Isotretinoin - Accutane

[Honkey_Kong]

So last week, I started taking Isotretinoin after a trip to a dermatologist. I got a few questions.

First I've been noticing more muscle spams after about the 2nd dose. They aren't so bad as where it's painful and completely contracts the muscle, but it is a bit annoying and uncomfortable. Who here has had experience taking Accutane and can tell me if they got this symptom and when does it start to subside.

Second, since starting, I've notice the acne hasn't gotten better at all (mind you I'm only 5 doses in right now),. but I've notice it starting to get a little worse. From you guys' experience when is it going to start getting a little better?

My joints are starting to hurt more than usual. I mean this could be, because of the change in weather that we're experiencing in socal, but it really hurts and started a little after I started the accutane.

And did everybody else have to signup for some iPledge shit? You know where you promise you're not going to allow yourself to become pregnant due to possible birth defects (which I don't know that's even possible considering I'm not a female)

[scotty51312]

Accutane is horrible man. I did 10 weeks about 2 years ago. My experience with it was achy joints constantly feeling dehydrated. My lips were always dry and chapped so bad the only thing that worked was lanolin. My skin got dry and red and i had more breakouts for about the first month. The dry mouth and dehydration went away about the same time. Noticable improvement around week 6 and by week 8 or 9 i had almost no acne.

I also changed my soap to some all natural anti fungal soap made for grapplers and MMA fighters from the arm bar soap company. Haven't had much in the way of acne since.

[Honkey_Kong]

Accutane is horrible man. I did 10 weeks about 2 years ago. My experience with it was achy joints constantly feeling dehydrated. My lips were always dry and chapped so bad the only thing that worked was lanolin. My skin got dry and red and i had more breakouts for about the first month. The dry mouth and dehydration went away about the same time. Noticable improvement around week 6 and by week 8 or 9 i had almost no acne.

I also changed my soap to some all natural anti fungal soap made for grapplers and MMA fighters from the arm bar soap company. Haven't had much in the way of acne since.

I've started noticing the red flaky dry skin around my nose and upper lip. They told me this is going to be 6-9 months. I'm at that point where I'm tired of the acne popping every timeI rest my head on the pillow. Or the chest acne that doesn't go away. And it fvuking hurts.

[Fluidic Kimbo]

I've started noticing the red flaky dry skin around my nose and upper lip. They told me this is going to be 6-9 months. I'm at that point where I'm tired of the acne popping every timeI rest my head on the pillow. Or the chest acne that doesn't go away. And it fvuking hurts.

Have you tried sunbeds?

When I go on a sunbed, it totally clears up my skin. Obviously UV rays are harmful to skin so you don't over-do it. But 4 or 5 minutes on a sunbed might help.

[Honkey_Kong]

Ok I've got some updates on what I've been experiencing:

I've had my 9th dose today (30mg tablets).

The flaky skin near my nose and upper lip is pretty bad, but it's not getting any worse. I'm using an exfoliating bath sponge to keep it at bay, but the skin is sensitive around there.

My nose is real dry inside. I don't feel like it's going to bleed, but then again the only times I get nose bleeds is when I've been hit in the nose.

I've got a very slight wheeze. I don't think it's enough to worry about just yet. And it could be asthma related (I had childhood asthma and only get attacks now, when I'm sick with a cold or flu).

My lower back is very stiff. I have a lot of pain in the lower right side of my back that shoots down to my ass cheek. When I stand up, I really can feel it. When I try to bend over it's agonizing. I've been taking Aleve and Tylenol to try to make the pain manageable, but I think it does nothing. I can't deadlift very much because of this (even with a mouth guard so I can bite down).

Both of my elbows are hurting and the pain shoots in to my forearms. I normally have pain in my right elbow, but not my left and not to this degree.

Both of my wrists hurt, but the right one only hurts when I'm putting a weight load on it (pushups or benching). My left wrist is hurting all the time. It's more of a dull burning pain though.

My left shoulder is very painful and stiff. The pain is coming from what I think is the long tendon head of the biceps and stretching doesn't make this any better.

My right ankle is a bit achy as well. It's not that bad and aches the same whether I'm resting or using it.

And I've been experiencing aches in the bones inside my hands and feet. They're not that bad though more of an annoyance.

My knee and hip pain hasn't been bothering me. I'm attributing this to my back and shoulder hurting so bad it's taking all of my attention.

I've been getting tired earlier in the night, but it's still difficult to fall asleep.

I'm still not noticing any difference in my acne (not that I'm expecting it to get better this soon). It hasn't gotten worse though.

I am thinking about going to an urgent care tomorrow (because I can't get an appointment with my doctor for at least 3 weeks and they suggested going to one instead), to see what they can do about the pain, if it doesn't get any better when I wake up. Hot showers, Aleve and Tylenol aren't doing anything, but I don't want anything that will make me feel like I'm high.

[lovbyts]

Why havent you stopped taking it?

[yeahbuddy289]

I get terrible acne on cycle and was considering accutane to control it but after reading things like this I have second thoughts about it. My acne is terrible, it completely covers my back and shoulders, it’s itchy, painful, and I don’t dare wear a light colored t-shirt because they burst and bleed through it. I have found tanning helps but the whole skin cancer thing worries me. But I’m starting to think tanning may be the lesser of two evils compared to accutane.

[Honkey_Kong]

Why havent you stopped taking it?

Because the acne gets that bad. Can't put your head on a pillow without bursting one of them and getting blood/puss all over the pillow case. Not to mention how bad it hurt. You see this shit in the mirror and it's fvuking gross to look at. I keep thinking if I tough it out, I'll be done with this acne nightmare.

[wellshii]

Not my own research but this might help

How to Destroy Acne ~without accutane~ [Comprehensive]

##Preface

(Wall of text incoming, skip to next headline for the treatment) most of this information can also be found at /r/skincareaddiction but I wanted to break it down for you guys.

My motivation for writing this post is because I have been struggling with bacne almost my whole life as well as gruesome pubertal facial acne, but its only my bacne now that gets significantly worse on cycle. My SO also has persistent acne on her face leading to me studying how to destroy acne without accutane.

Why without accutane? It somewhat worries me that people advise accutane when someone asks how to reduce acne while on cycle, without knowing the actual severity of their acne. Accutane should be the complete last resort for acne.

Accutane has been connected not only to the short term side effects that we all know of (stomach discomfort, dry skin/eyes/lips, liver effects, joint pain) but also to severe, potentially permanent side effects such as: joint pain, Crohn's Disease, Irritable Bowel Syndrome, depression, sexual side effects, dry skin, nosebleeds, reduced healing ability, etc. Accutane is structurally similar to Vitamin A, and most of these effects are related to Vitamin A toxicity. Research accutane side effects, and Vitamin A toxicity before getting on Accutane.

Sure there are plenty of people running 20mg ED/EOD that don't report sides, but is the Steroids community the best bet for long-term safety type stuff? We have people running grams of gear blasting for years without coming off, people running tren as a 'cruise,' people running superdrol for years with no tudca never coming off. I guess people think well if I'm running steroids, fuck it i'll run accutane too, but I don't think that's necessarily the right mindset, everyone has their own level of risk and people deserve to know the issues that accutane to cause as well as ways to alleviate their problems without accutane.

#Steroids and Acne

Unfortunately, any amount of steroids is going to increase acne if you are predisposed to it. Some hormones will affect people differently, some get more acne on tren, some test, some NPP, etc. Regardless of E2, you will get acne from steroids.

EstrogenE2 high or low can both cause acne, and acne may result even from having normal estrogen levels just due to the androgens in your system. Aim for *consistent* E2 levels, this will lower your chance of acne the most.

#DHT and acne

I've used nizoral before and had a similar effect with head and shoulders (which apparently works on fungal acne, do not know how to identify it though.)

Ketoconazole or Nizoral are typical anti androgens. Get the benefits of stopping DHT from binding to the sebaceous gland without ingesting an anti-androgen.

#Lifestyle habits and washing habits for Acne

Firstly, a great resource is acne.org and it's subsequent forums and this includes much general consensus from acne groups.

**Refrain from using harsh washes or activities that will increase inflammation of the skin (#1 reason for acne). This means:**

- Do not use alcohol, sulfates (soap), acne bead scrubs, overly drying washes. **instead use gentle cleansers, (acne.org has one), sulfate free, and wash your face very lightly and splash water to wash it off. PAT to dry DO NOT scrub.**

- Do not touch, scrape, or pop your acne. Don't run your dirty fingers over your acne. Do not spend time pushing out plugged comedones, black heads, white heads. Do not excessively press and pop pimples that are not popping, even if the end result it pops. If it takes more than 15 seconds for it to pop, leave it alone until its ready **instead: if you must, only pop pimples that are easily popped and ready with clean hands right before you wash it. A warm shower can make it easier to pop but scalding hot water may be negative to skin moisture. However it is more ideal to never pop pimples**

- Do not sleep on dirty bedsheets or pillow cases. Do not re wear dirty shirts, or continue wearing a gym shirt that you just worked out in. **instead, shower/rinse immediately after gym and put on a clean shirt. If you go home after gym and shower that is usually fine too. Replace bedsheets 2x a week and pillow cases EOD (flipping the pillow after the day to get double use)**

- Do not excessively wash your skin, it leads to overdrying. **If possible, wash your back/face with a gentle wash 1x a day at the max. If you need to take a second shower before bed due to general day sweat, rinsing with water and wiping with hands is completely fine.**

#Washing

- As counterintuitive as it sounds, over washing can lead to acne. Your aim should be to maintain a certain level of stability with your skin. This means overwashing will dry out your skin and cause acne. You must completely avoid normal soap and sulfates.

- Consider a salicylic acid wash or benzoyl peroxide wash (the OG proactive uses this) and using 1x a day max. If they dry out your skin stop for a couple days. Some people find success with a benzoyl peroxide wash, but I think salicylic acid is better as benzoyl peroxide is a generally better treatment for leaving on skin. Others have the opposite opinion.

- Consider washing your back with no soap at all if you haven't gotten extremely dirty. Your body maintains a natural ph and good bacteria that lessen the ability for bad bacteria to colonize and from acne. Simply rinsing off and not washing at all can do wonders due to the reduced inflammation on your skin.

- Wash lightly, do not scrub, do not rub hard. Your objective is to clear the previous medicine from your skin and remove any layer of acne promoting containment on your skin. (Bacteria from sweat, pollution, clogged pores, etc.)


#Treatment

This is where it gets to the good stuff. I'm so fucking surprised barely anyone here knows about the best treatments for actually removing acne.

**Test all medications first in a small part of skin before dousing yourself with it. BP, azaelic acid tend to be the biggest culprits of redness and differin to a lesser extent.**

- **Benzoyl Peroxide 2.5% (gel version is best)** - there is no evidence that stronger concentrations are better, and they generally just dry out the skin more. [Benzoyl Peroxide](https://en.m.wikipedia.org/wiki/Benzoyl_peroxide) is the holy grail of treatment because bacteria never get resistant to it. It provides an oxygen rich environment that is impossible for bacteria to live in. **Issues with BP = sensitivity to sunlight, redness on skin, allergic reaction (under 5% have this)** so take away = start slow when using benzoyl peroxide, EOD at first, then ED. 2x a day if your body can handle it. It also bleaches clothes, so if you put it on before putting on clothes you need to let it dry, and probably have a white t shirt/white sheets.

- **[Adapalene](https://en.m.wikipedia.org/wiki/Adapalene)** (brand name Differin) is a 3rd generation retinoid that specifically targets the mechanisms that produce acne. It prevents the formation of comedones by 50-60% according to studies. Retinoids are structurally related to Vitamin A - and accutane is a retinoid. Differin is a topical retinoid and since being applied to the skin it does not absorb through the blood stream (as shown by studies significantly insignificant amounts get through). So, you're basically taking topical accutane. Differin has always been the most effective acne medication for me in permenantly reducing the amount of acne I get, and after a year of diligent use in my teens I never got pimples anymore. Additionally, Adapalene *increases* the efficacy of other popular acne treatments such as topical clindamycin and benzoyl peroxide.

- **Topical clindamycin:** clindamycin is a popular antibiotic, but when used topically for acne treatment it significantly boosts the efficacy of adapalene and benzoyl peroxide. However, tolerance increases pretty quickly, and I only recommend using it when a breakout occurs, or for spot treatment of specific pimples. It's useful l usually sold in combination with benzoyl peroxide 5% but it's in your interest to get it separately because 5% BP is over drying and this way you can regulate your tolerance to it

- **Curology (prescription)** 4% [azelaic acid ](https://en.m.wikipedia.org/wiki/Azelaic_acid). (precursor to salicylic acid) 1% clindamycin, 4% [nicotinamide](https://en.m.wikipedia.org/wiki/Nicotinamide). I've read good things about this from skin care addiction but have not used myself. Studies show nicotinamide being as effective as 1% clindamycin without resistance.

- **Salicylic acid option:** a slightly weaker option than benzoyl peroxide, but still effective. Be sure the lotion it's mixed with is quality and you might find something useful. You might be better off finding it in pure gel. However BP has shown in studies be more effective and the combo treatment with differin is promising.


- **Jojoba oil:** widely considered the best type of oil to moisturize your skin because it is very similar to the natural oils that we produce. It's a favorite on /r/skincareaddiction

**zinc 20-50mg for 3 days after breakout** you can't stay on high zinc forever but I do this when I get a breakout and it's pretty effective. Lots of anti inflammatory properties in zinc. 10-20mg is about a maintainece dose. I like to use zinc-carnosine complex because it has the added benefit of restoring stomach lining and reversing damage from spicy food etc. No heartburn since using it.

Adapalene is prescription only, but should be over the counter soon. **it also comes in a mixture formula with BP called epiduo**

Clindamycin is prescription as well. Benzoyl peroxide can be found anywhere. For all of these drugs you should be aiming to get the gel versions. If you go to yourdermatologist and ask for them you should probably be able to get everything that you want.

Adapalene (used first) followed by clindamycin, and benzoyl peroxide, is the holy trinity of destroying acne. If using these 3 medications is causing you to get overly dry skin, you probably want to drop everything but always continue adapalene usage as it improves your skin over time and reduces your ability to create new comedones. If you can only take adapalene 1x a day is fine. 2x is better. It's better to use a thin layer of it everywhere (more just overdries) if your skin is sensitive from overuse, just spot treat with it for a while but you really want to throw it on everywhere

##Moisturizing

Use a non-comodegenic moisturizer. The oil you should be using on your face in my opinion is jojoba oil. Cetaphil and CeraVe make great facial moisturizers. Use these after treatment in combination with jojoba if jojoba oil is not enough.

##Dietary Factors

- Many people swear that cutting out dairy reduced their acne. Considering the amount of hormone derivatives pumped into cows, it is a reasonable assumption. Since many of us are putting hormones into our body anyways, it might not matter, but most people get reduced acne from cutting out Dairy.

- Cutting out Sugar & Fructose can reduce acne. Inconsistent blood sugar levels are related to acne, and high amounts of sugar provide a good environment for bacteria to proliferate. Try it out.

- Eating more veggies. Try it out, fuck it, it might help.

Generally diet cannot cure acne on its own, but if it helps, it's worth it. If something you're eating is creating acne, it's probably not something you want in your body anyway.

Hope you guys enjoyed this post, if you get anything out of it: GET ADAPALENE! it's the most effective treatment for preventing further acne (and reducing current). It's basically topical accutane.

[Honkey_Kong]

As an update. I couldn't take the joint and back pain anymore. So I went to the Urgent Care.

The doctor there gave me a shot of Toradol 60mg. It relieved most of the pain within minutes. My back and shoulder still hurt some, but it's nowhere near what it was.

Since the dermatologist office was closed today (MLK day), I decided along with advice from the Urgent Care doctor to not take today's dose of accutane and tomorrow morning I will call them up and take it from there. Maybe there's an alternative?

[SampsonandDelilah]

As an update. I couldn't take the joint and back pain anymore. So I went to the Urgent Care.

The doctor there gave me a shot of Toradol 60mg. It relieved most of the pain within minutes. My back and shoulder still hurt some, but it's nowhere near what it was.

Since the dermatologist office was closed today (MLK day), I decided along with advice from the Urgent Care doctor to not take today's dose of accutane and tomorrow morning I will call them up and take it from there. Maybe there's an alternative?

Are you experiencing acne all over the body or just face. On cycle or when you started TRT? What about when you were younger?
I have some friends that work in dermatology, I’ll ask around for you. Not sure if this sounds like a viable alternative and reading your thoughts, the accutane doesn’t sound sustainable and is affecting your quality of life. Med spa with some non commercial grade products might be the answer and geographically you’re advantaged in that regard.

Fingers crossed bro

[Honkey_Kong]

Are you experiencing acne all over the body or just face. On cycle or when you started TRT? What about when you were younger?
I have some friends that work in dermatology, I’ll ask around for you. Not sure if this sounds like a viable alternative and reading your thoughts, the accutane doesn’t sound sustainable and is affecting your quality of life. Med spa with some non commercial grade products might be the answer and geographically you’re advantaged in that regard.

Fingers crossed bro

I never had more than a few pimples as a teen. It wasn't until I first did gear that I had a real breakout. I get it on the sides of my face (more towards my ears), my scalp (on the sides and the back of my head) a little bit on my shoulders and on my chest. It's cystic too.

I've been doing TRT for years and I wouldn't get more than a few outbreaks here and there. Nothing I couldn't handle. This last year though, it's been something else.

Originally I tried taking antibiotics for acne and they do work, but as soon as I stopped taking them the acne came back with a vengeance.

Yeah Bro if you could ask them for ideas, I'm open ears and really thankful.

[Test Monsterone]

Man I’m sorry you’re dealing with this. Sounds awful. I’ll give my 2c. I had back acne before starting trt. On trt my back acne got worse. On cycle I would get cystic acne along my spine and even the lower back. I just figured that I get acne no matter what.

I got off trt 4 months ago. No more back acne. Zero. No bumps or those clogged pores even.

What also really helped for me was using a loofa on a stick with Bed Bath and body works body wash. I don’t know why, but when I ran out of this soap I would get an outbreak.I still use it.

Try cutting your trt dose on half and wait a couple of months. That would be my suggestion. You may find you were taking too much before. Good luck..

[Fluidic Kimbo]

If you've never been on a sunbed before, I'd go into a sunbed shop and do 3 minutes on a stand up bed. It's a mircacle cure for some people.

[SampsonandDelilah]

I never had more than a few pimples as a teen. It wasn't until I first did gear that I had a real breakout. I get it on the sides of my face (more towards my ears), my scalp (on the sides and the back of my head) a little bit on my shoulders and on my chest. It's cystic too.

I've been doing TRT for years and I wouldn't get more than a few outbreaks here and there. Nothing I couldn't handle. This last year though, it's been something else.

Originally I tried taking antibiotics for acne and they do work, but as soon as I stopped taking them the acne came back with a vengeance.

Yeah Bro if you could ask them for ideas, I'm open ears and really thankful.

So my buddy asked specifically if it was “cystic acne”, given this post I stated yes.

He mentioned a product called adapalane, and is topical and not systemic so apparently it had far less adverse reactions. He also said hey a quality face wash (something all natural higher end - gels tend to be more drying) and make sure you’re following up every time with a high quality moisturizer. The moisturizer is the most important because the body creates oil to deal with the dryness, if you keep your face hydrated, the oil will at least slow down (won’t make it perfect) but it’s an important part of your skin care regimen.

Also mentioned trying the retinol products first line (some are OTC and some are RX, like retina-a (again, stay out of target/Ralph’s and go to a nice med spa place) then there are some RX strength and he mentioned Tretinoin (I think that one may be branded adapalene.)

Also suggested grabbing an acme cream that has salicylic acid in it, again high quality. It also exfoliates as well. Last is benzoyl peroxides but they can be extremely drying and lots of cheap products out there containing it.

Also said that since you had luck on antibiotics, he recommended running them again but alongside your new face regimen. They may take a couple of weeks but to stay with it and make sure your pillow case is washed weekly with a sensitive cleaner.

He’s a board certified dermatologist and I used to call on his office back in the day. He’s a solid guy and a meathead (ahem, I mean TRT patient) so he gets it.

Obviously getting it second hand, he said it’s probably the oils and was wondering if it changed when you changed labs or gear?

All good for thought, but agreed that isotretinoin can be some really nasty shit.

Hope this helps brother and best of luck!

[Honkey_Kong]

So my buddy asked specifically if it was “cystic acne”, given this post I stated yes.

He mentioned a product called adapalane, and is topical and not systemic so apparently it had far less adverse reactions. He also said hey a quality face wash (something all natural higher end - gels tend to be more drying) and make sure you’re following up every time with a high quality moisturizer. The moisturizer is the most important because the body creates oil to deal with the dryness, if you keep your face hydrated, the oil will at least slow down (won’t make it perfect) but it’s an important part of your skin care regimen.

Also mentioned trying the retinol products first line (some are OTC and some are RX, like retina-a (again, stay out of target/Ralph’s and go to a nice med spa place) then there are some RX strength and he mentioned Tretinoin (I think that one may be branded adapalene.)

Also suggested grabbing an acme cream that has salicylic acid in it, again high quality. It also exfoliates as well. Last is benzoyl peroxides but they can be extremely drying and lots of cheap products out there containing it.

Also said that since you had luck on antibiotics, he recommended running them again but alongside your new face regimen. They may take a couple of weeks but to stay with it and make sure your pillow case is washed weekly with a sensitive cleaner.

He’s a board certified dermatologist and I used to call on his office back in the day. He’s a solid guy and a meathead (ahem, I mean TRT patient) so he gets it.

Obviously getting it second hand, he said it’s probably the oils and was wondering if it changed when you changed labs or gear?

All good for thought, but agreed that isotretinoin can be some really nasty shit.

Hope this helps brother and best of luck!

Thanks man. I'm going to be doing some shopping this weekend, I guess from googling adapalene is an active ingredient of an OTC retinol. From what I read, it's going to take about 8-12 weeks to see results with these retinols.

I'm going to also ask my doctor for another antibiotic script to tide me over while this shit is kicking in.

I hope my experience here with isoretinoin will help others who are having acne problems and considering going down this route.

[Fluidic Kimbo]

I hope my experience here with isoretinoin will help others who are having acne problems and considering going down this route.

Even if you're milk bottle white, three minutes on a sunbed won't do anything more than make you just a tiny bit red. And it will be enough to see how your skin reacts to it. I can tell you when I was in my late teens I had pristine skin after doing sunbeds, it cleared up every single last little pimple.

If you're going to all this grief with antibiotics and creams then surely you have three minutes to spare.