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Dermatology  (Expert Forum)
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accutane not working
Answered by
Alan Rockoff, MD - dermatology, Child Skin Problems
The Rockoff Dermatology Center Brookline - MA
This forum is for questions regarding Dermatology issues, such as: skin rashes, acne, birthmarks, skin infections, rosacea, and general skin care.
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MedHelp Member's Question

accutane not working

by BSB, Aug 28, 2003 12:00AM
I am 20 year old male who has taken accutane twice before and in my current 3rd treatment. i tokk the previous for 5 months and my face was fantastic,no scarring, nothing.it looekd better by the end of the 4th month. my acne has always been mild to moderate never severe but persistent. I am wondering if sicne I ahve taken accutane twice before if i could have built up an immuntiy to the drug. i dont undertsand why my face is still gettin spots even so far into treatment. i ahev 2 weeks left on my 6 months and can i take it longer? my dermatolgist is not eays to talk to. i get red spots on my face that dont seem liek acne but mroe like sores or extrem,ely cracked skin.i ahve little holes from rpevious acne, that are quite small but visible to my crticial eye, do these tend to fade or fill in or am i elft with some scars. i cant believe i am still getting spots so far into treatment. i ahve spots undernath my skin on my forhead that dont seem to go away.they dont come to the surface,it looks like i ahve rough skin in this area. i touch my afce alot and think about it all the time, i know this is bad but I cant help doing it.whatever advcie you can give me I would greatly apprecitae it. i am really trying to be patient buty its getting harder by the day. i figure if it worked befoe it wud work again

Thanks-BSB
Doctor's Answer

by Alan Rockoff, MD, Aug 28, 2003 12:00AM
It is hard to interpret what you're describing.  I also would expect your face to be clear this far into treatment.  One thing you say that makes me suspicious is, "i touch my afce alot and think about it all the time."  I have to wonder whether you have some blotching or dryness that you are manipulating into something more visible by touching or rubbing the area.



Even if you are still breaking out, you should stop at 6 months, because the Accutane keeps working long after you stop.  So if you stop the treatment and leave your face alone (!!), you should be fine, at least for the next months to years.



If you can't talk to your dermatologist, perhaps you should find another.



Best.



Dr. Rockoff
Member Comments (13)

by BSB, Aug 28, 2003 12:00AM
To: dr.rockoff
could I have built up an immuntiy to the drug...this is my most important question

by sarahtee, Aug 29, 2003 12:00AM
The same thing happened to me.  I was using accutane for 4 months.  My condition got better.  However, I still had a few cystic acne on my face.  I was taking 40 mg a day and the doctor increased the dosage to 40mg one day and 80mg every other day.  This still didn't help my problem.  Also, I noticed an increase in hair growth on my chin.  And, this suggested to myself that i may have a hormonal problem (as testosterone does induce acne and hair growth).  I requested Diane 35 from my doctor.  He perscribed me the medication and after one month my face is so clear that people can't help to ask me how my skin went from being completely broken out to a perfect complexion.  I've never been so happy with my skin - finally my battle with acne is over!!!!!!  I would suggest for you to use Diane 35 if you have a greasy and oily scalp, above average hair growth on your body, and are an adult.  This indicates a increased sensitivity to testosterone and Diane 35 is a testosterone blocker.  I wish I knew about diane 35 10 years ago!!!!!!!!!!!!  I hope this helps.

by sarahtee, Aug 29, 2003 12:00AM
Ooops...forgot to add that diane 35 can only be used by females.

by lchan, Aug 29, 2003 12:00AM
Diane-35 is a birth control pill that is unfortunately not available in the US.  Females in the US can try Yasmin, a birth control pill with a progestin that is chemically similar to spironolactone, a mild diuretic with anti-androgen properties.  Spironolactone can also be used on its own or with birth control to combat acne, excess body hair, and scalp hair thinning (symptoms of excess testosterone in women).



Hope this is helpful.

by BSB, Aug 29, 2003 12:00AM
To: ROckoff and others
I am a male.this does not tell me much....i am curious if I ahve bult up an immunity to the drug? Also can touching my face often cause me to get new pimples or is that a myth?

I appreciate anybodys help please

BSB

by sarahtee, Sep 01, 2003 12:00AM
I did some research on male hormone treatment for acne.  



If you have very oil and greasy skin, this is caused by testosterone.  I had my hormones checked and i have the same amount of testosterone in my system as all other women.  But, I am genetically more sensitive to testosterone.  As a result, the average amount of testosterone in my system causes my sebacous glands to over-produce oil which results in acne. This, apparently, is a common problem and that is why diane 35 works for many women who have a sensitivity to testosterone because diane 35 blocks testosterone (contains estrogen and cyproterone acetate).  Because this medicine contains estrogen, it can not be used by men.



However, finasteride (propecia) is used by many men for hair balding.  Hair loss on head in males is caused by an increased sensitivity to testosterone.  Finasteride blocks the testosterone so that it can not act on the hair follicles.  Propecia can be used by males who have an extra-senstivity to testosterone (blocks the testosterone so that it can not act on the sebaceous glands, which in turn, prevents the glands from producing oil, which then prevents acne).  I do not know the side effects of finasteride.  But, like me, I developed a resistance to accutane.  And, once i blocked that testosterone, my acne went away.  Maybe you should try a testosterone-blocker for your acne.  Hope this helps.

by sarahtee, Sep 01, 2003 12:00AM
Flutamide (trade name:  Eulexin) is also an androgen-blocker (testosterone blocker).  Can be used by both males and females if you have androgen-dependant acne.  Go to the following link for more details on hormonal acne treatments:



http://www.neurosci.pharm.utoledo.edu/MBC3320/androgens.htm

by sarahtee, Sep 01, 2003 12:00AM
I don't think that you've developed a resistance to accutane.  I don't think there is such a thing.  The accutane just hasn't fixed the root of the problem and so your acne is reocurring. One thing that accutane does is that it shuts down your sebaceous glands (glands can not produce oil which then prevents acne - but experts don't know how accutane shuts down the sebaceous glands - not even the people that made the drug know how accutane works - go and look at the manufacturer's web site - it states that they don't how it shuts down the sebaceous glands). Over-active sebaceous glands are caused by testosterone - does accutane block testosterone????  I don't think so because:  For me, I am 100% sure that accutane does not block testosterone or reduce testosterone levels because while I was on accutane I got facial hair - and I never had facial hair before.  This means, instead of the testosterone effecting my sebaceous glands, it affected the hair follicle.  Another example is that accutane may cause alopecia (hair loss on head).  Hair loss on the head is caused by testosterone and so in this case, the testosterone is diverted from the sebaceous glands to the hair follicles on the head.  My observation may or may not be correct but no one can really dispute this observation because no one really knows how accutane stops sebum production.



I've never had bad acne myself either - just persistent as in your case.  I took accutane and it shut down my sebaceous glands very quickly.  However, I still got pimples here and there.  And so, the accutane really didn't get to the root of the problem.  It helped it 80% though.  And then I started doing my own research and found that, as stated above, no one knows what accutane really does.  But, when I got the facial hair