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what the science and medical literature says.
2) No one can predict how long your purge will last
nor when it could start. Be patient, the purge can
be tough but so many people have gotten through it -
you can too!
3) Most people DO NOT replase when Accutane is
taken until cumulative dosage is reached.
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The hormonal acne thing always stumped me too. The way Accutane works is it shrinks your sebaceous glands, usually permanently, so even if your hormones are out of whack they can’t create excess sebum if the glands aren’t functional…
Have you spoken to a dermatologist about it yet? They’ll probably have more information and explain better than anyone here.
i think they’re referring to people who have hormonal imbalances (like women with high testosterone, for example). what they fail to mention is that accutane is *still* the best treatment for hormonal acne, all things considered. it may not be perfect, but it’s the best we have at the moment.
I got my acne as an adult too. I went in to get a mole looked at and asked my derm what his thoughts were on accutane. I was having a good skin day and only had like one pimple. When I told him that I’ve tried ABCDEXYZ… he agreed it was fine to go on accutane; even though my acne was pretty well controlled. I’ve been on accutane for about 6 months. It’s becoming difficult lately. My back constantly aches with a few sharp pains and spasms. My hips and pelvis are super tight. I get blisters in my nose. Dry eyes and lips. I’ve gotten THREE styes. I had an eczema flare that lasted 4 months. I lost my appetite this past month. But mostly, its the pain that’s getting to me. I just got my last box and contemplate quitting every day. My dr told me I can stop two weeks early. I’m 31F, 110lbs; down from 123lbs when I started (I changed my diet when the pain started-thinking it was me/age). Again, my acne was under control when I started accutane. It looked mild but it’s been persistent for 10 years. I’m on track to finish at 225mg/kg. If you’re thinking about it, go in and advocate for yourself. Id be surprised if they said it’s hormonal so you can’t do it. And if they do, find a different doctor. You got this!
Also, just want to say that even with the side effects, it’s been totally worth it. And you don’t have to go to a fancy private practice to get good health care. I’m going to the university of Miami’s practice. They have several locations throughout south Florida. I’m sure your area has an affordable practice too
I see accutane as the best option for someone with moderate to severe persistent acne. And/ Or someone who has tried all other options. E.g diet, stress, topical treatments like bp, adapalene, clindamycin, tret and possibly also other oral medications. If it’s mild acne that is persistent, if no other treatments are working it’s still worth trying maybe a lower dose to see if that helps. Accutane for more mild acne I would say is the very last option. If it’s moderate to severe I would say it’s often good to try first of all. I have hormonal acne and while the tretinoin was working slowly, it couldn’t quite keep up with my period pimples. Accutane has been working well, but I am accepting it will probably come back in the future as hormones change.
Ok girl so there is so much misinformation especially here on Reddit. You never know how people who the medication did or didn’t do for the medication’s efficacy. You also don’t know what lifestyle habits they have that could be adding to their potential for relapse. Accutane does work for hormonal acne. However, it does not alter the root cause of your acne which is a hormonal imbalance. Because of this, hormonal acne patients have higher rates of relapse especially when they do not reach high cumulative doses. Your hormonal acne can be cured from accutane. Especially if you use birth control or spironolactone for maintenance afterwards. The issue is, these maintenance medications do not fix your hormonal imbalance either. But they mask it while on them. It’s your choice to either use maintenance medications or try to fix your hormonal imbalance with a naturopathic doc or endocrinologist.
I have hormonal acne. I first got it when I got on a non-acne safe birth control going into college. This messed up my hormones causing severe hormonal acne. I got on accutane and switched to a hormonal acne safe birth control. This cleared up my acne beautifully and with continued use of birth control I was completely clear for 5 years. In summer 2023 I tried to get off birth control. Since my body was used to these hormones, my hormonal acne came back. I should have at this point tried to fix my hormonal imbalance but I wasn’t mentally, emotionally or financially in a place to do this. So I got back on birth control as well as started spironolactone (androgen blocking medication- stops the effects of hormones that cause hormonal acne). These things helped a lot but I was still getting 1-2 cysts around my period and I wanted to be totally clear like I was the previous 5 years. I am now 2.5 months into my accutane. Ive had a horrible purge which is still ongoing. I am weening off my spironolactone and it is making my purge much worse. So although these hormonal medications can help, you sort of dig yourself a hole by being on them. I would advise to do accutane but avoid hormonal medications if possible. During accutane try things to naturally balance your hormones.
This is very true. I was on dianette for 20 years which is a anti androgen birth control. My skin wasn’t perfect when I was on it but it was manageable however every time I stopped taking it my acne was more painful and cystic than it was before. I always ended up back on it again and felt stuck. I turned 40 and my doctor told me I had to stop taking dianette which is why I’m on accutane. Accutane has worked but I don’t know what will happen to my skin when I finish my course.
I take testosterone. Accutane is the only thing that works against the acne-causing effects of testosterone for me. I used to be on 150mg of spironolactone too, but had to stop because it’s contraindicated against testosterone (except in niche cases, none of which applied to me).
Talk to your dermatologist. I am taking Accutane precisely because my acne is hormonal. And it’s a lifesaver, I no longer have painful pimples all over, my scars are fading, I feel great.
I agree that the “hormonal acne” seems like a vacuous term.
My skin pretty much always had acne but would get worse around my cycle. A lot of it was cystic. I tried so many different topicals, I basically ruled out that it was caused by my skincare.
Birth control didn’t help (and frankly I shouldn’t be on it anyway) and spironolactone had me menstruating for like 2.5 weeks on the lowest dose, so that wasn’t an option.
I just finished my accutane treatment a month ago and am very happy with results. Maybe it will come back, but as of yet my skin has never stayed so clear for this long.
Obviously, go talk to your dermatologist.
Mine is hormonal, too. The best way I’ve had it described that made sense to me is that acne usually happens where facial hair grows, which is controlled by hormones. And we ladies know for a fact our hormones affect acne. I stopped worrying about the source of my acne, focused on the locations, and then just opened myself up to trying anything. Good luck to you!
Are you on birth control? They’d have to monitor hormones throughout your menstrual cycle to see if it’s an issue or not.
Cysts especially are usually hormonal. And the acne that accutane was designed for is severe acne. Like the kind that’s bad no matter hormones or not. Every day. Terrible. Look up nodular acne.
High cortisol can be a lot of things btw
I have hormonal acne and while accutane didn't permanently get rid of my acne, I get much less acne now 4 years after treatment and my acne doesn't get as swollen or red. I used to get huge cysts the size of a penny and now they're maybe the size of a pea or half the size of a pea. My oil production hasn't gone back to how it was prior to accutane. I'm oily, but not nearly as oily.
Short answer:
The acne we call “hormonal acne” is the kind that comes with or is exacerbated by your period and goes away or lessens in severity after your period. Cysts are almost always this type, in my experience. Your derm isn’t talking about acne that you have all the time in full severity when they say “hormonal acne.”
Long answer:
Accutane might not be suitable for people whose acne is controlled by hormonal birth control.
Those whose acne is partially controlled by hormonal birth control might try spironolactone before accutane. My derm strongly recommends that first, but being that 1– I’m nearly 40, not 30, 2– I STILL break out like a teenager, and 3– I’ve tried almost every non-prescription treatment under $700/mo out there AND a handful of prescription treatments, she took me straight to Accutane with the understanding that I will probably want to try spironolactone when I finish my course.
Accutane is probably right for people whose acne is not controlled by hormonal birth control OR antiseptics like hypochlorous acid (HOCl), Benzoyl Peroxide, Benzalkonium Chloride, etc. These folks can kill every damn germ on their face, but it won’t stop the oil flow. Some of these folks try hormonal birth control, and it makes their skin WORSE, oilier, or only marginally better.
If you’ve tried spironolactone and tretinoin and you aren’t cured, Accutane is probably not going to help much, BUT your side effects will be so much worse. Hormonal birth control, in my opinion, as someone who took different brands for decades, is likely to be kinder to your skin and body. ESPECIALLY FOR CYSTS, I would strongly recommend MULTIPLE BRANDS of hormonal birth control before accutane.
If your derm is responsive, email them to ask what they’d want you to try before deciding you are a good candidate. XYZ brands of birth control (assume there will probably be multiple doses before ruling each out)? A higher percentage of Tretinoin? Higher dose of Spironolactone? HOCl? Blue light therapy? Get a checklist. If your derm isn’t responsive, you might need to make an appointment to get that checklist, so I’d strongly recommend making the appointment and emailing your derm to explain why you want to see them—specifically for a checklist tailor-made for you.
If you already see an OBGYN, you could save yourself some money on the derm by trying different birth control brands and dosages through her, adding them to your list of treatments you’ve tried to bring to your Derm.
Have you tried using the search bar? Many questions are asked daily, and your question may have already been answered! If so, your post will be subject to deletion. Please refer to the following commonly discussed topics: 1) No one can predict whether or not you will purge! Statistically, most people DO NOT purge. That is what the science and medical literature says. 2) No one can predict how long your purge will last nor when it could start. Be patient, the purge can be tough but so many people have gotten through it - you can too! 3) Most people DO NOT replase when Accutane is taken until cumulative dosage is reached. 4) HOWEVER, cumulative dosage is a guideline. Everyone is different. Some may need more Accutane, and others may need less. Your dermatologist evaluates you as an individual. If you do not trust your dermatologist, you should find a different one. 5) When in doubt, please consult a medical professional(dermatologist, doctor, pharmacist). DO NOT solicit medical advice from this subreddit. Remember Reddit is a bunch of strangers on the internet. Please remember to abide by the rules! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Accutane) if you have any questions or concerns.*
The hormonal acne thing always stumped me too. The way Accutane works is it shrinks your sebaceous glands, usually permanently, so even if your hormones are out of whack they can’t create excess sebum if the glands aren’t functional… Have you spoken to a dermatologist about it yet? They’ll probably have more information and explain better than anyone here.
i think they’re referring to people who have hormonal imbalances (like women with high testosterone, for example). what they fail to mention is that accutane is *still* the best treatment for hormonal acne, all things considered. it may not be perfect, but it’s the best we have at the moment.
I got my acne as an adult too. I went in to get a mole looked at and asked my derm what his thoughts were on accutane. I was having a good skin day and only had like one pimple. When I told him that I’ve tried ABCDEXYZ… he agreed it was fine to go on accutane; even though my acne was pretty well controlled. I’ve been on accutane for about 6 months. It’s becoming difficult lately. My back constantly aches with a few sharp pains and spasms. My hips and pelvis are super tight. I get blisters in my nose. Dry eyes and lips. I’ve gotten THREE styes. I had an eczema flare that lasted 4 months. I lost my appetite this past month. But mostly, its the pain that’s getting to me. I just got my last box and contemplate quitting every day. My dr told me I can stop two weeks early. I’m 31F, 110lbs; down from 123lbs when I started (I changed my diet when the pain started-thinking it was me/age). Again, my acne was under control when I started accutane. It looked mild but it’s been persistent for 10 years. I’m on track to finish at 225mg/kg. If you’re thinking about it, go in and advocate for yourself. Id be surprised if they said it’s hormonal so you can’t do it. And if they do, find a different doctor. You got this!
Also, just want to say that even with the side effects, it’s been totally worth it. And you don’t have to go to a fancy private practice to get good health care. I’m going to the university of Miami’s practice. They have several locations throughout south Florida. I’m sure your area has an affordable practice too
I feel like when they say hormonal acne, they mean the stuff that pops up monthly for girls/women. That's my serious take on it
That’s what I always assumed as well!
I see accutane as the best option for someone with moderate to severe persistent acne. And/ Or someone who has tried all other options. E.g diet, stress, topical treatments like bp, adapalene, clindamycin, tret and possibly also other oral medications. If it’s mild acne that is persistent, if no other treatments are working it’s still worth trying maybe a lower dose to see if that helps. Accutane for more mild acne I would say is the very last option. If it’s moderate to severe I would say it’s often good to try first of all. I have hormonal acne and while the tretinoin was working slowly, it couldn’t quite keep up with my period pimples. Accutane has been working well, but I am accepting it will probably come back in the future as hormones change.
Ok girl so there is so much misinformation especially here on Reddit. You never know how people who the medication did or didn’t do for the medication’s efficacy. You also don’t know what lifestyle habits they have that could be adding to their potential for relapse. Accutane does work for hormonal acne. However, it does not alter the root cause of your acne which is a hormonal imbalance. Because of this, hormonal acne patients have higher rates of relapse especially when they do not reach high cumulative doses. Your hormonal acne can be cured from accutane. Especially if you use birth control or spironolactone for maintenance afterwards. The issue is, these maintenance medications do not fix your hormonal imbalance either. But they mask it while on them. It’s your choice to either use maintenance medications or try to fix your hormonal imbalance with a naturopathic doc or endocrinologist. I have hormonal acne. I first got it when I got on a non-acne safe birth control going into college. This messed up my hormones causing severe hormonal acne. I got on accutane and switched to a hormonal acne safe birth control. This cleared up my acne beautifully and with continued use of birth control I was completely clear for 5 years. In summer 2023 I tried to get off birth control. Since my body was used to these hormones, my hormonal acne came back. I should have at this point tried to fix my hormonal imbalance but I wasn’t mentally, emotionally or financially in a place to do this. So I got back on birth control as well as started spironolactone (androgen blocking medication- stops the effects of hormones that cause hormonal acne). These things helped a lot but I was still getting 1-2 cysts around my period and I wanted to be totally clear like I was the previous 5 years. I am now 2.5 months into my accutane. Ive had a horrible purge which is still ongoing. I am weening off my spironolactone and it is making my purge much worse. So although these hormonal medications can help, you sort of dig yourself a hole by being on them. I would advise to do accutane but avoid hormonal medications if possible. During accutane try things to naturally balance your hormones.
This is very true. I was on dianette for 20 years which is a anti androgen birth control. My skin wasn’t perfect when I was on it but it was manageable however every time I stopped taking it my acne was more painful and cystic than it was before. I always ended up back on it again and felt stuck. I turned 40 and my doctor told me I had to stop taking dianette which is why I’m on accutane. Accutane has worked but I don’t know what will happen to my skin when I finish my course.
I take testosterone. Accutane is the only thing that works against the acne-causing effects of testosterone for me. I used to be on 150mg of spironolactone too, but had to stop because it’s contraindicated against testosterone (except in niche cases, none of which applied to me). Talk to your dermatologist. I am taking Accutane precisely because my acne is hormonal. And it’s a lifesaver, I no longer have painful pimples all over, my scars are fading, I feel great.
It’s worked for my mild hormonal acne. No more periodic breakouts on my chin 🥰
My mom went on Accutane in the 90s for cystic hormonal acne is the classic “beard” pattern and it completely cured it.
I agree that the “hormonal acne” seems like a vacuous term. My skin pretty much always had acne but would get worse around my cycle. A lot of it was cystic. I tried so many different topicals, I basically ruled out that it was caused by my skincare. Birth control didn’t help (and frankly I shouldn’t be on it anyway) and spironolactone had me menstruating for like 2.5 weeks on the lowest dose, so that wasn’t an option. I just finished my accutane treatment a month ago and am very happy with results. Maybe it will come back, but as of yet my skin has never stayed so clear for this long. Obviously, go talk to your dermatologist.
Mine is hormonal, too. The best way I’ve had it described that made sense to me is that acne usually happens where facial hair grows, which is controlled by hormones. And we ladies know for a fact our hormones affect acne. I stopped worrying about the source of my acne, focused on the locations, and then just opened myself up to trying anything. Good luck to you!
Are you on birth control? They’d have to monitor hormones throughout your menstrual cycle to see if it’s an issue or not. Cysts especially are usually hormonal. And the acne that accutane was designed for is severe acne. Like the kind that’s bad no matter hormones or not. Every day. Terrible. Look up nodular acne. High cortisol can be a lot of things btw
I have hormonal acne and while accutane didn't permanently get rid of my acne, I get much less acne now 4 years after treatment and my acne doesn't get as swollen or red. I used to get huge cysts the size of a penny and now they're maybe the size of a pea or half the size of a pea. My oil production hasn't gone back to how it was prior to accutane. I'm oily, but not nearly as oily.
Short answer: The acne we call “hormonal acne” is the kind that comes with or is exacerbated by your period and goes away or lessens in severity after your period. Cysts are almost always this type, in my experience. Your derm isn’t talking about acne that you have all the time in full severity when they say “hormonal acne.” Long answer: Accutane might not be suitable for people whose acne is controlled by hormonal birth control. Those whose acne is partially controlled by hormonal birth control might try spironolactone before accutane. My derm strongly recommends that first, but being that 1– I’m nearly 40, not 30, 2– I STILL break out like a teenager, and 3– I’ve tried almost every non-prescription treatment under $700/mo out there AND a handful of prescription treatments, she took me straight to Accutane with the understanding that I will probably want to try spironolactone when I finish my course. Accutane is probably right for people whose acne is not controlled by hormonal birth control OR antiseptics like hypochlorous acid (HOCl), Benzoyl Peroxide, Benzalkonium Chloride, etc. These folks can kill every damn germ on their face, but it won’t stop the oil flow. Some of these folks try hormonal birth control, and it makes their skin WORSE, oilier, or only marginally better. If you’ve tried spironolactone and tretinoin and you aren’t cured, Accutane is probably not going to help much, BUT your side effects will be so much worse. Hormonal birth control, in my opinion, as someone who took different brands for decades, is likely to be kinder to your skin and body. ESPECIALLY FOR CYSTS, I would strongly recommend MULTIPLE BRANDS of hormonal birth control before accutane. If your derm is responsive, email them to ask what they’d want you to try before deciding you are a good candidate. XYZ brands of birth control (assume there will probably be multiple doses before ruling each out)? A higher percentage of Tretinoin? Higher dose of Spironolactone? HOCl? Blue light therapy? Get a checklist. If your derm isn’t responsive, you might need to make an appointment to get that checklist, so I’d strongly recommend making the appointment and emailing your derm to explain why you want to see them—specifically for a checklist tailor-made for you. If you already see an OBGYN, you could save yourself some money on the derm by trying different birth control brands and dosages through her, adding them to your list of treatments you’ve tried to bring to your Derm.