Dilemma: After Acutane
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Fri Mar 24, 2006 6:59 pm

I am a 25 year old male. In my early to mid teens I had bad acne. I tried everything but nothing worked. Finally, my dermatologist prescribed me Acutane, which really cleared my skin up. However, the side effect of Acutane was that it dried up my skin very much and made my skin very sensitive to the sun. Since I never really had to worry about getting sun burnt, I didn't take my doctor's orders to use sun screen while being outside and after a few rounds of golf in the summer the damage was done. Ever since, the end of my nose is very sun damaged. It is noticeably red, oily and even more sensitive to the sun. It's basically the top layer of skin on my nose is gone. I went to my dermatologist about this and of course he gave me a hard time about not following his orders but gave prescribed me Renova, which said over time (years) would help resurface my nose. But my prescriptions ran out and I never had them refilled. Is there anything out there, that I can use to bring back the surface texture and coloration of the end of my nose without a prescription? I would greatly appreciate any help. Another annoyance about my nose being so sun damaged is that it sweats very easily, unlike the rest of my face, either when I'm physically doing something or if I eat spicy foods. HELP ME!!!

Fri Mar 24, 2006 9:54 pm

Well, I am not sure about this because (a) I am not a derm, and (b) I can't seem your skin Smile

But, my approach would be to use an AHA cleanser (slowly at first since your skin is now sensitive) and also use a vitamin C serum daily. Did the derm recommend this to you? Vitamin C helps to heal the skin and also protects it from further environmental damage and reverses some of the sun damage. So, something like MD Formulations glycolic cleanser (or similar) and a good l-ascorbic vitamin C serum (e.g. Vivier, or another stable product). Of course, if I were you I would also be using sunblock on a daily basis.

Btw, is there a reason why you don't want to continue with the renova as prescribed by your derm?

free skin care · Fri Mar 24, 2006 11:35 pm

Hi SoonerFan80 - You absolutely must use an effective sunscreen! I'm surprised your dermatologist didn't excoriate you Shock

It's worse to use a retinoid without following up with sunscreen than it is to go without the retinoid to begin with. You're going to have serious skin trouble, especially since you're out on the links in full sun. You should even reapply it after at least 2 hours or less of sun exposure. The tip of the nose is the most common site for skin cancers. I have an aquaintance who's a risky phototype (blond and blue-eyed) who's had her nose practically removed from so many cancer treatments. She grew up in Chicago and spent summers on the lake all through her childhood and beyond. Now she looks a bit freaky, sorry to say, and she's wealthy enough to have any kind of restoration possible but the damage's been done. My husband is fair as well and has had some nasty lesions on the tip of his nose worked on. It's quite disfiguring during the treatment. Please do what's right by your skin and for your general health and get with the program.

BTW, I couldn't tolerate Renova. Some forum members have no problem using prescription retinoids but I just can't -- they make my skin extremely dry, irritated, crusty and red. If you're having the same trouble, you may want to try an OTC retinoid since they're not as strong as the prescription types. If acne is still an issue, a glycolic product, whether it be a cleanser or some kind of night cream to alternate with the bedtime retinoid application is a good idea. This helps prime your skin for the retinoid by helping to quickly dissolve the horny outer layer (stratum corneum).

Like Mabsy suggested, Vit.C serum in the morning [waiting 10 or 15 minutes] before you religiously apply your sunscreen Wink

will help with redness and also give your sunscreen a boost.

Another forum member, betterat40, swears by LaRoche Posay Dermo-Pediatrics SPF40, PPD18 sunscreen (it's a spray, but you spray it into your hand and then apply it to your face). She says it's matte -- not oily like the more effective LRP Anthelios XL Fluide Extreme SPF50+, PPD28 (which I use). I'm going to try it myself this summer when it gets hot and humid here. If you can tolerate an oily suncreen, use the Fluide Extreme since you're out in the sun so much. Your derm may not recommend it to you because it's French and hasn't been approved yet by the FDA, and isn't even sold in the states! But you can get a good deal on eBay (this stuff is a lot more expensive than sunscreens you can get at your local drugstore, but worth every penny) from the seller "lwsue" in Singapore. I always buy multiple bottles which saves on shipping costs. Besides, my husband and I both use it now, so one bottle isn't enough anyway.

Since you golf, I really think you should spring for the best sunscreen. Your description of your nose is worrisome, and skin cancer diagnoses are rising at an alarming rate. Men are also vulnerable on the back of their necks and on and behind the ears, so you really should apply it in those areas as well. Good luck!!!

Sun Mar 26, 2006 2:26 pm

m. april...

Thank you for the helpful suggestions regarding sunscreen. However, I am focused on something, non-prescription, that will be able to bring back coloration and surface texture of the end of my nose. Is there any OTC topical treatment out there able to do this?

Also, would micro-dermabrasion or laser skin resurfacing be an option?

free skin care · Sun Mar 26, 2006 4:44 pm

Hello again SoonerFan80 - The reason your derm prescribed Retin-A is because it's been clinically proven that topical Vit.A (which is at the highest levels in prescription form) can help reverse damage because of its superior ability to penetrate the skin and cause more rapid cell turnover. Sunscreen is requisite in any case, and particularly so with the use of retinoids.

Microdermabrasion (ouch!) of red, sensitive, damaged skin will only irritate your condition, IMHO, and so I suggest again an OTC retinoid if you don't want to stick with the prescription form (SkinCeuticals offers the strongest ones), a topical Vit.C product (as Mabsy said, it promotes healing and healthy skin tone), and sunscreen. For example, doctors advise people who've suffered skin trauma (wounds) to use sunscreen as it helps to avoid ugly scarring. Again, as Mabsy suggested, a glycolic product will help too and is often prescribed by derms because it's an extremely effective exfoliant and therefore preps the skin to better utilize/accept other topical treatments. All of these products help to refine texture and tighten pores. I seriously doubt that it will take YEARS, as your derm said (he may have been really pissed at you for not using sunscreen and wanted to scare you -- after all, this is why you have the nose problem in the first place). Retinoids and glycolics work quickly and truly produce results, but patience is nevertheless required!!!

Sun Mar 26, 2006 4:54 pm

m.april...

Thank you again for the helpful advice. OK, since you suggest an combination of an OTC retinoid or a topical Vitamin C with sunscreen, which are the best and which would you suggest for each? Now again, these should help with both surface texture and coloration correct?

What OTC retinoid?

What topical Vitamin C?

What sunscreen?

Sun Mar 26, 2006 5:05 pm

m. april....

Also, you mentioned I should look for Vitamin A and Vitamin C topicals in your previous response, which one is it, A or C?

free skin care · Sun Mar 26, 2006 5:07 pm

P.S. - I don't know much about laser resurfacing, but I DO know that effective laser treatments that penetrate deeply should be performed by physicians or other medically-licensed pratictioners, and that a side effect is skin reddening, which can last several months. As far as salon-grade laser treatment goes, hopefully other forum members can give you some advice. But why don't you consult with your derm again to see if he thinks this would be a good option for you? You may also want to ask him about chemical resurfacing which would involve using something stronger than a retinoid. Your doctor may have prescribed Renova because it's more emollient than other prescription versions of tretinoin, and is supposedly gentler, and the fact that he didn't already discuss other options may be that he thinks this is the best, safest route to go. A second opinion could be in order, though. The tip of the nose is such a prominent facial feature that I think caution is advised or else you risk permanent disfigurement.

free skin care · Sun Mar 26, 2006 5:15 pm

Both Vit.A (retinoids) and Vit.C (ascorbic acid) can improve the appearance of skin, but in different ways. Vit.A penetrates more deeply and speeds up cell turnover. Vit.C products improve skin tone and healing, and when used in tandem with Vit.A, they will help to offset the concomitant redness that occurs with retinoid use. There's a lot of debate about which form of Vit.C is more effective, but it's generally thought that products containing l-ascorbic acid are more penetrative. However, they're also most perishable (I've begun keeping my SkinCeuticals CE+Ferulic serum in the refrigerator), so some believe the more stable versions of Vit.C are better, if weaker.

free skin care · Sun Mar 26, 2006 5:34 pm

After doing a lot of research, here's what I use:

SkinCeuticals Retinol .5% (a 1% product is also available). I can only tolerate this 3x/week at most (I'm quite sensitive to retinoids -- just cannot tolerate the prescription strength), and have just started using a weaker retinol product to give my skin a rest. But you're younger so maybe you can take the stronger stuff.

SkinCeuticals C E + Ferulic serum, because it claims to offer superior photo-protection.

There are many many glycolic products on the market. I used to use MD Forte glycolic creams, but now I use IS Clinical Firming Complex which has a lower level (5% AHA). This is for mature skin and wouldn't be appropriate/necessary for you.

And then I use the LaRoche Posay sunscreen I mentioned earlier. When I wear makeup (which is most of the time), I use an Avene sunscreen because it's active ingredient is more stable (a lot of makeup ingredients can degrade the active ingredient in LRP, but this wouldn't be an issue for you and that's why I didn't mention it before). But the Avene isn't as good of a sunblock when it comes to UVA rays: SPF50+, PPD18

These are all expensive products!!! Prescription tretinoin products are actually less expensive than SkinCeuticals Retinol. There are much cheaper Vit.C sera than the SC one I use, too. There are cheap glycolic acid (AHA) products that you can even buy in your local drugstore. But I wouldn't scrimp on the sunscreen because there's no equally-effective product available here in the states.

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