e34

(4764)

on September 10, 2012
at 11:41 PM

Assuming you've tried tretinoin gel and tazorac gel, the latter being my favorite. Having said that, I think you're a good candidate for accutane and wouldn't worry about it too much.

2
Medium avatar

(2923)

on August 05, 2012
at 04:47 PM

Bleh, went through a cycle of Accutane when I was a teeneager. Yes, it dramatically reduced acne, but also included seriously dry skin and chapped lips. Blissfully, I didn't know about or suffer the other side effects.

Looking over the Wikipedia entry, I wonder if there might be safer options? Wikipedia mentions that its benefits (and side effects) are due to its close resemblance to retinoic acid.

Maybe just upping your Vitamin A levels (cod liver oil) or upping Beta-Carotene intake? And then, as Katherine mentions, upping Vitamin D and Vitamin K to control the Vitamin A toxicity.

In 2009, Roche decided to pull Accutane off the US market after juries had awarded millions of dollars in damages to former Accutane users over inflammatory bowel disease claims. Among others, actor James Marshall sued Roche over Accutane-related disease that resulted in removal of his colon.

2
C835934198ffe146cb90eebc22c6b8d8

on August 05, 2012
at 04:32 PM

Best of luck to you! I feel like I've tried everything as well. Ive had it since I was a pre-teen..and I'm 30 now...so I feel ya.

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 09:57 PM

It can wear on you after a while, and is so crippling when you get your skin to clear up for a few weeks and wake up with a bunch of cysts. It quickly brings your spirits from a high to very low.

1
Ef440a27c6b252b4a8dd63287b84d209

on September 25, 2012
at 06:22 PM

I read on Chris's Kresser Facebook page that eating liver twice a week will help with acne, he has 4 articles in which he discusses skin health, he also recommends taking Green Pastures fermented butter blend/ cod liver oil, I will give that a try but am getting pretty close to trying out accutane, thank's for the updates. I have found out that nuts aggravate my acne.

1
9426eec8c8385c90bdf843aa44bd5a4b

on September 05, 2012
at 08:13 PM

You sound similar to what I was like. Do you have oily skin patches as well? I used to have really bad cystic acne up to the age of 21. I got fed up when I was having 5 cysts forming on my face at various stages at one time. I had facial redness, dry body skin, and chronic chapped lips. My hair would get oily too.

To find out I was combination skin, but instead of dry and oily in the different places, I was dry and oily in the same place at the same time! I still argue with people to this day that this skin condition exists while asia it's considered a real skin type and it's quite common.

I am wondering if you have a skin type like mine? It's hard to treat it correctly when western skin care does not generally recognize an oily/dry skin type as described above.

There's also a perpetuating myth that if you're oily in an area, then that place is moisturized. This is not always the case! If your skin has trouble producing it's own moisture and tends to draw it from the air then an oil on top will serve as a barrier to keep the moisture out.

This is exactly how my skin behaves. Dry skin -> produces some oil -> no moisture -> Oil hangs out in T-zone instead of spreading evenly -> skin under T-zone can't draw moisture from air and flakes off into the oil -> dead skin and oil film develops and clogs pores -> wash face, but cannot get film off without scrub -> dead skin builds up over time -> acne.

I found a website in college that really helped me out (which I'm sure is impossible to find now that's been 6 years ago).

  • I started being gentle to my skin instead. I started using a gentle cleanser like Purpose, CeraVe, or Cetaphil. I washed every morning and night with lukewarm water.
  • When I got the cysts I iced them to bring down the swelling as the Zeno can leave brown marks. Some people have reported finding a entire face gelly mask that they put in the freezer to use every night to keep the cysts at bay. That or icing cyst prone areas.
  • I also found out that I'm allergic to Benezyol peroxide (using a strong dose every night all over as part of the plan). So I switched to salicylic acid instead.
  • It would also take 2-3 months to see results because acne causing bacteria can incubate in your skin, so I kept at it.

This relieved a majority of my symptoms even though I was exercising and eating clean for a good 4 years before that. Once my skin healed somewhat, I realized I got skin build up and started using scrubs in order to use make up (I never used make up before but wanted to so badly without looking like a flaky mess.)

I'd still have a greasy T zone and small breakouts here and there. My pores would be still be dirty, and I could not get rid of the dead skin with a mere wash cloth. The OTC scrubs weren't abrasive enough even for daily use.

Once I figured out I was dry all over I attacked everything with water based/gel moisture's and hyaluronic acid. For me opaque moisturizers tend to leave residue that contributes to the build up so I avoid those.

When I started moisturizing with hyaluronic acid, the following happened,

  • My hair wasn't as greasy as I thought. It was just picking up the oil on my forehead at night.
  • My oil started to distribute itself more evenly across my face and I started to glow.
  • Pores were hydrated enough to allow me to more easily wash off dirt and effectively use products like Biore strips (before they would not pick dirt out of my pores and extracting devices did not work at all!).
  • My pores would stay clear longer and were more able to flush out on their own.
  • I'd wake up with no facial redness (not rosacea). Of course touching it or rubbing when splashing water would redden it a little. Still, an big improvement. Crisco did the same thing for redness overnight for me (was trying to find a La Mer cream substitute), but obviously I don't like my pillow greasy. Hyaluronic acid was a much better choice.

Everything is not perfect. I won't lie. I still have to scrub, just not as frequently now and not as hard. I do get acne but nothing like it was before.

Since Accutane can be very drying so you might be interested in below,

Hyaluronic acid has the ability to absorb large amounts of water which can help keep your skin hydrated. You have to apply enough moisturizer when using it so it doesn't draw moisture from your skin though. Applying the moisturizer in layers on a damp skin helps. It will even draw humidity from the air.

CeraVe has a creamy moisturizing facial cleanser with hyaluronic acid in it for normal to dry skin. I also use it on my face, and like a body wash from time to time with cool water letting my skin air dry. I prefer this over a harsher cleanser and lotion.

You can also obtain hyaluronic acid in serum form. It's really hard to find in regular drug stores though. I found some at Walgreen's and I had to scour the ingredients on almost every bottle. It's difficult to avoid stuff that says 'firming' as firming ingredients tend to be drying.

Garnier makes a grape seed extract moisturizing gel (blue green jar). I switched from a white lotion to this and experienced less build up. The stuff with the sunscreen in it seems to be the worst for build up. If I need protection on my face, I'd rather do a wide brimmed hat.

I hope what I have written here will help someone out.

1
5e22ee3adb04e430e2e45f3273f634e5

on September 05, 2012
at 05:06 PM

Awesome, awesome! I'm really considering giving this a go now. Please keep the updates coming!!!

91882203467f64f68f25f58f1caeee68

(1017)

on September 06, 2012
at 01:16 AM

will keep up the updates as long as i continue the regimen

1
121a16aded2bed8dca492d3c9662ef4c

on September 03, 2012
at 09:45 PM

Vitamin D was what finally fixed my acne after what seemed like a lifetime of suffering. I was in my mid-thirties. The key point -- one I'd missed before -- was that I was not getting nearly enough of it to make any difference.

I had to take a liquid form of cholecalciferol at doses more than of 5000 IU a day before things really changed. I noticed that my skin temperature went up. Lo and behold, my skin started to clear up. I verified my levels with blood testing. The improvements did correlate with the 25-OH-D level.

I also eventually found, after a few self-experiments, that vitamin A actually made the acne worse, unless I took doses so high I started to get the toxicity symptoms (joint aches, super dry skin; the "therapeutic action" of Accutane - isotretinoin - is really just a toxicity symptom of vitamin A).

Along with that, I took substantial amounts of Omega 3 from fish oil (four capsules a day was typical for several years). The striking thing about this is that it took months before I saw the biggest improvements. I realize in retrospect that I gave up much too soon on some of the things I tried.

Oh, and my diet? It is essentially paleo, and devoid of junk. The only sweet things I eat are fruits, and then in very limited amounts. This is really hard for many people to do. I often meet people who claim they are strict, then when I observe them see that they cheat - a lot.

All these things together have given me the clearest skin I have had in my whole life.

I suspect that there is a connection between acne and intestinal health. All those years of antibiotics have likely screwed up your intestinal flora completely. You might want to consider an anti-inflammatory regimen typically used for reactive arthritis, in which you actively try to repopulate your large intestine with beneficial organisms. One thing I have not heard anyone try for this sort of thing yet, but would be curious to test, is a fecal transplant, but those are not generally used for things like acne and you will probably have a hard time finding a physician willing to do something like that.

All the other things, though, are doable, and if you haven't tried them, I'd give them a look. Acne sucks.

Remember that acne is primarily an inflammatory condition. Anything you can do to mitigate inflammation is likely to help and certainly won't hurt. Good luck!

91882203467f64f68f25f58f1caeee68

(1017)

on September 05, 2012
at 12:25 AM

I actually tested for low vitamin D. In Oct it was around 23 nl/mg, and around April (i think, can't remember the month) it was around 43 ml/mg. I started taking 5,000 to 8,000 per day (i take the D3/K2 drops from Thorne). I'll continue to take that while taking accutane, and will get my levels tested again soon.

Eecc48184707bc26bce631485b5b7e34

(4764)

on September 10, 2012
at 11:49 PM

Hey Shawn, consider dropping your D down to 2000-3000 IU per day. At 23 ng/ml, 2000 IU per day will bump you up probably up to the mid 40s. 3000 IU per day may get you to the high 40s or 50s. You really don't want to be higher than that. Also consider that the thorne K2 (mk4) and some MK7 (carlson I think has one) may be better options than the thorn k2/d3 combo. mk4 k2 has a very, very short half life so we need higher doses more...mk7 has a longer half life but may have slightly different effects - which is why I take both.

1
5e22ee3adb04e430e2e45f3273f634e5

on September 02, 2012
at 08:50 AM

Yeah, please keep the updates coming, I am very interested in how this will turn out for you. I've been considering doing the same thing for a while now. Nothing else seems to work...

91882203467f64f68f25f58f1caeee68

(1017)

on September 03, 2012
at 09:16 PM

Will do. So far I am pleased but we'll see what happens over time.

1
07243c7700483a67386049f7b67d90a4

on August 13, 2012
at 10:46 AM

I???ve done low dose isotretinoin and its pretty good TBH no noticeable side effect and easy to tolerate. It didn't keep my skin clear all that long afterwards, which was disappointing, despite a near 18 month course.

I found that masses of vit A (40 Kiu) from halibut oil and liver a great help but I also needed to get lots of sun to avoid dry itchy skin. This is how I???m dealing with it ATM and I???m happy to be avoiding drugs like isotretinoin.

Adding pregnenolone and desiccated thyroid perfected what the Vit A started.

I understand your frustration and good luck with what ever regimen you start

91882203467f64f68f25f58f1caeee68

(1017)

on August 13, 2012
at 11:41 AM

I'm not sure how accurate these stats are, but according to my dermatologist with a high dose there's a 10% chance it comes back, and with a low dose there's a 50% chance. Any reason you wouldn't do a second low dose round if there were minimal side effects?

1
Ec792bda217175243c50205e1e6126f5

on August 05, 2012
at 10:04 PM

I went on the anti Candida diet and without even knowing it my skin cleared up. Anti Candida is a very strict diet. I read that you tried everything, does that include strict diet changes? I know everyone's skin is different and stronger methods are sometimes necessary. As others have noted, please be careful with accutane because from what I've researched it is related to Crohn's disease and ulcerative colitis. Two very serious diseases that involve inflammation of the intestines and uncontrollable bleeding.

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 10:45 PM

That's why I'm trying a very low dose, I am afraid of the side effects that come along with the normal and higher doses. My cousin has Crohns and I have Celiac, so maybe I'm at a high risk for developing Crohns using accutane and it's a stupid move...

1
99ac392257e444e014be6d4da6a900e4

(1036)

on August 05, 2012
at 06:26 PM

Get your hormone levels checked.

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 09:54 PM

I've had my hormones and thyroid checked three times in the last year. Everything came out within a normal range each time.

4ef079c57d2140bba4dbf4e30240a645

(4413)

on August 05, 2012
at 06:28 PM

WHY Jason? What are you thinking specifically. They are probably fine and then what...?

1
0a9ad4e577fe24a6b8aafa1dd7a50c79

on August 05, 2012
at 02:54 PM

Have you tried GAPS?

Medium avatar

(3024)

on August 05, 2012
at 03:12 PM

+ 1 for perseverence!

91882203467f64f68f25f58f1caeee68

(1017)

on August 05, 2012
at 03:02 PM

Not the full two years, but I've tried GAPS, candida cleansing/diet (20 weeks), laser therapy, acupuncture, paleo, auto-immune paleo, 5 or so years of antibiotics, creams/lotions, caveman regiment, colon hydrotherapy, liver supplements, FCLO/BO, vitamins A/D/K/E, mega dosing vitamin B5, zinc, gluten/dairy free for years, probiotics,...name it and I've probably tried it.

0a9ad4e577fe24a6b8aafa1dd7a50c79

(5150)

on August 06, 2012
at 04:57 PM

You have a linoleic acid deficiency and it's causing your sebum to be formed by oleic acid instead of linoleic acid. Have you tried topical application of high LA oils along with consumption of said oils? Evening Primrose, Safflower and Borage are the only 3 I would recommend.

0a9ad4e577fe24a6b8aafa1dd7a50c79

(5150)

on August 06, 2012
at 04:59 PM

Iodine supplementation is also a good idea.

0
C16d6d6c567693cc1223b7c0a9748269

on October 01, 2013
at 05:19 PM

I really appreciate your posting this. I'm also 29, fed up with moderate but completely recalcitrant inflammatory acne, and just starting isotretinoin. Have been on 20 mg for a week.. came across this blog looking for guidance on the typical starting dose, and how soon I should go up to 40 mg, which I intend to.

0
C16d6d6c567693cc1223b7c0a9748269

on October 01, 2013
at 05:17 PM

I really appreciate your posting this. I'm also 29, fed up, and just starting isotretinoin. Have been on 2- mg for a week.. came across this blog looking for guidance on the typical starting dose, and how soon I should go up to 40 mg, which I intend to.

0
6a4b111ca34a1253bbed7fdbe75dd484

on August 02, 2013
at 01:00 PM

I went on 20 mg of accutane a day for six months. I'm 33 and would get one/two horrible cystic spots every month. Well. only 3 months coming off accutane, the acne started returning although not as severe. My derm prescribed another 20 mg a day for only 4 months although I've decided to just take 10mg a day. Don't know if this will be effective at all at permanently curing the acne but I had some strange side effects (I was kind of emotional and would have weird crying spells) suicidal thoughts crossed my mind but I knew I would never act on any of it. And I had some joint and bone pain, although I was exercising like crazy at the time but osteoporosis runs in my family! All of that from just 20mg a day! My face was perfect while on it but I just don't think my dose and length is enough to cure it for good..but oh well..doing what I can.

0
E3fda8c19b23926f6c878fac5b316afa

on March 09, 2013
at 03:36 PM

I have been taking 20 mg every 10 days for 2 years. I seldom get any pimples, if I do they are very small. I first took the full course treatment in 1982 and it was effective but I had to repeat it twice within the first 10 years.

I stopped drinking alcohol 30 years ago when I was 24. I can state definitely that alcohol made my acne worse.

I have found that the low dose (20 mg every 10 days) is very effective. My skin and hair remains dry and I have virtually no acne. If I take 20 mg every week then my skin and eyes become too dry. If I take 20 mg every two weeks then my skin starts to become oily.

Medium avatar

(39831)

on March 09, 2013
at 05:46 PM

Have you considered just taking vitamin A?

0
0859683443aff4a9d341606dbd326d32

(137)

on September 25, 2012
at 12:58 PM

I took accutane when I was 16 for my severe acne and it destroyed my liver! Be careful about drinking when you're on it. I'm dealing with serious problems in my life now because of the accutane I took 4 years ago (and my acne came back regardless).

The one thing that instantly cleared up my skin (after about 8 years of struggling with antibiotics, lotions, creams, meds, etc) was getting tested for food intolerances and then cutting out those foods.

91882203467f64f68f25f58f1caeee68

(1017)

on September 27, 2012
at 12:49 AM

What foods did you turn out to be allergic to and which test did you take?

0859683443aff4a9d341606dbd326d32

(137)

on October 05, 2012
at 01:38 PM

I'm severely allergic to eggs, and then moderately allergic to dairy and gluten. Basically I NEVER eat eggs, it's instant cystic acne and other symptoms, but I can have gluten and/or dairy once every few weeks and it's not too bad. My naturopath took a tiny sample of my blood for IgG food intolerance testing. It was fairly expensive, but so worth it. The acne side effect of food allergies is bad enough, but you're doing so much other damage to your body eating those foods unknowingly too. So I definitely think it's worth it.

0
Ba20b502cf02b5513ea8c4bb2740d8cb

on September 25, 2012
at 12:42 AM

Yeah I would make sure you were getting enough vitamin D and also eat mass amounts of fish oil.

0
1da74185531d6d4c7182fb9ee417f97f

on September 05, 2012
at 05:27 PM

Have you tried a high dose cod liver oil regimin? Why not get the vitamin A from A natural source? Also, have you looked in to treating for a dermodex mite infestation? I know this approach has helped keratosis pilaris and rosacea sufferers. I've seen anecdotal evidence on the rosacea forums that it helped people's acne too. The high vitamin A helps my KP and then I've been experimenting with a dermodex killing regimin using camphor and sea buckthorn oil and borax. There's lots of stuff on it on the Internet. I'll edit this post when I'm on my computer and include some links. A lot of cystic acne sufferers also have rosacea so it may be related.

Keep with the accutane if it's working, I'm not trying to convince you otherwise but there might be other routes besides diet or drugs that you havent tried. And this might help with the lingering redness

1da74185531d6d4c7182fb9ee417f97f

(10904)

on September 06, 2012
at 04:01 AM

10ml is two of the syringe-fulls that come with the bottles

91882203467f64f68f25f58f1caeee68

(1017)

on September 06, 2012
at 01:18 AM

I tried 30iu a day of vitamin A in pill form, the source was cod liver. I also went through 2 bottles of high vitamin butter oil/cod liver oil from green pastures with little success. Maybe I needed to take way more. I'll check out the dermodex thing, never heard of it before.

1da74185531d6d4c7182fb9ee417f97f

(10904)

on September 06, 2012
at 04:00 AM

I take 10ml of the fclo which is about 18k iu of vitamin A and 4500iu of vitamin D. I am, however, breastfeeding so you could Probably get away with the Weston price dose of 5ml or maybe a bit more. Good luck!

0
D4d83e7981ca572aaaa19fc620bb54f1

(467)

on September 02, 2012
at 12:35 PM

I know you said you've tried everything, but I thought of mentioning some things just in case they can be helpful:

Have you tried a nightshade-free and low omega-6 diet?

Apple cider vinegar (perhaps diluted the first time you try, to make sure it doesn't sting) and coconut oil topically may not cure, but might help. http://www.earthclinic.com/CURES/acne.html

Some people have mentioned healing with this protocol: http://www.acne.org/regimen.html

I hope you get improvements soon, one way or another. :)

Oh, I did start acutane once for skin problems (not acne), but it only gave me side effects, so I regret taking it.

91882203467f64f68f25f58f1caeee68

(1017)

on September 03, 2012
at 09:16 PM

Thanks for the suggestions. I've tried nightshade free (I was following auto-immune protocol for a while) and it helped but never stopped my acne. Also tried very low omega 6 and it didn't stop it either. What was your accutane dosage?

D4d83e7981ca572aaaa19fc620bb54f1

(467)

on September 04, 2012
at 08:13 AM

Sorry, I don't remember what dosage it was, since it was a long time ago. After 1.5 months, I had a blood test that showed my triglycerides were absurdly high, so the doctor said I had to stop taking accutane immediately. I just remembered another thing, the zinc/copper level may be important too. Make sure you don't have too much copper (no unfiltered water from copper pipes, for example). For showering, it may be better to avoid too hot water, since the copper pipes are normally used for hot water. I too try everything for my skin, and have even had my amalgam fillings removed. ;)

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