Does Accutane destroy sebaceous glands permanently?

[Sally]

Is it true that Accutane destroys sebaceous glands permanently? i.e. there will be no return of normal oil/sebum production when you stop taking it?

I don't want my skin and hair to remain as dry as they are now after 9 months on Accutane. It's helped enormously with inflammation and getting rid of p&p's but the excess oil I used to have kept wrinkles at bay. And that's not a bad thing when you're getting older, believe me!

Sally

[Ghost]

Marc, How does Accutane repair sebaceous glands?

Thanks.

Ghost

[Ghost]

Regarding my question on sebaceous gland repair and accutane:

Never mind. I just read the Dr Nase post that he put up this morning about accutane and sebaceous glands. It sounded like accutane works like a facial from the inside [I paraphrase] 'pushing the illegal stuff upwards and out'.

Ghost

[Sally]

Thanks Marc

My dermatologist says I may have to stay on Accutane for a couple of years. I stopped taking it (probably too abruptly) after 6 months and the p&p's came back. The thought of this long period of time worried me because I can see my skin getting drier and drier. And my hair is like straw.

I thought that it wasn't the actual amount of sebum produced that caused Rosacea but more the inflammatory response in the skin. And somehow Accutane acted on that.

Seeing my derm again tomorrow and want to sound knowlegeable.

Sally

[drnase]

Sally,


On low dose, it actually shrinks them by about 50% but normalizes the thick abnormal secretions.

If you go on accutane for more than one year, there is only one concern which is rare. In a small percentage there is minor calcification of parts of the vertebral column (just bone spurs) and in even less, there may be slight calicification of tendons -- keep mobile and it wont happen or go to a DO. and he can check you out every 6 months to assess flexibility have him check hand ligaments and achilles tendon --most susceptible.

[clsykes00]

when you say shrinks the seb glands, does that mean permenantly? even after being off accutane for over a year?

This would be huge!!! I'm thinking of going on low dose in two months.

Thanks,
Trey

[drnase]

Nope, they return to normal or plus/minus 10% even on the high doses.

[clsykes00]

Interesting, so what is it that would potentially reduce sebum production post accutane?

Thanks again (enormously helpful in making such a decision)!
Trey

[drnase]

Trey,

In many cases it is not the amount of sebum that is the problem, it is the sebum cells (immature sebacytes) that are the problem. Normally the sebacytes are produced in the gland and the sebacytes migrate upwards and out the pore, conditioning the skin. In certain skin conditions, the sebacytes get sticky. They stick together and form a plug, which oxidizes and makes a mess. Accutane can permanently decrease the stickiness and thus no plugs form. This is why it is so great for acne and seborrhea.

[clsykes00]

In order to "train" the sebaceous glands, do i have to take a normal full course? If training is similar to that done for "teenage" acne patients, the below study would seem to imply that. If that is right, and I want to be on low dose, would I have to take accutane for nearly 3 years to up my chances of its effectiveness (fully course [120mg/kg] / low dose [.1mg/kg] /365)?

Thanks so much again! Enormously helpful per usual!
Trey



Low-dose schema of isotretinoin in acne vulgaris.

Mandekou-Lefaki I, Delli F, Teknetzis A, Euthimiadou R, Karakatsanis G.

State Hospital for Skin and Venereal Diseases, Thessaloniki, Greece. drfsn@yahoo.com

In severe papulopustular and in nodulocystic/conglobate acne, oral isotretinoin is the treatment of choice. It is also required for patients with moderate to severe acne, especially when acne scars start to occur A new therapeutic approach consists of a low-dose regimen of isotretinoin. We performed a comparative study of high- and low-dose schemas of isotretinoin per os for the treatment of acne. The purpose of this study was to assess the therapeutic effect and tolerability of low doses of isotretinoin in the treatment of acne vulgaris and compare low-dose with high-dose regimens. Sixty-four patients (35 women and 29 men) with different types and grades of acne vulgaris were divided into two treatment groups of 32 patients, in a trial that compared a low dose of 0.15-0.40 mg/kg per day with a high dose of 0.5-1.0 mg/kg per day. These regimens were analyzed with reference to clinical history of acne, baseline investigations, dose and response to isotretinoin, clinical and laboratory adverse effects, relapses and cost of therapy. The mean success rate of the low-dose schema was 69%. The total dose up to 120 mg/kg should be followed for optimal results (success rate of 91%) and avoidance of relapses. The low-dose schema produced fewer adverse effects and offered a very beneficial effect on pre-existing scarring. Our results confirm the beneficial effect of the low-dose schema. We recommend a total dose > or = 120 mg/kg, as this therapeutic regimen of isotretinoin has proven to be the most successful in preventing relapses and scarring.

[irishgenes]

I guess my sebaceous glands failed their "training". I took 4 month courses of 80 mg. day Accutane three times in my late 30's and 40's. I did not have rosacea at that time that I was aware of. I would get a few big, hard pre-menstrual pimples with clogged pores and pus that went away after my period started. Accutane only cleared up the oily skin and acne for about a year each time, and then I relapsed until menopause, when my skin finally cleared up. (However, now, 8 years into menopause, I suddenly have rosacea "papules and pustules", but they are not like the sebum-clogged pimples I had previously.)

When I was about 56, I discovered a way to stop the excessive oil on my face. I read that the "male prostate herb", saw palmetto, stopped testosterone from converting into dihydrotestosterone, the "bad" testosterone. I thought dihydrotestosterone might have something to do with acne, so I started taking a standardized dose twice a day. The first day, I noticed a significant decrease in oiliness. After taking it for a year, I read that women should not take that herb. I can't remember why, but maybe you can Google it and find out. It should be good for you guys, though.

I looked for another way to decrease my facial oiliness and discovered a very weak topical cream containing estriol that is sold by Women's International Pharmacy of Madison, Wisconsin. It is prescription, but estriol has a very good safety record and is considered the "anti-cancer" estrogen. I tested this by putting it on only one side of my face at first. Even though this is a cream, I found that the side of my face with the estriol cream was devoid of excess oil. This happened within hours. It also helps plump your face with moisture and diminish fine lines. Note that my face is very sensitive to cosmetics and I can't even wash with soap, but this cream did not bother me at all. I get the one without preservatives and keep it in the refrigerator. Hope this helps someone.

[Sally]

Thank you irishgenes.

That's very interesting. I have always had an oily complexion and thought this was the reason I looked younger than my age. Hence my worries about accutane. However, the product you mention sounds great. I guess it's moisture and not oil that's needed whilst fighting Rosacea.

Now my quest will be tracking it down in the UK.

Sally

[irishgenes]

I can attest to the fact that oily skin does not prevent wrinkles! I once asked a plastic surgeon that question when I was 29, and he said he did a lot of facelifts on women with oily skin. I think looking young is more due to staying out of the sun, maintaining a good diet and proper weight, and having good genes.

The estriol cream is .3%. Here is the URL for the study on estriol cream:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8876303&dopt=Abstract

The study showed that wrinkle depth and pore size decreased 61-100% in the postmenopausal women who used estriol cream. It noticeably increased elasticity and firmness of the skin, but did not have any systemic hormone effects. Estriol is the estrogen that is abundant during pregnancy, when a woman's skin usually looks "glowing". I'm thinking that since it increases skin thickness and reduces oiliness, it should be good for rosacea and seb derm.

[irishgenes]

I forgot to ask what dose of Accutane you are on, Sally. I know that some people with rosacea are lucky enough not to get the papules and pustules. I'm taking 25 mg. doxycycline twice a day to control mine. It does a pretty good job. I am holding off on Accutane because I want to be ready to get IPL as soon as I can get the money together. I have no medical insurance, and even if I did, most policies won't pay for IPL. Does the UK national health care program consider rosacea only a cosmetic problem and not pay for treatment?

[Sally]

Hi Irishgenes

I have been taking 20mgs once a day but yesterday my derm said I could try 10mgs instead and see how I got on.

Accutane, antibiotics, creams etc for Rosacea are available on the National Health Service where you pay a small fixed fee but IPL is only available privately.

The study on estradiol and estriol was very informative. Now I won't be worrying so much about oil loss. I guess it was my sebaceous glands that caused all this mess in the first place and I should be glad those pesky sebacytes are getting annihilated, eh?

Good luck with IPL.

Sally

[Library Lady]

I took the full dose of accutane for 6 months years ago when it first came out, I was about 30. I had hit the end of the line with acne treatments, had been seeing a derm since I was 14!

At the time my derm said it should take care of the oil for quite some time but I might need a second course, maybe in 10-15 yrs.

15 yrs was exactly when my face started getting oily again and I started getting the P&P's and topical sensitivity of rosacea. I don't really know what started it off, but I strongly suspect Clinique Turnaround Cream for the P's and Eveining Primrose Oil for the oiliness. It was overnght - as soon as I started the EPO my face got very oily. Could have affected some hormonal changes, perhaps. My OBGYN changed my BC pill and that helped. Now I'm menopausal and have had breast cancer, so no more hormones. I also have hi cholesterol, so I doubt and DR would let me take accutane again, even low dose, my last derm wouldn't even talk about it. New Dr time! I'm also on Arimidex, an estrogen suppressant like Tamoxifen, to help prevent a recurrence of the cancer, so I am afraid to take any more medicine.

Any way, full dose accutane can keep oil at bay for a very long time, but sometimes a second course is needed, especially if your first course was not long enough. This happened to a friend who only took it for 4 months, her acne came back very bad.

[Sally]

Hello Library Lady

Many thanks for your input. It's amazing what you can learn about one specific drug. My gut feeling is to take as small an amount of Accutane as I can possibly get away with. Are you unable to take it again because of high cholesterol? I didn't know that was a problem.

My derm seems to think my Rosacea needs whacking with 20mg a day but I persuaded him to reduce it to 10mgs and... bingo.. when I went to the hospital pharmacy I found they dispense this in 5mgs capsules. So I'm going to do my own medicating and wean myself down to this smaller amount.

My main concern is my voice. Accutane has altered this greatly but the benefits of clearing up my p&p's far outweigh this inconvenience. I just don't talk as much or sing in the bath any more. Not a bad thing!

Sally

[bettina]

My cholesterol is 268 but my both HDL and LDL are high. I am on 10mg per day and my derm suggests policosanol.

Irish, sounds like we are about the same age and going through our relapses at the same time. I was on accutane, ocp and prednisone for my first problem, almost 30 years ago, am in my 50's now.

Hope you are doing well!

Betts

[irishgenes]

Bettina, I am 59. I think Dr. Nase recommends against taking 40 mg. a day of Accutane for rosacea patients our age due to thinning of the skin that it causes. Have you read his book? Maybe you could lower your dose? Or are you on 10 mg. a day? You said "q" and I thought that meant 4 times a day. It is not good for high cholesterol patients, either. My cholesterol is the same as yours, exactly! I also have very high triglyerides, and Accutane increases triglycerides. I read about policosanol on lef.org. If you go on it, I'd be interested to know how it works for your cholesterol.

Well, I said the estrogen cream was not bothering my skin, but I hadn't used it for very long. I started getting acne-type pimples and greasy skin again, probably from some of the base ingredients. I always get greasy skin and pimples from any face cream, even Noritate topical. So I have gone back to the saw palmetto capsules (internally). I did some online research to see why I'd heard women weren't supposed to take it, but couldn't find anything except that you shouldn't take it if you might become pregnant and that it "might" interfere with hormone replacement therapy. I haven't found that to be the case in the year I took it. It is just so tempting to take that herb when I can stop the grease instantly, that I can't resist. I also have read that it might do something for male pattern hair loss, and my hairline does seems to be receding a bit.

[bettina]

I meant 10mg once a day. I always thought that qd meant 4 times a day, too, then I saw it in an instance where it HAD to be once a day. (I think!)

But no it's only once a day, after breakfast.

My skin feels like every pore is clogged and SUPER rough, and that's what one derm said, "It's like every pore of yours is clogged" -- and glazed over with a rough, crusty coating.

That is why I am hoping that the accutane will work like little scrubbing entities inside the pore, cleaning off the sticky substance on the pore wall. I'm looking forward to normalization, and trying to visualize it!

It's maddening to deal with this at our age. Oh, and I am on HRT as well. My gyno has me on premarin .625 with Prometrium every 3 months in the hopes that will help. PRometrium is an estrogenic progestin, unlike medroxyprogesterone, which is in Prempro and apparently is androgenic.

Betts

[irishgenes]

Bettina, you do realize that Premarin is from pregnant mares urine, don't you? It is a drug and not the natural human estrogen at all. All the studies showing bad side effects have been done with Premarin. Prometrium is good because it is natural, but some women seem to get clogged pores from natural progesterone. (See my thread called "Help for Women With Pre-Menstrual Acne" under "Similar and Co-Existing Conditions".)

I recommend a great book "Natural Hormone Balance for Women" by Uzzi Reiss, MD. Also ANY book by Elizabeth Vliet, MD, but particularly "Screaming to be Heard: Hormonal Connections Women Suspect & Doctors Still Ignore" (although, unfortunately, she doesn't discuss rosacea). "Natural Hormone Replacement for Women Over 45" by Jonathan Wright, MD. is good, too. He developed Tri-est, the compounded estrogen I take. A popular book is "The Sexy Years" by Suzanne Somers. However, she talks mostly about herself and doesn't really get into the specifics of bioidentical hormones. All these books are available used from Amazon. I can honestly say that I wouldn't want to live without my Tri-est. I just had such extreme symptoms without it, like running a 2 degree fever all the time. No puny hot flashes for me! I found zero relief from black cohosh and soy. Even plain estradiol, which is natural but only one type of estrogen, failed to stop my menopausal flushing. Tri-est stopped it and even made me lose weight.

[bettina]

Interesting; did Tri-Est help or hurt your rosacea? I wasn't aware of an alternative to Premarin/Prometrium combination. Does Tr-Est have an estrogenic progesterone component?

3 months Premarin, 10 days Prometrium, just started the Premarin. I understand that it couldn't worsen the rosacea, but I don't know that it is helping! Will look into Tri-Est if it has estrogenic prog.

[irishgenes]

Tri-est stopped my menopausal hot flushes, so in that sense it helped my rosacea. I still flush to some foods, hot rooms, exercise, and the sun because of rosacea. But with the Tri-est, I don't have the 2 degree fever all the time and the constant migraines. I used to get 2 severe migraines a week. I would go to the ER for a shot when the Imitrex didn't work. Have had very few migraines since starting Tri-est, and those are handled by Excedrin Migraine. I haven't used Imitrex at all since Tri-est. Tri-est is a compounded prescription item consisting of 3 different human-identical estrogens: estradiol, estrone, and estriol. It is made from soy and yam, but converted in the lab to human-identical compounds. It is not like the useless OTC yam products. It has no progesterone in it. I take that separately, every 3 months, just like you, because I do not have a good reaction to progesterone. Unlike most women, it bloats me.

The only problem is finding a doctor who will prescribe you the Tri-est. Most gynecologists know only one thing: Premarin, because that is what the drug company has pushed on them all these years. Maybe if you look in the Yellow Pages of your phone book, there will be an ad for a gynecologist who prescribes bio-identical estrogens. It has become more the "in" thing because of Suzanne Somers' book--the power of celebrity! You might also ask Women's International Pharmacy of Madison, Wisconsin, for the name of gynecologists who prescribe Tri-Est near you. This is assuming that your regular doctor won't prescribe it, and a lot of them have never even heard of it.

I started out taking estradiol (Estrace), but I never took Premarin because they confine mares for months to little stalls with catheters to get their urine and sell their foals to the meat market in Europe. It is all so unnecessary because other drug companies can and do synthesize the horse estrogens. Not that horse estrogens are what human women need, but at least no horses are harmed by that.

Here is a good web page about talking to your doctor about bio-identical hormones: http://www.womentowomen.com/LIBtalkingtodoctorbioidenticalhormones.asp