Hello!

I had RNY two years ago and now suffer from very bad acne. My dermatologist has put me on oral 40mg of Isotretinoin (accutane), but I’m worried about how it will be absorbed.

Anyone had a similar experience and can share their experiences? Did accutane work? Was it successful post RNY?

Thanks :-)

Maggie (-231 lbs!!)

I tried Isotretinoin prior to WLS and can only say IMHO it is not worth the risks. I found the topical retinoid much more effective.

Safe Journey!

Both of my daughters did acutane as teenagers. I did not look at all the risks. They just wanted clear skin. Looking back I would only have put them on it if they had cystic acne.

It almost ruined one girls liver. Do your research & take with caution.

I only had surgery 3 weeks ago but my acne has EXPLODED. Both cystic and superficial bacteria. I desperately wanted Accutane, but looking at the risks, I wouldn't feel safe taking it now having gastric, given how fast everything can absorb (like alcohol). I went to the dermatologist last week and it was obvious he had never treated a gastric bypass post-op patient. He wanted to put me on a diuretic... 2 weeks post-op and already suffering from dehydration. So.... just keep in mind that gastric surgery is not that docs specialty and if you don't feel 100% safe taking it, don't. I ended up with a topical antibacterial. Retin-A topical only helps if it's your pores that are clogged. I don't know what type of acne you have.

I took accutane in 1995 after several years of being made fun of because of my absolutely horrible acne that a dermatologist couldn't get rid of after trying everything including cryo treatment.

I cannot speak to the absorbtion, but I can speak to the effects that I have seen.

• I spoke with an ophthalmologist who told me that accutane frequently causes people to have overdialation of their eyes. That makes oncoming headlight brighter than one would normally see.
• When I took it, I had unbelievable dry/cracked skin. My lips would crack and bleed at least once a week. My poor feet would crack and bleed (daily). I ended up using gauze with a coating of Vaseline on the bottom of my foot, and then I took medical tape and taped around my foot.
• When I took it, females had to sign a waiver because there are unbelievably bad effects on a baby. My dermatologist told me that it it was good enough for women, then it was good enough for men, and I had to sign it.
• This was before the links to suicide.

My parents didn't like the idea of it, but I was darn near 18, and I told them it was now or wait a few months and I'll do it myself. I took it for six months and haven't had any bad acne since. If you added up all of the pimples I've had since then, it would be less than the numbers I had come up daily beforehand.

Years later, my father and I argued about the suicidal effects. He was ticked at big pharma, but I explained to him it was no different than an anti-depressant - the population of the subjects are often extremely upset and (arguably) near suicide to begin with. It's no different than the death rate for obesity surgery. Anybody that knows anything about statistics will know that you can make numbers say whatever you want. If you look at the morbidity rate of BMI's over 100, then of course, you will see high(er) morbidity simply because said person's body is more stressed/fragile than one with a BMI of 40.

I'll get off my soapbox now. I will say this, I am 100% happy with the results and knowing everything I went through (And possibly permanent dilatation issues) I would absolutely do it again.

I would caution anybody on weight loss vitamins though: I seem to remember that there was a severe complication with a vitamin (Vitamin A if I remember right). Basically, you can get toxicity if you add to it. So I would recommend that you stick with whatever multi-vitamin you're taking and then take it to the prescribing doctor to make sure he is okay with the concurrent use. Doctors tend to brush off vitamins, but ours are way more potent, and that may change their mind.

Thank you so much for all your advice. My acne is quite severe cystic acne which developed post op, and more than anything it’s just really painful. I agree that my dermatologist has clearly never worked with anyone who has had gastric bypass, but she seems very competent and ready to help me. I’ve stopped taking my multi-vitamin because it contains vitamin A.... going to see if I can get an alternative multi-vitamin without vitamin A. I’ve also stopped taking B12 while on the treatment as it apparently is a root cause for acne development post-op.

In terms of the depression/suicidal thoughts, my doctor said that apparently this is most common with teens. As the treatment is so commonly given to teens (and hormones are raging!), this is where the link to depression has been. I’m 30 so hoping it won’t effect me too much. Although, I have told my boyfriend that if I start to get usually moody/aggressive or if my personality changes, he needs to go to my doctor or my parents, and get me off the pills!

I’ve been on the treatment since Sunday, so no real side effects now. When do you usually start to feel dry skin?

Thanks again for all your advice :-)

Maggie354, to be honest, I really don't remember because it was so long ago. I know I started before I went to College, and I also remember wrapping my feet in college. If I remember right, the lip bleeding started first. Being that I went to a school in the northern part of the country and it was very cold, so I'm sure that only made things worse. If you live where it gets cold, I would get yourself used to carrying some lip balm of some sort. It's harder for us guys because we're used to carrying a wallet and some keys (At lest then...Cell phones were for "rich" people at the time).

I was thinking about something since I posted. Allow me to postulate for a bit. We know that white adipose tissue (fat) has a pro-estrogen component. My "T" levels were very low when adjusted for my age. Heck, they were low for someone 20 years older than me. Most guys that are big also have "moobs" and while a component of that is simply another place to store excess calories, another component is simply that the extra fat suppresses androgen (testosterone) and either amplifies the existing estrogen, or simply makes more (I can't remember). Anyways, when you start playing around with Estrogen and Androgen, you get acne. I believe that guys that have more androgen than their bodies prefer end up with acne because of that. I also know that when women start using birth control hormones, one of the side effects is acne, and I would like to believe that supports my hypothesis as well.

Fast forward to post surgery. When our metabolism changes, when we lose the weight, and when whatever unknown ghrenlin/leptin changes happen (My surgeon said they don't fully understand the gamut of things that happen almost immediately after surgery), it likely throws off those hormones. So I would humbly suggest requesting your doctor to measure the testosterone and various estrogens, and maybe the SHGC (I probably got that acronym wrong) as well. Maybe there is a supplement such as pumpkin seeds or saw palmetto (Known to reduce testosterone) or something equivalent for excess estrogen? If there aren't any supplements that the doctor is comfortable with, then there are various hormone blockers, or simply adding a birth control (or changing it to a different progestin/progesterone/estrogen type/strength).

If I were female, I would honestly start there before I tried the acutane. I'm a bigger fan of treating the problem than the symptom....But take all of this with a grain of salt, I'm a research person/engineer at heart, and nowhere near a medical doctor!

Yes - I’ve had all the hormone tests and they have all come back normal. My dermatologist believes that this cystic acne is not caused by hormone changes (which haven’t been evidenced through the tests I’ve had), and rather is a result of the B12 supplement and other dietary changes that have happened post op. My skin was fine before the surgery! Anyway, going to try the Isotretinoin (the brand is actually called Curacne, not Accutane, but it is the same active ingredient) for a month and if I feel the symptoms are too much, I’ll come off it :-)

Excellent, I'm glad to see that you are approaching this from the ground up so to speak. I hope it works as well for you as it did for me. I can't remember if I already typed this but I was on it for 6 months. Yeah the side effects were a bit rough, but totally worth it if you ask me. I would keep an eye on your B-vitamins during the treatment. Sometimes the delivery method causes different effects, so if your B-levels drop too much, you could always try injections. When doing so, I (believe) it bypasses the liver, and also might mean that you don't need to take as much to achieve the intended results.

I'll be praying for you that it helps!

Have a wonderful Thanksgiving!