Vitamin B5 and acne, tretinoin, dapsone, tazarotene, antibiotics

[crazyforlatin]

Has anyone tried this supplement to help with acne? A couple of studies and numerous testimonies indicate positive outcome. 

Dd has been using tretinoin, and we had given up at the 4 -week mark because rather than noticeable improvement, I noticed even more clogged pores. But after reading a little more about it, we've continued it to see if the initial stage is the purging stage. I've never had a purging stage myself with tretinoin and don't know if that's common for the initial 12 weeks, as recommended. Any one experienced purging? 

The doc gave a tiny sample tube of dapsone, which may be helping a little. Someone on the other thread mentioned going through genrx for it in which I may be only charged $35 versus using Goodrx coupon at Costco at $150. So I’m waiting see if my insurance qualifies as commercial insurance.

And finally, I went through alldaychemist.com for both tretinoin (initially I bought it for myself) and tazarotene as neither is covered by insurance. Anyone tried tazarotene and had better results than tretinoin?

And finally a question about antibiotics as the doctor doesn't want to discuss this until after February. Is the antibiotics protocol a one-time thing where Dd takes it for a given number of weeks and then that's it? If her skin clears up, then that's the end of treatment? And if it doesn't work, then accutane? Or do some teens take antibiotics on an ongoing basis to prevent acne?

[Chris in VA]

Just getting your thread started--both ds had cream with erythromycin and benzoyl peroxide in it and they used it for several years. Eldest had cystic acne on his shoulders for a time and cleared it by patting on um...Mylox? Not Miralax...ugh I can't think of the name...the white, chalky-tasting liquid antacid.  IKR--sorry not so helpful. 

[regentrude]

We tried the erythromycin+benzyl peroxide topical. Worked for one, not the other. After repeated long term courses of oral antibiotics ( so no one-time thing, the acne never went away) in addition to the topical cream did not have any effect, we did accutane reluctantly. I regret that I did not do it years earlier and had spared my DC years of suffering. 

ETA: I would not consider ongoing continuous oral antibiotics a suitable solution. That messes with the system in worse ways than the accutane.

Edited January 13, 2020 by regentrude

[scholastica]

2 hours ago, Chris in VA said:

Just getting your thread started--both ds had cream with erythromycin and benzoyl peroxide in it and they used it for several years. Eldest had cystic acne on his shoulders for a time and cleared it by patting on um...Mylox? Not Miralax...ugh I can't think of the name...the white, chalky-tasting liquid antacid.  IKR--sorry not so helpful. 

I think you mean Maalox.

[Corraleno]

DS took abx (doxycycline) for 18 months for Lyme disease when he was 12-13 and had flawless skin as a bonus, but as soon as he went off it, the acne was really bad. Tried all kinds of topicals, tried several months of doxy again, and finally put him on Accutane for a year. The Accutane worked, but man did his skin look awful for a while. ☹️ I've since read that a longer/slower/lower-dose regimen is just as effective without the terrible side effects (peeling, inflamed skin; lesions that took forever to heal; lips so chapped they bled if he didn't use medicated chapstick constantly).

When he went off Accutane after a year, his skin looked great, but within about 6 months the acne started to come back. Now he uses Differin gel, which is available OTC and is relatively inexpensive. It's a type of retinoid that is supposedly more effective for acne, whereas tretinoin is better for wrinkles. He also uses the Differin cleanser and moisturizer, and his skin looks pretty good – an occasional break out but nothing serious. Compared to the extensive acne he had a couple of years ago, it's a vast improvement. If you haven't tried Differin yet, I would give that a chance, along with the accompanying cleanser & moisturizer. (Benzyl peroxide never did a thing for him except ruin his sheets and towels.)

[crazyforlatin]

1 hour ago, Corraleno said:

DS took abx (doxycycline) for 18 months for Lyme disease when he was 12-13 and had flawless skin as a bonus, but as soon as he went off it, the acne was really bad. Tried all kinds of topicals, tried several months of doxy again, and finally put him on Accutane for a year. The Accutane worked, but man did his skin look awful for a while. ☹️ I've since read that a longer/slower/lower-dose regimen is just as effective without the terrible side effects (peeling, inflamed skin; lesions that took forever to heal; lips so chapped they bled if he didn't use medicated chapstick constantly).

When he went off Accutane after a year, his skin looked great, but within about 6 months the acne started to come back. Now he uses Differin gel, which is available OTC and is relatively inexpensive. It's a type of retinoid that is supposedly more effective for acne, whereas tretinoin is better for wrinkles. He also uses the Differin cleanser and moisturizer, and his skin looks pretty good – an occasional break out but nothing serious. Compared to the extensive acne he had a couple of years ago, it's a vast improvement. If you haven't tried Differin yet, I would give that a chance, along with the accompanying cleanser & moisturizer. (Benzyl peroxide never did a thing for him except ruin his sheets and towels.)

Do you think skipping Accutane and using Differin at that time would have yielded the same result as now? Or Accutane from that time has helped with the present condition? I have no idea if Accutane has some cumulative effect. Because Dd is a girl the doc doesn’t want to prescribe this until absolutely necessary bc of government involvement. I’m going to remember that if we do start Accutane to take your advice on the length and dosage. 
 

Does Accutane cause purging?

[Amy in NH]

My kids use adapalene gel, which is Differin.  It works great if used every single night.  We can definitely tell when they haven't been using it.

You can get it at Walmart for ~$28/tube which lasts about a month.  Alldaychemist also has it, but it's the same price unless you hit a shipping discount.

[Corraleno]

2 hours ago, crazyforlatin said:

Do you think skipping Accutane and using Differin at that time would have yielded the same result as now? Or Accutane from that time has helped with the present condition? I have no idea if Accutane has some cumulative effect. Because Dd is a girl the doc doesn’t want to prescribe this until absolutely necessary bc of government involvement. I’m going to remember that if we do start Accutane to take your advice on the length and dosage. 
 

Does Accutane cause purging?

I can't say for sure if he would have had the same results without Accutane, but if Differin had been available sooner I would have tried that for quite a while before resorting to Accutane. I would say at the time he started using Differin, his acne was maybe 60-70% as bad as it was before the Accutane, so I don't know if Differin alone would have totally cleared him up, but it might have, given enough time.

Accutane definitely has a cumulative effect — that's exactly how it works. They calculate the "effective dose" based on a specific amount per kilogram of body weight, and then you keep taking it until you hit that cumulative total. The standard approach, which is what DS's dermatologist's did, is to increase the dose each month until the patient is at the highest dose his body can tolerate, and then keep taking that amount until he reaches the cumulative total required. DS actually ended up having to back off the maximum dose for a bit because of liver issues (if you take Accutane, you have to get a blood stick every 30 days to check your liver). There are a lot of side effects at high doses, though — in addition to dry skin, many people get cracked and peeling lips, cracks in the corners of the mouth, and nosebleeds, and it tends to make your skin much worse before it gets better. You also have to be really careful not to touch or pick at your face while on Accutane, even if your face is itchy and the acne is worse than ever, because if you pick at a zit it will take forever to heal, and instead of a small red spot that might last for an hour or two, you can end up with a big purple blotch (or even a scab) that lasts a week. 

I know it probably sounds horrible — like why would anyone ever take that stuff!? — but for some people it really does work miracles, and once they complete the course of treatment their skin is beautifully clear and the acne never comes back. The doctor did warn DS that some people end up needing a second (or in rare cases even a third) course of treatment, and unfortunately DS was one of the unlucky ones who relapsed. But at least Differin was available OTC by then, and over the course of about 6 months that seems to have cleared things up. He still uses it every day for maintenance. If I could do it over, I would have started him on Differin (used religiously with the cleanser and moisturizer) first, and then if that wasn't enough on it's own, I would try Accutane at about half the dose he was prescribed. Supposedly that's just as effective, with far fewer side effects, since what matters is the cumulative total, not the daily dose.

 

[J-rap]

We've had some bad cases of cystic acne along my dh's family line.  One of my dd's had it very bad starting around 14/15.  Her dermatologist kept having to "up" her creams and pills.  (We did start out trying to treat on our own, with Proactive and such, but it did nothing.)  Finally the doc had her on oral antibiotics, tretinoin, birth control pills, benzyl peroxide, and one other cream whose name I can't remember.  We were told that if that didn't work, the last resort would be Acccutane, which we were trying to stay away from.  (But would have used if we absolutely had to.)  

I wish I could remember the exact period of time.  The doc had actually given up and was encouraging her to go on Accutane, but could see that we were hesitant so gave us the option of staying on the other regiment for another month or two.  It was long after the doctor's usual time frame when everything finally started turning around.  It was really, really amazing.  It was either right at the 3-month mark or the 4-month mark.  (I'm thinking the 4-month mark.)  Once it started turning, it just kept on going until it completely cleared up.  It looked so good, that my dd went off of everything again after high school, thinking she didn't have a problem anymore.  The cystic acne completely came back, just as bad as before, if not worse.  She started the same routine again, and it took just as long again to start improving, and in fact began turning around at almost exactly the same time.  So at least for my dd, it certainly took longer than one month to notice any difference at all!

Each time she began the routine, she stayed on the oral antibiotic initially only.  I can't remember for how long -- not long term.  Maybe 6 months or so?

She's 23 now, and hasn't taken the oral antibiotic for a long time.  She still uses tretinoin and benzyl peroxide (so yes, we still have bleached towels!), but not the other prescription cream.  Her skin is staying very clear but with an occasional small break out, so we think it's still necessary to be on a skin regiment.  She has two (boy) cousins who eventually had to go on Accutane as a last resort, and it worked miracles for them.  I know they had to go off after a certain period of time, then on for awhile, then off, etc.  I don't know if they're still doing that or not.

I've never heard of Differin!  I should look into that since tretinoin isn't covered by most insurance after age 18. (Apparently no one has acne after age 18???)

 

[Monica_in_Switzerland]

Depending on age, you might want to seriously consider one of the anti-androgenic birth control pills.  The one that fixed my acne is Bellara, but I'm not sure it's available in the US, I think it's more European.  But I know there are others with anti-androgen ingredients.  It is certainly worth weight the risks and benefits of BCPs to those of long-term abx use.  

For tretinoin, yes, I purged, and I am purging again because I stopped using it over the summer.  About the time when I am able to apply nightly without major peeling is when the purging stops for me.  Right now, I apply every 3 nights as I work my way back up to nightly.  

[BeachGal]

Another treatment that you might want to consider is photobiomodulation. It’s being used for all kinds of health problems, including acne. Some people use it in conjunction with medications. Here’s one article but there are many others online if you’re interested.

https://www.researchgate.net/publication/322580409_Photobiomodulation_in_Dermatology_Harnessing_Light_from_Visible_to_Near_Infrared_for_Medical_and_Aesthetic_Purposes