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Destinations, Dreams and Dogs - International adventure with a fast-track family (& dogs) of Old World values, adopting the Russian-Italian-American good life on the go…!

Acne Update – II

If you are squeamish, or easily grossed-out, do not read this post.  It is the one-month update of our son, almost 16 years old, on isotretinoin for acne.

So, how has it been over the past month?  In some ways, his face and and back (shoulders) became worse.  The acne vulgaris morphed into nodulocystic acne, developing hard nodules and soft cysts that became huge and tender to the touch, an issue he had not previously encountered to such an extent.

Great, just great.  Hopefully, the storm before the calm.

When the massive whitehead pimples became too unsightly, he used a blackhead tool sold in drugstores, which looks like a metal crochet hook with a loop at either end.  The loop is placed over the nodule/papule and pressed directly down, allowing the blemish to erupt out of the skin without any squeezing which might cause scarring.  Often, the core or plug of oil will pop right out, allowng the teen to then cleanse the skin with a topical solution, so that the bacteria is not spread around.

Not now.

It appears that the consistency of the pimples has gone from liquidy to a thick, yellow, pus-like fluid. Yuck.  It’s as though the isotretinoin is pushing the oil out of the skin.

However, in the last couple of days as we are nearing the one month mark of using the medication, the number of pimples appears to be diminishing.  Slightly.

The side effects?  His whole body is becoming dry, dry, dry, causing peeling on his face, lips, chest, and dryness in his ears, eyes, and nose.  Sheets of skin are coming off, particularly on his lips.  As his mother, I hate that.  His lips are cracked and occasionally bleed if he smiles.  This is my happy-go-lucky son who cannot smile.  Not acceptable.

He still has a positive outlook and does not seem psychologically damaged by the drug that some say could lead to thoughts of suicide.  But he seems under more pressure lately, more “short” lately in areas of life that would not have thrown him before.  He seems very tired, opting to head to bed anywhere from 30 to 60 minutes before schedule, and using eyedrops to soothe his tired eyes.  As he and Benedetto headed to the dermatologist for the almost-one-month check-up, they mentioned these side effects to the doctor.

The doctor immediately changed his prescription, noting that they can tweak it.  Instead of taking one light orange, oblong capsule of 40 mg. twice a day, he would now take one 20 mg. capsule in the morning, and two 20 mg. capsules in the evening.  In effect, the medication would be decreased from 80 mg./day to 60 mg./day, along with a topical prescription cream for his peeling face.

We felt much better about that.  Figuring that the downgrading of the medication’s potency would mean a decrease in the $850 that we paid last month for the pills (http://www.destinationsdreamsanddogs.com/the-high-cost-of-acne-resolution/), Benedetto headed to the CVS pharmacy with a spring in his step.

Not so fast.  A couple of hours later, the pharmacist called with a heads-up FYI that the new medication would cost $1,100 for this month’s supply—an increase, rather than a reduction in costs.  Having lived in the Middle East for far too long in his early adult years, Benedetto did not flinch at protesting the price.

“No, no,” he said incredulously into his phone.  “How can this be?  The medication has been decreased from 80 mg. per day to 60 mg. per day.  We’re receiving less medicine, and yet paying more money-?”

“You pay per capsule,” the clerk explained.  “You have three capsules per day, rather than two capsules.”

“I’m paying for the CAPSULE?” I think his voice rose slightly at this point.  “You mean the silica capsule costs more than the medicine inside?  This doesn’t make sense.  The silica should be pennies.  No—.”

He quickly called the doctor’s office and spoke with our nurse.

“Try Sam’s Club, or WalMart,” she suggested.  “CVS is generally one of the worst, in terms of price.”

Not being highly-medicated individuals, we had no idea that prices to fill prescriptions varied dramatically.  Although these stores were nowhere near us, Benedetto put in a call to a Sam’s Club near our dacha in our other location.  Getting off of the phone, a smile spread across his face.

“The cost?” he looked at me.  “Not $1,100, but $600,” he declared victoriously.

“What-?!  That’s almost a 50% reduction!” I exclaimed, mentally calculating the new monthly cost of doctor’s visit, bloodwork at another clinic, and the new meds.

“Right, and they mentioned something about a further cost break for business members of Sam’s Club, so we’ll need to see how much more in savings that would be….”

The CVS prescription was cancelled and we never looked back.  Our son would receive a more suitable dosage, be less dry and peely, and return to his happy, smiley ways.  Oh, and hopefully, the acne would eventually go bye-bye, as well….

Stay tuned.



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5 Comments : Leave a Reply

  1. avatar admin says:

    With the business-plus membership at Sam’s Club (around $60?), the total cost came down further to about $400. Well worth it!

    • avatar melin says:


      Is your son using Acutane? Generally the acne does get worse before it gets better. It really does work. Unless your son came into the treatment with scarring, eventually his skin will become flawless. Your will be nothing short of amazed. Some kids have no response for the first few months (most do 6 months but your son may be longer since it sounds severe) and only start to respond towards the end of the treatment. Others (my son) respond immediately but even they still need to finish the complete 6 months. Eventually it works for close to 100% of the kids.

      No getting around the dry skin issue. Even my son’s eyes were bloodshot since his eyes also “dried out.” Chapstick became useless and he move to pure vaseline. Sunscreen was applied four times a day (you probably noticed how this med can make their skin fry).

      But now on the other side with a truly flawless complexion, he would do it again in a heart beat.

      Just throwing it out there that many dr.’s believe there is no relationship b/w drug and suicidal ideation. In fact, research shows that kids with severe acne are depressed b/c of the acne. Many won’t even consider making eye contact and will isolate themselves from peers.
      I don’t know any kid who didn’t begin the treatment feeling a bit “depressed” because of how unattractive they felt. Complexion is a big, big deal at this age and they feel shame when they look at their oozing/almost painful to look at, face.

      • avatar admin says:

        Thanks for sharing your experience, Melin, we are hopeful. We figure that the derm has been through this many times and he knows what he’s doing. Besides, he’s Italian and a nice, grandfatherly figure. 🙂

        It’s an Accutane lookalike, since I guess that’s been banned. It’s called isotretinoin. Thankfully, our son has no scarring, and his happy-go-lucky demeanor kept him from treatment for a couple of years. Nothing gets this kid down and he didn’t want to be on any kind of medication. I told him that he’s been diligent to try all of the products (topical) that are out there, and why suffer? Then he felt like it might be time and is happy to be kicking it out of his system.

        The eyes, skin, and lips are very dry. The derm gave him a prescription strength moisturizer for the lips, since nothing helped, not chapstick, vaseline, intensive moisturizers, nothing. Now he’s back to smiling and we’re relieved. He seems to have fewer overall bumps, but the ones he has seem huge at just over one month into this. The doctor said he’s looking at a 5 or 6 month regime. I’ve heard from others that it seems to really start working around the fourth month. I’ll try to give a month-by-month update if it’s not too much for everyone!

  2. avatar Sybil says:

    I really hope he gets the miraculous results that melin spoke of.
    Also, I think we all ought to take out stock in the company!
    Yes, please give us updates on how he is doing with the meds.

    • avatar admin says:

      Thanks, Sybil. That’s what they say about this type of medication. It zaps the acne and I guess the over-active oil production, and it never comes back (or very slightly). The other types of acne medications are taken for years and years (not 5-6 months) and are hopefully cheaper, but probably milder. Our son’s acne was maybe a 6 or 7 on a scale to 10 (my own unscientific rating scale). The main drawbacks for him so far: the dryness and extreme tiredness. We’ll see how this new dosage goes.

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