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Sebaceous gland hyperplasia, enlarged oil glands, and cosmetics

In my younger years I had painful cystic acne, and now as an adult I have sebaceous gland hyperplasia, which is the technical name for enlarged oil glands. I produce lots of oil and you can actually see my oil glands below the surface of my skin. I have been on a full-dose regimen of Accutane five different times and on two longer-term low-dose regimens. Accutane seems to be the only thing that helps, but it comes with lots of nasty side effects, and as soon as I stop taking it the problem returns.

I went to a new dermatologist several weeks ago and he gave me a prescription for a topical cream that contains the same ingredient in Accutane. It contains 6 percent "Accutane" in an emollient base. The prescription had to be filled at a special pharmacy and it still needed the special sticker about risks and everything. Now my skin is flawless. This topical form of Accutane works great without the need for blood tests or any of the other side effects. This has been a miracle for me and I want to share what I've discovered with as many people as I can.

_ John, Torrance, Ga.

A: I certainly understand your joy at finding a solution to your problem. I felt the same way when I took Accutane many years ago, and for the first time went weeks without noticeable blemishes. But unlike you, Accutane worked fairly well for me and it did feel like a miracle.

Sebaceous gland hyperplasia is a common disorder related more to sun damage and aging than to the typical problem of oily skin, which is strictly hormonal. As you discovered, Accutane can work while you are taking it, yet typically the problem recurs soon after you stop taking it, and long-term usage is not recommended (Source:, Sebaceous Hyperplasia, November 2005).

Topical Accutane (which goes by the trade name Isotrex, and has the same active ingredient as Accutane, isotretinoin) isn't available or approved for use by the FDA in this country (Source:, which is why you had to find a pharmacy that could mix it for you. It is, however, available in other countries.

While I understand your enthusiasm over finding something that finally worked, the research just isn't there for me to echo your praises, at least not without some strong cautions. The few studies that do exist demonstrated that topical Accutane does show some benefit, but it was not as effective as benzoyl peroxide. On the other hand, it was just as effective as Retin-A. There don't seem to be any systemic problems connected with topical application of Accutane, but again, the research is so limited that there is no way to state that definitively (Sources: Clinical Experimental Dermatology, May 1992, pages 165-168; Journal of the Medical Association of Thailand, September 1999, pages 868-875; and Acta Dermato-Venereologica, January 2001, pages 14-17). Especially for women, this could potentially be a risky drug to apply daily, given the risk of birth defects that are found when Accutane is taken orally. For a man, I guess if other treatments have failed, it may not be a problem, but I would definitely talk this over with your physician or dermatologist.