Oh, Accutane. I do not understand thee. No real side effects, and 40mg is high enough to produce at least some side effects by this point. My skin and eyes aren't really dry, I don't seem to be having an initial breakout, just my own regular brand of acne on my cheeks. The only thing I can think of is that I have a lot of plugged pores around my chin, but I think those have always been there. Let's see what happens. Yeah, there's a little bit of dryness, but I think that's just because of weather and artificial heat. My mom woke up with a nosebleed from the dry air, so I don't think my very mildly dry skin is anything special just yet.
So, today is Day 10. I'm on 40 mg to start. My dermatologist seems to be fairly aggressive with his treatment - I'm not entirely positive, but I'm under the impression that he wants to hit a peak close to 2mg/kg if possible. This is the highest prescribed dose, for the most severe cysts, but it seems like he wants to do that for every patient, since it also appears that Accutane is most effective (least recurrence of acne) at a dose of 100-120mg. I haven't weighed myself properly in probably a good eight months. My guess is that I'm probably 63kg, give or take a couple pounds. I *think* he won't actually hit 120mg (although he could) and my guess is that I'm going to peak at 100mg. He definitely knows what he's doing, but he's also fairly gruff and brief and I'm going to have to find out for sure at the next appointment.
Onto my acne and PCOS. (This is going to be long - if you don't want the backstory, skip to the last paragraph, especially for PCOSers looking for info.) Honestly? My acne right now is not terrible. There are actually days when my skin is basically clear, except for the scars, and looks really awesome with proper makeup on. However. The acne I do get IS cystic, and it's damn persistent, and there are most definitely legitimate reasons for me making this choice. I'm just putting this out there for people who are trying to figure out if their acne warrants Accutane. My skin between the ages of 11 and 15 was a freak show. I'm not even joking, it actually looked like I had dark, almost black, SHEETS of congealed blood underneath the skin of my cheeks at times. Even when it didn't look like that, the acne itself was still horrific. It was the kind of acne strangers pointed at and gave unsolicited advice to out of pity. I went on every. single. medication my pediatrician/derm could think of, both topical and oral. When I was about 13, I finally got a blood test done. My testosterone levels were off. Not horribly, but by a large enough margin that it was obvious I needed to see an endocrinologist.
I'll cut this hellish saga short - birth control pills (Yasmin) did not do a thing for me, and my doctor refused to listen to me b/c I was so young. I still want to weep over all the time I lost in fixing my body. After wasting three years on pointless treatment, I finally found a doctor who would listen. He reassured me that there were other options than the damn pill, which I swore I would never go on again. He put me on Metformin (Glucophage to some) and Spironolactone (Aldactone). Fairly high doses, too. I'm still on pretty much the same... I have to double check, but it's two 750 or 850 pills of Metformin a day, and he'd initially wanted to put me on 200mg of spironolactone to deal with the facial hair. Over the last few years, I've pretty much shed that off, and I'm really only taking the Metformin now. I've gotten laser treatments for the facial hair, which has gotten MUCH better, but I still definitely need to wax or thread every month or so. It's more than the average amount of facial fur, but so, so much better.
The Metformin was the charm. It took a few months for my body to respond, but for the last three or four years, I've had my period more or less every month. My cycle is more like 35ish days, but it's regular. I can't even remember the last time I've truly *missed* a period, which happened all the time before I got diagnosed.The facial hair is much better. My metabolism isn't, BUT I'm still pretty average in weight, which is quite the accomplishment with PCOS, anyway. PCOS related obesity has never been a problem for me. The acne got MUCH better also, but still, qualifies as pretty bad by normal standards. I highly recommend Metformin. But obviously, some people will just respond better to other treatments. It's important to find a doctor who's willing to explore all your options.
Now then, to my point. The Accutane! I debated for years. I even registered for iPledge and then backed out at the last minute. My acne was horrendous, and there were multiple times when I had to go in for emergency cortisone shots when acne cysts started getting to big around my eyes or grew so far into my lip that I couldn't use my mouth. If my regular derm wasn't available, the sub would literally walk in, look at me, and ask me why I wasn't taking Accutane before even saying hi. The answer was that I was terrified of using such a strong drug when my acne could have been all PCOS related - Accutane wouldn't treat that.
I finally understood something. PCOSers, pay attention! I know some of you have doctors who will not put you on Accutane because they say that you will not respond. This... is only partly true, at best. Here's the thing. There are different kinds of acne. Noninflammatory. Inflammatory - cystic. Environmental/bacterial whiteheads and blackheads. Hormonal. The last is what us PCOSers have. Every one of these types of acne require different treatments. Sure, you have cystic acne. But some of that is due to hormones and some of that is due to overactive oil glands. Here's the theory, which every doctor I've spoken to agrees with: the Metformin has dealt with the hormonal component of my acne, and what's left, these bloody (literally) cysts that I have time and again, are the type of acne that Accutane can kick. If I take Accutane and stay on top of my hormone levels, I should achieve clear skin. Right now, I have less acne than I ever have, and at first glance it's probably mild to moderate. However. Even if I don't have very many of them, nearly every zit I have is a cyst that eventually dries out and bleeds all over my face, scabbing and scarring. I rarely get a typical whitehead or blackhead, 99% of the time it's a cyst, whether mild or severe. That's NOT OK! No one, PCOS or not, should have to worry about their face bleeding in the middle of the day. I finally reached my last straw this December, when a cyst grew so far into my lip that I looked like someone had punched me. It HURT, man. It was so painful, and took forever to go away, and I'd had it. I made an appointment, went through the iPledge process, and actually went through with it. Hopefully, I'll have no regrets. So far, I think I'm making the right choice.
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