so i am having a problem right now, i live in Hawaii and all the dermatologist here (which are only 3) do not prescribe accutane, when i asked why their answer was basically that they just didn’t want to go through the process of having to get me on 2 forms of BC and filling out IPledge paper work…basically the dermatologist here are lazy. Which i don’t get at all because when i lived in Oregon I went to a dermatologist and she was ready to prescribe me it and told me that as of age 16 it was ultimately MY choice whether or not i wanted to get on accutane, so there for if i decided to take it the dermatologist would have to go through the process and prescribe me the recommended dose and also prescribe BC. At the time i didnt think my acne was bad enough to take it so i didn’t go on it.
I tried to order 90 capsules of 20mg generic accutane on the internet but the site i ordered from ended up being non-legit and i had to go through this long process to get my money back…it was awful, I wish i could just get prescribed it but the only way i can do that is if i were to go to a different state to see a dermatologist and thats just…a lot of time and money to maybe not even be able to get it. Does anyone know if there are any sites at all that you can get generic accutane on? has anyone actually taken pills ordered from online and had positive results? I know that its not really safe to order meds online but when I’m left with no choice and I don’t want to suffer from acne anymore, its seems that online may be my only option.
But to describe my face situation a little better let me tell you a little more. About 6 months ago i moved back to Hawaii, and my face has gone berserk, at first i thought it was just the climate change and my face would get used to the weather in no time, but it just keeps getting worse and worse, i know it may also have allot to do with the fact that my job requires me to be in the sun 8 hours a day 5 days a week and i am always sweating, but i have been told before that as long as i wore the right sunscreen (i wear SPF 50 oil free, non-comedogenic) that the sun would be good for my skin, so i don’t know if thats the problem. I also have really oily skin all the time, well that is until i was it, then i have really dry skin…so i am really at a lost. It may also be my hormones, so I was thinking of getting on a birth control pills I read about that stops your period for 3 to 4 months then you get your period once and not again for another 3 to 4 months, have any girls out there tried this and had positive results?
So any advice, does, don’ts, what to buy, what not to buy etc…please let me know.
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Has Anyone Taken Online Accutane?1 comment to Has Anyone Taken Online Accutane? |
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Treatment should be directed toward the known pathogenic factors involved in acne. These include follicular hyperproliferation, excess sebum, P acnes, and inflammation. The grade and the severity of the acne help in determining which of the following treatments, alone or in combination, is most appropriate.
Topical treatments
Topical retinoids are comedolytic and anti-inflammatory. They cause epidermal differentiation and, thus, normalize follicular hyperproliferation and hyperkeratinization. Topical retinoids reduce the numbers of microcomedones, comedones, and inflammatory lesions. They may be used alone or in combination with other acne medications. The most commonly prescribed topical retinoids include adapalene, tazarotene, and tretinoin. These retinoids should be applied once daily to clean, dry skin, but they may need to be applied less frequently if irritation occurs. Skin irritation with peeling and redness may be associated with the use of topical retinoids. The use of mild, nondrying cleansers and noncomedogenic moisturizers may help reduce this irritation. Alternate-day dosing may be used if irritation persists. Topical retinoids thin the stratum corneum, and they have been associated with sun sensitivity. Instruct patients about sun protection.
Topical antibiotics are mainly used for their role against P acnes. They may also have anti-inflammatory properties. Topical antibiotics are not comedolytic, and bacterial resistance may develop to any of these agents. The development of resistance is lessened if topical antibiotics are used in combination with benzoyl peroxide. Commonly prescribed topical antibiotics include erythromycin and clindamycin alone or in combination with benzoyl peroxide. Clindamycin and erythromycin are available in a variety of topical agents. They may be applied once or twice a day. Gels and solutions may be more irritating than creams or lotions.
Benzoyl peroxide products are also effective against P acnes, and bacterial resistance to benzoyl peroxide has not been reported. Benzoyl peroxides are available over the counter and by prescription in a variety of topical forms, including soaps, washes, lotions, creams, and gels. Benzoyl peroxides may be used once or twice a day. These agents may cause a true allergic contact dermatitis. More often, an irritant contact dermatitis develops especially if used with tretinoin or when accompanied by aggressive washing methods.
Systemic treatments
Systemic antibiotics are a mainstay in the treatment of acne vulgaris. These agents have anti-inflammatory properties, and they are effective against P acnes. The tetracycline group of antibiotics is commonly prescribed for acne. The more lipophilic antibiotics, such as doxycycline and minocycline, are generally more effective than tetracycline. Greater efficacy may also be due to less P acnes resistance to minocycline. However, P acnes resistance is becoming more common with all classes of antibiotics currently used to treat acne vulgaris. P acnes resistance to erythromycin has greatly reduced its usefulness in the treatment of acne. Subantimicrobial therapy or concurrent treatment with topical benzoyl peroxide may reduce the emergence of resistant strains.
Other antibiotics, including trimethoprim, alone or in combination with sulfamethoxazole, and azithromycin, are reportedly helpful.
Some hormonal therapies may be effective in the treatment of acne vulgaris. Oral contraceptives increase sex hormone binding globulin, resulting in an overall decrease in circulating free testosterone. Combination birth control pills have shown efficacy in the treatment of acne vulgaris. Spironolactone may also be used in the treatment of acne vulgaris. Spironolactone binds the androgen receptor and reduces androgen production. Adverse effects include dizziness, breast tenderness, and dysmenorrhea. Dysmenorrhea may be lessened by coadministration with an oral contraceptive. Periodic evaluation of blood pressure and potassium levels is appropriate. Pregnancy must be avoided while on spironolactone because of the risk of feminization of the male fetus.
Isotretinoin is a systemic retinoid that is highly effective in the treatment of severe, recalcitrant acne vulgaris. It causes normalization of epidermal differentiation, depresses sebum excretion by 70%, is anti-inflammatory, and even reduces the presence of P acnes. Isotretinoin therapy should be initiated at a dose of 0.5 mg/kg/d for 4 weeks and increased as tolerated until a cumulative dose of 120-150 mg/kg is achieved. Coadministration with steroids at the onset of therapy may be useful in severe cases to prevent initial worsening.
Isotretinoin is a teratogen, and pregnancy must be avoided. Contraception counseling is mandatory, and 2 negative pregnancy test results are required prior to the initiation of therapy. Baseline laboratory examination should also include cholesterol and triglyceride assessment, hepatic transaminases, and a CBC count. Pregnancy tests and laboratory examinations should be repeated monthly during treatment.
Associated mood changes and depression have been reported during treatment. Although the cause is not clear, patients should be informed of this potential effect and must sign a consent form acknowledging they are aware of this potential risk.
A US Food and Drug Administration–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information on this registry, see iPLEDGE. This registry aims to further decrease the risk of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.
The patient is considered at high risk for abnormal healing and development of excessive granulation tissue following procedures. Many dermatologists delay elective procedures, such as dermabrasion or laser resurfacing, for up to a year after completion of therapy. Other procedures to be avoided during therapy include tattoos, piercings, leg waxing, and other epilation procedures.
Surgical Care
Procedural treatments include manual extraction of comedones and intralesional steroid injections.
Additionally, some patients may benefit from superficial peels that use glycolic or salicylic acid.
Phototherapy using red light or blue light and photodynamic therapy are being assessed as potential treatments for acne.
The usefulness of some laser treatments in the management of acne is also being evaluated.
MEDICATIONSection 7 of 11 Authors and Editors Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Multimedia References
The goal of pharmacotherapy is to reduce morbidity and to prevent complications.
Drug Category: Retinoids
These agents decrease the cohesiveness of abnormal hyperproliferative keratinocytes, and they may reduce the potential for malignant degeneration. They also modulate keratinocyte differentiation.
Drug Name Isotretinoin (Accutane)
Description Most effective oral medication. Oral agent that treats serious dermatologic conditions. Isotretinoin is synthetic 13-cis isomer of naturally occurring tretinoin (trans-retinoic acid). Both agents are structurally related to vitamin A. Decreases sebaceous gland size and sebum production. May inhibit sebaceous gland differentiation and abnormal keratinization.
Effective March 1, 2006 the FDA requires that prescribers of isotretinoin, patients who take isotretinoin, and pharmacists who dispense isotretinoin all must register with the iPLEDGE system.
Female patients must sign an informed consent that they will use contraceptives during the treatment course and for 30 d after discontinuing therapy.
Adult Dose Total cumulative dose of 120-150 mg/kg recommended; starting dose should be <0.5 mg/kg/d PO; dose may be increased to 1 mg/kg/d as tolerated
Pediatric Dose Not established
Contraindications Documented hypersensitivity
Interactions Toxicity may occur with vitamin A coadministration; pseudotumor cerebri or papilledema may occur when coadministered with tetracyclines; may reduce plasma levels of carbamazepine
Pregnancy X - Contraindicated in pregnancy
Precautions Obtain 2 negative pregnancy test results in patients of childbearing potential prior to initiating therapy; pregnancy must be avoided during and for 1 mo after treatment, and monthly pregnancy test results must be documented; hyperlipidemia may develop; pseudotumor cerebri, vision impairment, headaches, myalgias, arthralgias, and depression have been reported; dry skin and cheilitis are nearly universal adverse effects
Drug Name Tretinoin (Retin-A, Retin-A Micro, Avita)
Description Inhibits microcomedo formation. Normalizes follicular epidermal differentiation and exhibits anti-inflammatory properties. Available as 0.025%, 0.05%, and 0.1% creams. Also available as 0.01% and 0.025% gels.
Adult Dose Begin with lowest tretinoin formulation and increase as tolerated; apply hs or qod; lower the frequency of application if irritation develops
Pediatric Dose <12 years: Not established
>12 years: Apply as in adults
Contraindications Documented hypersensitivity
Interactions Coadministration with benzoyl peroxide may lessen effectiveness
Pregnancy C – Safety for use during pregnancy has not been established.
Precautions Photosensitivity may occur with excessive sunlight exposure; erythema and peeling may occur (most prominent within first few wk of treatment)
Drug Name Adapalene (Differin)
Description A naphthoic acid derivative that binds the retinoic acid receptor. Normalizes follicular epidermal differentiation and exhibits anti-inflammatory properties. Available in cream, gel, solution, and pledget formulations.
Adult Dose Apply a small amount to involved skin qd
Pediatric Dose Not established
Contraindications Documented hypersensitivity
Interactions None reported
Pregnancy C – Safety for use during pregnancy has not been established.
Precautions Erythema and peeling may occur in some individuals; avoid contact with mucous membranes, eyes, mouth, and nostrils; avoid exposure to sunlight and sunlamps; dryness of skin, scaling, erythema, burning, and pruritus may occur
Drug Name Tazarotene (Tazorac, AVAGE)
Description Retinoid prodrug whose active metabolite modulates differentiation and proliferation of epithelial tissue; may also have anti-inflammatory and immunomodulatory properties. Available in 0.05% and 0.1% cream and gel formulations.
Adult Dose Apply sparingly to affected area qd
Pediatric Dose Children: Not established
Adolescents: Administer as in adults
Contraindications Documented hypersensitivity
Interactions Do not use concomitantly with dermatologic drugs or cosmetics that have a strong drying effect on the skin (eg, salicylic acid, benzoyl peroxide, astringents)
Pregnancy X – Contraindicated in pregnancy
Precautions Erythema and peeling may occur at application site
Drug Category: Antibiotics
Topical and systemic antibiotics used in the treatment of acne vulgaris are directed at P acnes. They also have anti-inflammatory properties.
Drug Name Minocycline (Dynacin, Minocin)
Description Treats infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible chlamydial, rickettsial, and mycoplasmal organisms. Available in 50-, 75-, and 100-mg preparations.
Adult Dose 50-100 mg PO bid
Pediatric Dose <8 years: Not recommended
>8 years: 4 mg/kg PO initially, followed with 2 mg/kg q12h
Contraindications Documented hypersensitivity; severe hepatic dysfunction
Interactions Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy; tetracyclines can increase hypoprothrombinemic effects of anticoagulants
Pregnancy D – Unsafe in pregnancy
Precautions Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines; hepatitis or lupuslike syndromes may occur
Drug Name Doxycycline (Bio-Tab, Doryx, Vibramycin)
Description Antibacterial agent effective against gram-positive and gram-negative organisms. Available in 20-, 50-, and 100-mg preparations.
Adult Dose 100 mg PO bid
Pediatric Dose <8 years: Not recommended
>8 years: 2-5 mg/kg/d PO/IV in 1-2 divided doses; not to exceed 200 mg/d
Contraindications Documented hypersensitivity; severe hepatic dysfunction
Interactions Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy
Pregnancy D – Unsafe in pregnancy
Precautions Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines
Drug Name Tetracycline (Sumycin)
Description Antibacterial agent effective against gram-positive and gram-negative organisms.
Adult Dose 250-500 mg PO q6h
Mild-to-moderate infections: 500 mg PO bid or 250 mg PO qid for 7-14 d
Pediatric Dose <8 years: Not recommended
>8 years: 25-50 mg/kg/d (10-20 mg/lb) PO divided qid
Contraindications Documented hypersensitivity
Interactions Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy; tetracyclines can increase hypoprothrombinemic effects of anticoagulants
Pregnancy D – Unsafe in pregnancy
Precautions Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines
Drug Name Trimethoprim/sulfamethoxazole (Bactrim, Bactrim DS, Septra, Septra DS)
Description Antibiotic with activity against many gram-positive and gram-negative organisms. Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Available as 80 mg trimethoprim and 400 mg sulfamethoxazole or as 160 mg trimethoprim and 800 mg sulfamethoxazole (double strength).
Adult Dose 160 mg TMP/800 mg SMZ PO q12h
Pediatric Dose 8 mg/kg/d TMP/40 mg/kg/d SMZ PO/IV divided q12h
Contraindications Documented hypersensitivity; megaloblastic anemia due to folate deficiency
Interactions May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration of diuretics increases incidence of thrombocytopenia purpura in elderly persons; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase levels of zidovudine
Pregnancy C – Safety for use during pregnancy has not been established.
Precautions For adults, adjust dosage accordingly: CrCl (mL/min) 80-50, IV dose q18h recommended; CrCl 50-10, IV dose qd recommended; CrCl <10, not recommended; HD, 4-5 mg/kg after HD; and during peritoneal dialysis, 0.16-0.8 g q48h
Discontinue at first appearance of skin rash or sign of adverse reaction; obtain CBC counts frequently; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, give 5-15 mg/d leucovorin); caution in folate deficiency (eg, persons with chronic alcoholism, elderly persons, those receiving anticonvulsant therapy, those with malabsorption syndrome); hemolysis may occur in individuals with G-6-PD deficiency; in patients with AIDS, TMP-SMZ may not be tolerated or cause a response; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); give fluids to prevent crystalluria and stone formation