Heres "ClenAche's" accutane study.
Very informative IMO.
Treating Severe Inflammatory Acne: The Last Word, Albert M. Kligman, MD, Phd
Despite poplar beliefs, acne conglobata is not the only or even the most common type of severe inflammotory acne. Other forms that cause much misery include acne fulminans, gram-negative folliculitis, and persistent papulopustular acne.
My central thesis is that orthodox treatments that fall within the "official" guidlines will often be inadequate or useless. This is an area for innovative appoaches, for custom tailoring treatment to each patient, and for increased sensitivity to quality-of-life impairments, especially the psychosocial stresses that grevioulsy afflict the facially disfigured.
ACNE CONGLOBATA
Textbooks estimate that acne conglobata affects about 5 percent of acne suffurers. This is a wild overestimate! Since 100 percent of adolescent male subjects have demonstratable comedonal acne. 5 percent would amount to many mllions of patients. This load would keep dermatoloigists so busy that they would scarcely have time to take care of the common chronic dermatoses. I estimate the prevalence at well under 1 percent.
Another misunderstanding is that acne conglobata burns itsel out with time. The fact is that acne conglobata is almost life lone, lasting well into middle age and beyond, albeit in a quiescent state. Some glowing embers can almost always be found among the ashes. A biopsy specimen of the palpable scars of these burned-out cases shows a continuing chronic inflammatory process with marked distorsions of tissue and broad fiborous bands. The skin is often tender and sore; periodically a few deep-seated papules appear. Continuing treatment is therefore appropriate decades after the wildfire has seemingly burned out.
The soverign treatment for acne conglobata is, of course, oral cis-retoioic aicd (accutane). The recommended dosage is 0.05 to 0.1/kg daily, amounting roughly to 40 to 80 mg. That's the "high road" schedule.
I shall now descibe my unpublished, unknown, but effective "low road" approach and how it came about. Accutane deserves its sobriquet as a miracle drug. However, full doses are associated with a distubingly long list of advers events. These include a multitude of uncomfotable mucocutaneous signs and a variety of systematic changes that oblige the physician to monitor patients carefully. Among these changes are evlevations in serum lipid, tiglyceride, and cholestorol levels, abnormalities in hepatic enzymes, muscle ailments, ligament calcifications, osterioposic, and others.
We, and others, have found that dosages much lower than 80 mg are almost equally effective in bringing acne conglobata under control. Measurements of sebum production, using Sebutapes (described in a previous piece) are a convenient way to monitor the pharmacologic effects of Accutane. The 80 mg dose will start to lower sebum production in two weeks and can often effect a 75 percent reduction by three months. Full recorevry to the original sevum level may not occur until one year after stopping the drug.
We found that 20 mg daily would lower sebum production to almost the same level in about the same time and was just as effective therapeutically. Thus encouraged, we reduced the dosage to 10 mg daily. This reduced sebum output by at least 50 percent in three months and was just about as effective in controlling the disease as full doses, although the effect occurred more slowly. Gerd Plewig in Munich and I have found that 5 mg daily substantially depresses sebum production and is beneficial in the treatment of acne, rosacea, and some aspects of photoaging. The threshold sebolytic dose is actually 2.5 mg. This is a powerful drug. I would lower my 10 mg daily dose to 5 mg if that doseage unit was available in the United States.
There is one fly in this nice ointment: relapses occur too frequently after cessation of treatment. Becamuse of this a strategy had to be devised that would conunteract this limitation. The protocol for successful management of acne conglobata using 10 mg doses involves the following:
!)10 mg daily for four to five months, until near clearing is effected.
2)10mg on M, W, F, for one to two months.
3)If no breakthrough occurs, 10 mg on Sats, and Suns, for two to three months, after which use of the drug is stopped.
Gradual weaning is the key here but the door to relapse must be kept closed by concomitant treatment with topical tretinoin. After three months of Accutane treatment, I introduce nightly application of .05 percent tretinoin cream (Retin A), increasing to 0.1 percent as tolerance permits. RetinA is continued indefinitely after completely weaning patients off Accutane,
I belive the cite to this is: Cutis, Volume 57, January 1996. There is a bit more to this article, but i'm tired of typing and it's not too relavant anyways. I can say i've taken the "high road" and i feel the "low road is AS effective with less side effects". I dont quite agree with the Retin A regime(as it may be way too strong for people--u have to find your own skin tolerance to retin-a) in my experience, but i do agree with the idea--that being the weening aspect. (once off the the oral retin-a (accutane), which brings sebum to a controlable level, keep it under control with topical retin-a treatments--whatever strength that may be for your skin)With Retin A, its very subjective. .05 and .1 are too strong for me. But .025 Retin A i will use for the rest of my life to keep it in check. I used it right after Acc therapy. I'm very knowledgable and experienced here, so please feel free to hit me back with any responses! I love to help--as wack as that sounds!
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