Question: My 17 year old daughter has been taking Zenatane since mid October. Her dose began the first month at 40mg/day with 10mg Prednisone. Month two, her dose was increased to 40mg/2x/day and 10mg/prednisone/day. Month 3, her dose remained 40mg/2x/day and 5mg/prednisone. Overnight, she developed blurry vision the next day and had blood in her stool. Zenatane was immediately stopped. Prednisone was increased to 20mg/day. Opthamologist checked her eyes. Healthy. No more blurry vision or blood in her stool since (was 1time occurrence). Gi appt pending. Pediatrician seen when off and on long term back pain, became acute one day. No longer acute, just achy in later part of day. L-spine and t-spine x-rayed because of location of tenderness. X-rays negative. Urine test for protein negative. Zenatane resumed after a week at half dose 40/mg/day. Severe acne is purpose for Zenatane. Don't know how long plan is to remain on prednisone. Worried about cont'd use of meds, especially prednisone to counter Zenatane, but acne scarring has started so, of course my daughter is very emotional about not having a successful treatment for her acne. Is there/Should I seek another option to treating her acne? Is prednisone causing more acne, other permanent problems? We're in XXXXXXX AZ. Names of recommended dermatologists welcome.

Dr. Hudda,

Thank you for responding in detail.

My daughter is almost 5'10" tall and 162 pounds. She has had mild acne throughout her teens. Last July 2016, it grew worse and severe, meaning the type of acne was deep and clustered on either side of her lower cheeks, mouth and chin. It was cystic and nodular, where once healed, indentation type scarring has resulted. The scarring is not severe yet, but has occurred. I have an appt. for a second opinion on January 24th with a nurse practitioner. It is the soonest I could have her seen at this dermatologist's office that her pediatrician referred me to in seeking a second opinion. Once established, she will be able to refer her to be seen by the dermatologist more immediately after that if she recommends it.

Regarding her blurry vision, it occurred in one eye and upon it occurring, Zenatane was stopped. A week later, Zenatane was resumed. Her acne was improving while on Zenatane, but after having stopped it a few days, the acne began to grow worse. My daughter and her dermatologist felt it was working, the cystic nodular acne had cleared and superficial acne and discoloration was what remained. It is why my daughter and I are reluctant to stop
mid-treatment, without an alternative plan as long as there are no more blurry vision and bowel problems. I understand your advice. I do not have high confidence in her dermatologist at the moment, which is why I am seeking advice while waiting to have a second opinion. I became further concerned when I spoke at length with a local pharmacist before contacting this site, and he raised high concern for a regimen for prolonged steroid use with the Zenatane. He said if she needs to do that, she should not be taking Zenatane. It is also why I welcomed referrals for dermatologists. However, the problem is getting seen. Time is critical, though not immediately life-threatening. Her pediatrician is responsive as well as her dermatologist. However, my confidence is not high at the moment in her dermatologist, though she has been my dermatologist for 17 years treating my skin cancer and treating her older sister's cystic and nodular acne while she was in high school.

Regarding her back, for a year she has had periodic back pain, which she attributed to straining in dance and/or basketball. Just before Christmas, she strained it again. This is why her pediatrician did not think it was related to the medication. Her dermatologist also recently instructed her to take a glucosamine-chondroitin supplement to help in healing.

However, please understand, I am not disputing your analysis, just clarifying her history. I need to be sure what the healthiest course of action is. The emotional toll on my daughter is high to have her stop mid-treatment when she saw improvement. I didn't mean to miscommunicate that point. Side effects did occur once the prednisone was reduced. Then, the acne increased after stopping Zenatane. However, now her prednisone level is high, and her zenatance is at 40mg/1x/day.

With knowing her height and weight does that make a difference in your opinion of the zenatane dosage? Do any of these other clarifying points affect your recommendation?
I can request it be 20mg/2x/day so that she can be weaned of it while simultaneously weaning her from prednisone. Both are strong medications, and I am so concerned about what the right thing to do is.

I am trying to figure out how to upload a picture from my phone.