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Tuesday, February 7, 2012
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Tuesday, February 7, 2012
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Skin Care and Diseases |
Severe acne 201/11/2001 |
I`m a 22 year old male writing from Luxembourg, Europe. First of all, I would like to thank Professor Heaton for his answer to a question I sent on August 2000 concerning my acne. I showed the answer to my dermatologist who followed the Professor`s advice. I made an endocrine check-up which showed nothing unnormal and I once again took Accutane. Unfortunately the result of the course is quite disappointing. After 4 months of treatment there are still new nodules coming out on the face and on the neck and spots on the legs. In the last 5 years, I had 3 Accutane treatments, I took antibiotics (tetracycline, doxycycline, minocycline) and dapsone. Apart from isotretinoin, which at least improved my skin condition, nothing helped. Consulting a university based dermatologist is not easy because there is no medicine faculty in Luxembourg and the health insurance probably won`t cover a consultation in a foreign country for acne. What can I do ? Is there any other treatment ? Thank you in advance.
It sounds as though you have especially severe acne. It is rare that Accutane given in proper doses for adequate time periods does not clear acne at least for 6 months. So I must wonder if you received an adequate dose. The dose of Accutane must be at least 1 mg/kg and for those resistant to its effects, the dose is increased at least to 1.5 mg/kg or even 2 mg/kg. Please check on the dose.It is also very unusual for acne to affect the legs and arms. Face, neck, chest and back are common areas to be involved. But the extremities are not involved. It has been published that sometimes individuals with altered chromosomes (i.e., XYY) have severe acne that affects the extremities. I have not seen any such individuals and know about it only because of an article in the literature. The extra Y chromosome seems to have a single effect, bad acne.
Or might the lesions be something other than acne, for example folliculitis or hidradenitis suppurativa. These latter do not respond to Accutane. These latter suggestions are long shots but might be considered.
I wish I had a simple solution for you. Without seeing you I think my next attempt would be a course of Accutane at a maximum dose of 1.5-2 mg/kg body weight unless these large doses have been tried.
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James J Nordlund, MD Professor Department of Dermatology College of Medicine University of Cincinnati |
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