My name is Steve and the story of my seemingly life-long battle with acne goes something like this:
Like all boys going through adolesence, I began to develop acne at age twelve during my sixth grade year in middle school. My acne started out slowly and I began by treating it, like most other teenagers, with over the counter preparations such as isopropyl (rubbing) alcohol saturated cotton balls, Witch Hazel astringent, Oxy pads, Clearasil products and the like. Those products made my face tingle and even burn so I figured that they were doing a good job in treating my acne. In seventh grade, on my annual visit to my family doctor, he told me that I should go see a dermatologist to have my acne treated which introduced me to Harold Milstein, M.D. (one of the most respected and knowledgeable dermatologists in the Philadelphia area). He began to treat my acne with oral minocycline as well as benzoyl peroxide soap (Pan-Oxyl 5%) along with a gentle cleansing soap (Purpose). Over the course of my seventh grade year, I noticed a moderate improvement in the severity of my acne which kept me happy figuring tha I would grow out of it soon enough. Eighth grade continued with much the same treatment as well as using every over-the-counter product under the sun. My acne seemed to be held in check. However, the worst was yet to come.
Before entering high school, my acne seemed to clear up fairly well and I stopped using the antibiotics and soaps that had been prescribed to me. I think that I attributed my resolution to all the exercise I was doing in training to become a long distance cross country and track runner. I figured that working up a good sweat would help to keep my pores clean. During high school, I would develop the occasional flare which would last for a little while then eventually clear up. Pan-Oxyl and Purpose had gone from prescription to over the counter so I went back to using those when I felt that I needed to. During my summers of high school, I would work doing construction in the morning, go running to my job as a lifeguard at midday and finish by running at cross country practice in the evening. I was always working up a good sweat, jumping into the chlorinated pool water, and eating a very healthy and nutritious diet. I tend to think that the combination of exercise, sweat, drying action of the chlorine and improved diet helped to keep my acne in check throughout high school. My face remained fairly clear.
Next came college. My complexion was still well controlled as I entered school probably because I was just coming off the summer in which I was doing my same old routine. As I went into my first semester of college, the stress of the transition of more advanced classes and going from an excellent high school running program to an elite collegiate running program seemed to be getting to my face. I worked and studied endlessly as I was a pre-med/biology major who needed to maintain a spotless GPA in order to get into medical school. I had also started out my collegiate running career as a "freshman phenom" making it into the top five on my college team. I ran double runs on my own to improve my ability because I was one of the top point scorers and the team was depending upon my performance every week. I think that the stress began to get to me. I was holding my own in school and doing extremely well as I had planned but it took every ounce of energy for me to jungle my studies and athletics. I also began to volunteer my time as a student-athletic trainer which took most of the free time that I had left. My acne started to return with mostly blackheads and the occasional inflammatory lesion. Over Thanksgiving break, I went to my family physician who gave me a prescription for Differin (adapalene) gel and told me to use the same soaps I had been using. My acne settled down for a while but I still had the occasional flare which I treated with rubbing alcohol and Stridex pads. My acne stayed in check for my freshman and sophomore years in college but then came the next step.
During my junior year in college, the stress of advanced biology and chemistry classes really took the toll on my body and mind. I was still one of the top runners and had become one of the better athletic trainers plus I had taken on leadership roles in the biology program tutoring others and being a leader in the college's athletic programs. My face started to break out left and right especially while I was studying for the medical college admissions test (MCAT) which would decide my future in life...whether or not I would get into medical school. My acne continued to worsen. I went back to my dermatologist who put me on doxycycline and benzoyl peroxide 10% which settled things down for a while.
My acne was held in check throughout the rest of my college career. My senior year was the best year of my life to that point. I graduated Magna Cum Laude with distinguished honors in biology/pre-medicine, I was the captain of both my cross country and track teams (MVP of the team in track), I was named the head student athletic trainer and received the Student Athletic Trainer of the Year award long with a postgraduate scholarship for my athletic services which would be applied to furthering my education after college. I was accepted into three of the five medical school I applied to and felt that all of the hard work I had put in was finally paying off.
Right from the start of medical school, I found myself battling my nemesis, acne, once again. During the summer, my face was clear but when classes started, I had flare after flare after flare. I went to the school dermatologist who put me back on doxycycline as well as a benzoyl peroxide wash in the morning and a lotion at night. My face seemed to improve a little bit but things still weren't perfect. It went that way for my first two years of medical school. Back and forth between being blemish free to being frankly horrible to look at.
During my third year rotations, I decided to use my first elective rotation to spend time at Dr. Milstein's office. There I saw all shades of dermatologic disease including every stage of acne from comedonal to nodulocystic. I observed and learned how he treated these patients and witnessed the dramatic results over the span of a month. I was fascinated by those who had been on accutane. I saw the before and after pictures and thought about using it but talked myself out of it when I saw the side effects that people who were on it were showing up with...dry/chapped/cracked lips, peeling erythematous skin, even rectal bleeding. I saw all the testing that had to be followed monthly (liver function tests, pregnancy tests, checking for muscle breakdown "myositis") and figured that it wasn't worth the risk for something that I was bound to grow out of. After all, I was 24 years old and the end of this had to come sooner or later. I think that I even disuaded a few of his patients from going on accutane from the stories I told them and the explanation I gave them. I continued on my doxycycline regimen and added azeleic acid & retin A to the mix. My complexion was o.k. with the occasional blemish. I figured that I would just have to be happy and wait it out. Things remained good during that year and I felt that I had my disease under control.
During my fourth and final year of medical school, a time when stress tends to hit its highest with preparation for national boards and applications for residency programs would begin with their stressful interviewing process. Well, that summer my face turned on me. My acne was now out of control. I had frequent inflammatory lesions that were leaving scars on my face and no matter what I did, I would also develop another after one went away. I started to date the girl that I had always dreamt about in college. She was a cheerleader and a runner who had the most gorgeous figure and the most wonderful skin. She was and is beautiful in every way. I really figured that I didn't stand a chance to go out with her because my complexion seemed to be at its worst (not to mention that I had a bad haircutting experience the day before our first date so that I ended up looking like a pimply faced marine). My girlfriend didn't even think twice about me. She knew me for who I was and looked past all the blemishes and the "bad hair day" I was having. She had even mentioned that she had been on accutane when she was in high school because she had had horrible acne and now she was the gorgeous angel who sat before me. I gave a long hard thought into going for it and doing the accutane therapy.
I had another rotation with Dr. Milstein and I would see what he would suggest. During that rotation, I saw the same patients who had all the side-effects from the accutane in follow-up at his office. Their results were unbelievable, clear skin with only one or two treatment failures who later completely resolved after a second course of therapy. Not only that but Dr. Milstein's physician assistant was also on accutane and she said that the benefits far outweighed the side effects. So I said to myself, "Its time for a change!"...
I started accutane in August initially at 20mg twice a day. Not too many side effects with that one aside from my lips being a little dry. I had read the literature on accutane therapy thoroughly and I knew that my lips would chap and crack. I used chapstick and Aquaphor ointment endlessly and managed to keep my lips from falling apart. I knew that things would get worse before they got better and in the second month I had the dosage increased to 20mg in the morning and 40mg at night. I experienced a period where I had a terrible flare up with cracking lips and dry skin. My face was red, full of blemishes and just looked horrific. That started to subside and the next month (October) was a little rougher due to the weather becoming colder. Throughout October, November and December, my face was constantly wind burned, sore, dry and my hands were cracking as were my lips. I didn't have any blemishes which was good but my face still was not looking picture perfect. I finished my course of therapy in January which was the most exciting time for me (I was counting down the days when I wouldn't be on accutane anymore and hopefully never again). My skin started to become moist again, my lips healed ad the redness resolved. Occassionally, I would develop a small breakout which would resolve almost as quickly as it started. Dr. Milstein told me to wait another two months as the effect of accutane was still working even though I wasn't taking the pills any more. After two months of not being on accutane, I was still having occasional minor breakouts but my face was probably looking 80-90% better than before. He gave me three short courses of accutane therapy during which time I would go on 80mg a day for a month and then stop for a month. I did those alternating months three times. The side effects were not that bad plus I had a month to allow things to recover.
Well, I graduated from medical school and I'm now a first year family practice resident. My complexion is nearly 100% clear and I might develop one or two small lesions on my forehead or cheeks once a month if even that. I love dermatology and have been treating my own patients for their acne with quite a bit of success so much so that even my fellow residents and some attendings are referring their acne patients to me to be treated.
I can't begin to sing the praises of how accutane has helped me in my life. I now have the confidence to look my patients in the face and know that they are looking back at me and not looking at the blemishes on my face. My confidence has soared and so has my outgoing personality. I have not hesitated to prescribe accutane when other treatments have failed. It is one of the best medical success stories that I have ever seen much less experienced for myself.
To those of you who are reading these testimonials, this one is definitely true and a definite success. I want to thank Hugh Delony for maintaining this site and providing this forum. I read the testimonials while I was on accutane to encourage myself that others have gone through the same thing and despite the side effects I could see a light at the end of the tunnel. I would also like to thank Dr. Harold Milstein (215) 483-3666 and my wonderful girlfriend for all of their support and advice as I went though my ordeal with acne.
On the Acne-Site webpage, Mr. Delony states that he is just a twenty year old kid and not a doctor. Well, my story comes from a 26 year old kid who is a doctor. No matter who you are and whatever your credentials might be makes no difference. We are all trying to battle this disease which afflicts and emotionally and physically scars so many of us. Feel free to e-mail me with any questions that you might have. I'll be more than happy to share my experience and any advice that I can provide to you.
Sincerely,
Steven R. Blasi, D.O.
Family Practice Resident
