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If you've read my Acne Journal from the beginning, then you know that I spent years battling breakouts with a variety of oral antibiotics and irritating topical medications.

In mid December of 2004, I had an appointment with my dermatologist where I voiced my frustration with the side effects and lack of long lasting results from all the anti-acne drugs that I had used in the past.

He suggested that it was time to employ the "nuclear bomb" of anti-acne drugs known as Isotretinoin. The most commonly used brand name of this powerful medication is Accutane, which is manufactured by Roche U.S. Pharmaceuticals.

The doctor spent the next half hour explaining all of the possible side effects, the monthly liver test procedures, drug interaction precautions, and the results that could be expected.

My dermatologist only took a few seconds to inform me of the risk of birth defects since I'm a guy, but I thought I should restate them here. Isotretinoin or Accutane has been found to be non-mutagenic but there is a significant risk of an unborn fetus developing birth defects if a pregnant woman handles the pills or is on the medication when she becomes pregnant. Some of the possible birth defects include cardiovascular (heart) abnormalities, craniofacial (skull & face) deformity, and an abnormal central nervous system.

Accutane Prescription Dosage Amount

After the long lecture, the doctor wrote me a prescription for 40 MG of Accutane brand Isotretinoin twice a day for a total dosage of 80 milligrams per day. Roche Pharmaceuticals recommends a normal dosage range of 0.5 to 1.0 MG per 2.2lbs of body weight. The maximum dosage is 2 MG for every 2.2 pounds of body weight which is reserved for very severe cases of cystic or nodular acne vulgaris. My average weight has always been around 180lbs so the 80mg per day prescription was right at the top of the normal dosage range.

First Pharmacy Trip

As soon as I left the dermatology clinic, I went to a nearby pharmacy and had my prescription filled. The pharmacist gave me a one month supply blister pack of Accutane that contained 60 of the 40mg pills. Each of the pills had a two layer child proof system with a thin poster board cover and a thick metal foil layer that had to be penetrated to remove the individual pill. Each of the perforated paper covers over the pills had a warning with a pregnant woman covered by the international symbol for 'No", the words "DO NOT GET PREGNANT" and "CAUSES BIRTH DEFECTS"  to remind you twice daily of the risks.

Prescription Costs, Insurance & Generic Brands

Luckily, my parent's insurance plan (Blue Cross & Blue Shield HMO) covered the cost of the Accutane with just a $40 co-pay. I later learned that the insurance company would only pay for my first two months of pills even though the manufacturer recommends a course of about 15 to 20 weeks (3.75 to 5 months). When I went back for my third month's supply of Accutane, the pharmacy rang up my bill at $900 , which works out to be $15.00 per pill. After a few phone calls to the insurance company, my parents, and the dermatologist, I had the pharmacist switch out the brand name Accutane pills for a generic brand of Isotretinoin known as "Sotret". The generic Sotret pills were still $500 per month, but that's a lot better than nine hundred dollars and the pharmacist assured me that they would work just as well as the premium priced Accutane brand medication.

First Two Weeks & Initial Breakout

My first week of taking Accutane was fairly uneventful with just one episode of nausea when I forgot to take the pill with food and drank only a small amount of water. At the end of the second week, my face experienced the dreaded and infamous "initial breakout". The dermatologist warned me that this would happen because the Isotretinoin was shrinking my sebaceous glands, which forced out all of the oily sebum deep under my skin into my pores. I developed several massive & painful "multi-zits" on my right cheek, my chin, and on my neck. I also broke out with small pimples in places I had never had them before such as my eyebrows, inside my nose, and near my eyes. To put it bluntly, it sucked. Luckily, my schedule allowed me to escape to my parent's house for a week long "visit" while I waited for my face to heal from "horrible" back to just "bad". You can see photos of my face during the initial break out by visiting my Accutane Treatment Before & After Pictures Page.

First Monthly Liver Function Test

The monthly liver function tests were not a big deal but I thought I'd give you the details of the procedure just in case you're worried about it. I made an appointment with my local LabCorp medical laboratory over the phone and then went in to have them take a blood sample. The LabCorp waiting room looked like one in a regular doctor's office and a nurse came out to get me in just a few minutes. She sat me down in a padded chair that had one wooden armrest while she prepared a brand new sterile blood sample collection vial. When she was ready, I turned my head to the side and stared at a painting on the wall. I felt a tiny pinch and then after a few seconds, it was done. The LabCorp office faxed over my results to my dermatologist. He called the next day to say that everything looked normal and I could continue taking my pills. Do not stop taking your Accutane pills unless you experience severe side effects or the doctor tells you to stop.

Accutane Side Effects

After my face had mostly recovered from the two week initial breakout, I began to notice all of the other subtle and some not so subtle side effects. From what I've read on the various internet forums and message boards, I got off pretty light when it came to the Accutane side effects. I experienced dry scalp, dry eyes, dry lips, increased sensitivity to the sun and a red bumpy rash on the back of my arms and the top of my hands.

Some of the other possible side effects of Isotretinoin include bone or joint pain, muscle pain, headaches, fatigue, exhaustion, overall dryness (mouth, lips, eyes, skin), drowsiness, dizziness, decreased night vision, nose bleeds, hair loss, difficulty concentrating, and increased sweating. From my research, it seems like the three most common side effects, in the order of their frequency, are dryness, joint pain, and hair loss.

There are also a long list of relatively rare but severe Accutane side effects that are an indication to stop taking the drug and seek medical attention. Some of these conditions are depression, seizures, impaired vision, yellowing of the eyes or skin, vomiting, darkened stool, hives or widespread rash, extremity numbness, hearing problems, extreme diarrhea, fever, chills and loss of appetite.

Isotretinoin Side Effect Remedies

There are obviously many different opinions on what products work best to combat the inevitable side effects of Accutane. In this section, I'll give you the details on what worked to alleviate the side effects that I experienced while taking Isotretinoin.

For my dry and cracking lips I used Aquaphor Healing Ointment, made by Eucerin, every night. To keep my lips moisturized and protected from the sun during the day, I finally settled on Natural Ice brand medicated lip balm with SPF 15 UV protection. I literally had a drawer full of lip balms, creams, moisturizers, and ointments before finding those two great products, which finally kept my lips looking somewhat normal without any irritation.

Since I wear prescription contact lenses, the side effect of eye dryness was particularly bothersome for me. I quickly learned that I could no longer keep my contacts in over night or even for a short afternoon nap. If I kept my eyes closed for more than 15-30 minutes both my eyes & lenses would become extremely dry. I would wake up with my contacts "glued" to my irritated and bloodshot eyeballs. The solution was to simply get into the habit of constantly putting drops into my eyes and always carry one of the eyedropper bottles with me. My favorite eye drops were the Visine Moisturizing drops, any brand of artificial "Tears", and Opti Free brand disinfecting saline solution if I didn't have the others.

I had never had dandruff in my life, but while taking Accutane I developed a mean case of the frosted scalp flakes. Until I got the problem under control, I stopped wearing dark colored shirts to make the white pieces of dried skin falling out of my hair onto my shoulders less noticeable. My dermatologist recommended that I try using Nizoral A-D anti dandruff shampoo twice a week. The active ingredient in Nizoral AD is an anti-fungal drug named Ketoconazole 1% and I discovered that they key to making it work well is to let it sit on your scalp for at least 5 full minutes or as long as 15 minutes. On the other five days of the week when I wasn't using Nizoral AD, I chose a moisturizing shampoo to alleviate my dry scalp problem. Another product that I've read people have great success with is Neutrogena's T-Gel anti dandruff shampoo.

For the overall dryness of my skin, I used a Dove Moisturizing Body Bar in the shower and Cetaphil Lotion twice daily. I also found that constantly drinking water and taking a One-A-Day daily multivitamin helped keep my skin feeling healthy. You should also try to avoid drinking alcohol, taking very hot showers, and exposure to the sun, all of which can cause skin dehydration.

To keep from getting sun burned due to the increased UV sensitivity of my skin while taking Isotretinoin, I learned to start using sun screen lotion constantly. After my shower in the morning I would apply a face moisturizer with SPF 15 UVA/UVB protection to my face, arms, ears and neck. My favorite products for daily use are the Neutrogena SPF 15 Oil Free Moisturizer face lotion and L'Oreal Futur-E Moisturizer SPF 15 with a "Daily Dose of Pure Vitamin E". I'd recommend that you specifically avoid the "Neutrogena Healthy Skin SPF 15" product which I found to cause a burning and stinging sensation.  For outdoor vacations and weekends at the beach where I would be spending more time in the sun, I've always used any of the Neutrogena brand SPF 30 or 45 UVA/UVB sun block products with minimal breakouts. Now years later after taking Accutane, I can pretty much use any type of cheap generic store brand sunscreen without worrying about pimples.

The worst Accutane side effect that I had to suffer through was the red bumpy rash that appeared on my arms and the top of my hands. I've read that the rash I experienced was similar to the psoriasis, eczema or "dermatitis" skin disorders. My dermatologist prescribed Eumovate Cream, which is a "corticosteroid", to reduce the inflammation. Once the rash was under control, I used Cetaphil lotion to keep the area moisturized. I've read in other people's Accutane journals that they've used Cortaid Cortisone cream, or Eucerin cream (a.ka. Aquaphor Ointment) to alleviate their rashes.

For those of you who have experienced joint pain or sore joints while taking Accutane, I'd recommend taking a daily dosage of a glucosamine sulphate and chondroitin supplement which will help keep the cartilage in your joints moist and flexible. I had some joint pain in my hands before beginning Isotretinoin but I think the drug may have worsened the problem. I found that remembering to take my glucosamine pill and drinking a "Joint Juice" just about every day did help keep the joints in my hands from cracking and popping as much when I'm typing on my laptop. At first I thought the pain in my hands was carpal tunnel syndrome but the exacerbating effect of the Accutane convinced me that it's a form of mild arthritis.

Accutane Results During 6 Month Treatment

Before I began taking Accutane brand Isotretinoin, I would classify my acne as being in the "moderate" category with some deep cystic nodules on my chin, neck, shoulders, and chest. The rest of my face would go through cycles of relatively clear skin and then breakouts of small to medium sized pimples.

During the first two weeks of taking my 80mg total dosage (one 40mg pill twice a day), all I felt was a general sense of overall dryness that kept on growing stronger no matter how much water I drank. Then like clockwork, I fell victim to the initial break out which occurs around the two week mark for most people who take Isotretinoin. As I already mentioned above, I fled to my parent's home until this painful and unsightly break out subsided a bit. It took almost a month before the bright red marks left behind from those huge "multi-zits" faded away.

Once the initial two week break out was over with, I began to see the positive effects that the Accutane pills were having on my skin. My face felt uncomfortably dry and tight but every morning I woke up with less new pimples than the day before. As the first month drew to a close, I switched from worrying about acne to dealing with the handful of bothersome Accutane side effects. I didn't enjoy the side effects, but it was actually a nice change of pace in comparison to coping with acne blemishes.

The last 5 months of my 6 month Accutane treatment were spent dealing with the side effects and experimenting with different OTC (over the counter) or Rx (prescription) remedies to make daily life bearable. Coping with my dry eyes, dry scalp, dandruff, dry lips, dry skin, and the arm/hand rash became much easier once I assembled my arsenal of products that worked best for each condition. You would have thought I was a hypochondriac if you peeked under my bathroom sink and saw my vast collection of eye drops, creams, lotions, gels, shampoos, vitamins, lip balms, and prescription medications.

Other than the annoying side effects, I was extremely happy with how the Isotretinoin had transformed my face from an oily zit plagued topographical map of the Himalayan mountains to one that was blemish free but dry. At the end of the 6 month treatment, I could still feel some of the deepest cystic acne nodules on my chest, neck, back and shoulders but they weren't visible on the surface of the skin. The cysts felt as if they were mostly dried up but some scar tissue had remained.

Life After Accutane & Persistent Side Effects - July 2004 to 2008

It's been about four years since I took my last Isotretinoin pill and I couldn't be more pleased to report that my face has been consistently clear the entire time. Now I only get a tiny pimple about once or twice a month.

The side effects from taking Accutane persisted for a few months but then they started to slowly fade away. My skin began to start producing a small amount of oil, which helped keep it looking healthy rather than dry and dull.

I was able to stop using the Nizoral AD when less and less dandruff was falling from my scalp. I also didn't have to use my eye drops every 30 minutes to keep my contacts from drying out, but I can no longer wear my contact lenses over night or even for a short nap like I could before taking Isotretinoin. If I do, my contacts literally become glued to my eyeballs and I wake up with bloodshot eyes. Luckily, the problem with my contacts is the only long term side effect that  from my 6 months of Accutane.

I'll be turning 29 years old in late 2008 and it seems like just one course of Isotretinoin is going to be enough to keep me mostly acne free for the rest of my life. I always regret not starting on Accutane much earlier in life when acne began dominating my face in high school. I'm almost certain that I would have required another 5-6 month treatment again in my mid 20's if I had taken it during my late teens, but that would have been a very small financial price to pay for the few years of confidence inspiring clear skin.

Click on the following link to see an image gallery with my Accutane Treatment Before & After Pictures, which will give you a better understanding of how Isotretinoin works.

To continue reading my Acne Treatment Journal, click on the following link for my next entry: 2005 "After Accutane".