Soolantra Topical Cream (Day 9)

After using Soolantra (ivermectin 1%) for nine days, I have decided to offer a follow-up.

I have found this medication to be quite beneficial. I have used it daily (a.m. application) with much success. I have noticed a decrease in overall redness and pustules, which are often associated with rosacea. Additionally, the overall appearance of my face is more uniform, which is always a good thing! Unlike Mirvaso, my face maintains its natural color with a matte appearance.

The topical cream goes on well and is absorbed by my skin without leaving a greasy residue behind. Initially, I was afraid that it may increase acne flare-ups, but it has not created that reaction. I will continue to use this medication on a daily basis and offer additional updates.

Accutane & Acne (Days 153-207)

After being on Accutane for over half of a year now, I am happy to report that my skin is acne free! My skin feels reborn. The only thing now to work on is the hyperpigmentation of former blemishes. I have been using a 5% glycolic facial wash, by DDF, which is really nice. Even though, my skin is blemish free, I still take 40mg of Accutane three to four times a week. Before, I was taking it daily (sometimes twice daily). It is a good maintenance program for me at this time. Of course, I will endeavor to wean myself completely from the drug in the coming months; even though, my dermatologist informed me that she takes 40mg once a week. She said it keeps collagen built up in her skin; I agree.

I did bloodwork on Friday, and I have an appointment with my dermatologist on Tuesday. I hope everything is a-ok!

Accutane & Acne (Days 116-152)

Since my last update, my acne situation has been in remission. Only this morning I was reminded of acne when I woke up to find a single pimple on my right cheek. It was sort of a let down, but let's face it, one zit in three or four weeks is better than three or four zits every day!

I'm taking one 40mg Accutane each day. I am going to take two Accutane today, a 10mg Prednisone, and a topical application of Topicort directly to the zit. If it doesn't go down in swelling by tonight, I will step up from Topicort to Vanos.

I feel like a dermatologist!

Accutane & Acne (Days 94-115)

Eureka!

I can report that for the past week I have been completely breakout free for the first time in about 19 years!

I first started getting spotty acne when I was 12 years old. For me, it is hard to believe that most people move beyond this skin ailment by the end of their teens and certainly by the beginning of their twenties; however, for me, I have been living with it for the majority of my life. The twenties were no relief, and my thirties certainly showed no sign of recovery. As I move into the end of my treatment, I am now concerned that once I stop taking isotretinoin that my acne may return. My dermatologist said in that case we'd simply start another regimen of isotretinoin, because it is possible for it to return in a mild form. I suppose I can live with that. Although the new acne is gone, I still have the visual remains of a decades long war on my face. I see fading hyperpigmentation and a very few scars along my right jawline. My scars are nothing compared to the discoloration. They are not even noticeable. If you looked really close you may see two or three. Of course, I've never seen my face completely acne free since I was 11 years old, so I may find more as time goes on.

Over all, I am happy!

Accutane & Acne (Days 77-93)

With the exception of two zits, I am pretty much acne free at the moment. I still suffer from the discoloration of previous outbreaks, but my dermatologist insists that it will all fade away once I stop taking the isotretinoin. I will trust her on that.

Thursday, marked another visit to the dermatologist. She said that she thinks next month will be my last prescription for isotretinoin. I will continue to take it for several months to come, because I have been taking one pill per day while the prescription says twice a day. Also, that is doctor's orders. She says that it doesn't matter how quickly you receive the dose as long as you do complete the regimen. My lab work shows normal liver function and my triglycerides are holding steady in the mid-200s. She said I can live with that, because more than likely they will drop once I stop taking the isotretinoin.

I picked up a new prescription of Amnesteem and Prednisone today at the pharmacy. I had to convince the pharm tech that I did have a prescription for Prednisone on my script, because she said it looked like the doctor had drawn a line through the quantity, which was 30. I read the script to her over the phone to convince her that the doctor wanted me to take it. I also told her to look at my prescription history to see she does prescribe the medication with the same quantity and instructions. My dermatologist loves to draw lines over things and circle things to make a point. In the case of the marked out quantity, I think she was attempting to emphasis for the pharmacy that there was a prescription at the end of the prescription paper.

Accutane & Acne (Days 66-76)

I am still plugging along. It seems that my acne is now wanting to play hide-and-seek with me. For a few days it is on my cheek and then it is suddenly on my forehead. I'm still taking Prednisone as a stop-gap measure. I have also moved the time I take my isotretinoin from the morning to the afternoon/evening. It is easier on my stomach, because I am able to eat a decent snack/meal before swallowing the pill. I have fudged a little bit on the number of pills I take each day. Most days I take one, but on others I may take 2.

Accutane & Acne (Days 52-65)

Better ways.

Since my last post, my skin has gotten better. The previous outbreaks have went down, leaving only discoloration behind to remind of its former presence. I went to the dermatologist for another month's follow-up on Thursday. My triglycerides were up a few points, but she said wasn't anything to get alarmed about. (I have cut back on red meats.) I did tell her that I was disappointed with the fact parts of my face were breaking out again, but she reassured me that it was common. Of course, I will continue the treatment. I did mention that I did not have Prednisone to take during the previous month, which did help tremendously with inflammation from the occasional outbreaks. She went ahead and gave me another supply of Prednisone 10mg to take each day. The doctor also gave me samples of Tazorac to spot treat any future outbreaks. I hadn't tried this product in my pre-isotretinoin days, but I like it. It has a drying effect on my skin. The cysts also responded with a decrease in swelling.

The pharmacy filled my isotretinoin prescription with another company's brand. It is Claravis by Barr Labs. I prefer Barr's packaging. It is much more user friendly than Mylan's packaging for Amnesteem. Of course, it still costs my insurer more than $600 for a month's therapy!

Accutane & Acne (Days 30-51)

Old ways.

That's the only way I can describe the right side of my face. While the left side of my face has cleared up considerably, the right side of my face is intent on returning to the ways of an acne-indulged lifestyle. With that said, I have to admit that the acne is not the same cystic nor nodule acne as I had before, but it is there nonetheless, doggonnit!

My skin is very dry. I rub my fingers over my cheeks and feel the dryness of my skin. Some skin even wafts off like dust into a gentle breeze. (How's poetic is that?) I do not wash my face at night anymore, in fear of aggravating its dryness. I was using CeraVe, but now I am using Cetaphil, because I had some of it left over.

Also, the eczema/dermatitis on the back of my hands has become quite painful and obvious. The back of my hands look like lobster claws sometimes. My left hand looks like a massive red island in a white sea, while my right hand looks like an archipelago of red dots strewn in the whiteness. They are incredibly dry, as well. I am using a homemade concoction of Cetaphil moisturizer of triamcinolone acetonide that I have mixed together. I only started using it last night and my skin is less red.

The only major difference in all of this is the fact I am not taking Prednisone anymore. I only had it for one month to go along with the Accutane. I am not sure if the dermatologist forgot to prescribe it last time or she doesn't want me to take it anymore. Nevertheless, I will be requesting a refill of it the next time I am there in about a week-and-a-half. I think it went a long way in helping me combat acne flare-ups.

Accutane & Acne (Days 24-29)

Thursday, I went in for my one month check-up with my dermatologist. My triglycerides were a little high (she said), but I think I can live with 237, even if 150 is normal. She said that it would probably be okay and she didn't have a real problem with it being at the number, but she wouldn't like it to get closer to 300 anytime soon. (But, in the meantime, I'm supposed to be cutting down on my cholesterol intake. Uh-huh!)

My face is continuing to progress. The doctor was very pleased with my result. She said that it won't be long before I am acne-free. I told her that I probably hadn't been acne-free in over 18 years. I wish someone had told me about Accutane about 18 years ago!

In other news, I went the pharmacy today to fill my new prescription for isotretinoin, but the pharmacy guy told me that the iPledge people wouldn't allow it to be filled. He really didn't know why, even though, he said he called them. He thought maybe I am too old to be taking it. I called the iPledge people, and the lady I talked to, who was very nice about it, told me that the prescription wasn't filled through any fault of mine, but because my dermatologist hadn't verified that I had went in for my follow-up office visit this month. She said it was incredibly rude for the pharmacy guy (who I think is a technician) to tell me that, because there isn't an age limit on who can take isotretinoin. That's exactly what I thought. If you think about it, if there were an age limit, why would the doctor put me on a regimen that will last for months, when she knew exactly how old I am?

I will call the doctor's office on Monday, and tell them to go ahead and take care of this issue.

Accutane & Acne (Days 17-23)

My face is flaking skin, like after a sunburn. My lips were cracking quite a bit on Friday and yesterday, but they seem to be healing today. They are not painful this morning, but they are peeling. I have been using Aquaphor and Blistex like mad!

I go back to the dermatologist on Thursday to see how things are going. I think my dermy will be happy with the results. I am! The only thing I am worried about is the blood test I had done on Wednesday to test my lipids level. The last time my LDL was up! Yikes.

Accutane & Acne (Days 12-16)

Starting my third full week of treatment, I am still seeing results, even though they are a bit slow. Acne is still rearing its ugly head, but it is much less intense. It is not painful, nor does it create hyperpigmentation. It seems that the hyperpigmentation that did exist has begun to lighten. My face is less red and irritated, which is always a good thing!

Accutane & Acne (Days 7-11)

It's hard to believe it has been more than ten days since I started taking isotretinoin for my acne. Now on day eleven, I am still chugging along with many of the same symptoms I discussed in my previous blog.

I am still experiencing acne; although, in a milder form. I have developed acne on my lower and upper lips, but it isn't too bad. I didn't have acne there before. The areas that were formerly inhabited by cystic acne are still in retreat with no sign of return. I just wish the hyperpigmentation would fade more quickly, though.

In other news, I took two pills on Friday. I thought I would see how I reacted. I did not notice any difference in physical side-effects to the 80mg of isotretinoin. I debated on whether or not to take a double dose tonight, but I decided not to do it, since I am feeling a bit sickly. Maybe tomorrow.

Accutane & Acne (Days 4, 5 & 6)

I am still marching forward in my combat against acne! I have taken almost seven doses of isotretinoin, since last Friday.

Over these three days, I have experienced what I consider to be typical side-effects from this drug. I have noticed my face has a reddish color to it (like when you're in the sun for 10 minutes in noon sun during summer), my shoulders and upper arms feel achy and weak, and tiredness (but that could just be work).

On day 3, I was excited because I woke up with any new acne. During these last three days, however, I have broken out slightly. On the bright side, though, this acne reminds me of those small little pimples I used to get. I haven't experienced anything remotely like the cystic acne of recent months.

It's still a good thing. After my fourteenth dose--or so--I am thinking about trying a double dose day.

Baby steps!

Accutane & Acne (Day 3)

Today marks the third dose of isotretinoin I have taken. It is still in the early days, but I am starting to get into it. Again, I am seeing results this early from taking the medication.

• I woke after a few hours of sleep and felt restless for a while, but went back to sleep. I did not experience any anxiety, like last night, though.
• I woke up with another mild headache.
• This morning I noticed that my face is not as oily as it usually is.
• It's too weird to explain, but my face smells different (take my word on it, I know).
• The taste that was in my mouth on days 1 & 2 has become almost non-existent.
• My hands and feet no longer have the bruised feeling, but I do still feel some muscle rigidity and discomfort; however, it has become less annoying and noticeable.
• My lips have begun to flake slightly.
• And for the first time in a very long time, I woke up with NO NEW outbreaks on my face! YES!!

Accutane and Acne (Days 1 & 2)

Yesterday, I received my first prescription of Amnesteem (isotretinoin), which I will refer to as isotretinoin or Accutane, because that is how I know it best. Isotretinoin is a treatment for severe acne. Over the last 4-6 months, I have developed eruptions of antibiotic-resistant cystic acne along my jawline and forehead, that any teenager would be proud to call his/her own; however, I haven't been a teenager in over 12 years.

First of all, I had to sign a document, called iPledge, stating that I understand there are copious amounts of risks involved in this systemic treatment. I can have anything from a stroke to a child born with severe mental and/or physical deformities (more on that later), even though, I am a guy. In addition, I am to be subjected to monthly lab work to measure my cholesterol and triglyceride levels.

This particular brand of isotretinoin comes in a cute little pack of ten pills with a silhouette of a pregnant woman and a big red circle with a slash through it on the back of each individual pill container. It includes a warning, in case the picture was too ambiguous, that states in bright red, capital type: "WARNING TO FEMALE PATIENTS: DO NOT GET PREGNANT." That is really charming to say the least. Of course, the effects to an unborn child are anything but cute. In a side note, my mother was looking at the packaging, which shows crude graphics of what can happen to an unborn child if the mother takes isotretinoin during her pregnancy. Mom thought those were things that could happen to my head and organs while taking the medicine. I had to laugh out loud over that. I'm a bit bigger than a zygote.

Five p.m. yesterday marks the anniversary of my first dose of 40mg. Since I am not a teenager, I am starting out by taking one pill a day, instead of the usual two pills per day.

So, what have I experienced thus far?

Day 1

1. In mere hours after my first dose, I noticed a curious taste in my mouth. I can't describe it really, other than to say it is a combination of bitter, sweet, and sour. It is like my taste buds are tasting things that aren't present. It got better as the I got closer to my next dose. I haven't really noticed it interfering with how I taste my food as I eat. It is just poignantly present between meals.
2. During the night, I was subjected to a period of intense fear and paranoia. I woke up feeling like I was being crushed by the world and that maybe my acne wasn't so bad. Perhaps, that was me in a semi-sleeping state of delusion.
3. I had some wildly vivid dreams that I do not care to share, after I settled down from my state of panic.

Day 2

This morning, call me a liar if you must, I noticed that many of the cysts on my face had shrunk and were no longer painful to touch. It is as if the swelling has reduced. Of course, the hyperpigmentation is still obvious, but hopefully that will fade, too. If not, thank the gods for concealer.

I took my second dose of isotretinoin around noon today, in an attempt to get it into my breakfast/lunch schedule. (It is best taken with food.)

1. I woke up with a nagging headache, which is unusual for me.
2. As the day has gone on, I have noticed that my muscles feel a bit more stiff. The palms of my hands and the soles of my feet feel bruised and are slightly sensitive to touch. Of course, they look perfectly normal to the naked eye.
3. I have noticed my sinuses, via my nose, are starting to feel dry and irritated.

Hopefully, I can continue the treatment. My dermatologist told me to experiment with how often I take the pills, not to exceed two a day. She recommended that I may take one a day, skip a day or two, and eventually try two per day, once I feel more confident. Of course, I need to see what the long-term side-effects of this treatment may be.