Hi there. At the outset, i apologise & commend the medical practitioner who passed this question onto mois after taking the time & trouble to look through the query & make a honest appraisal before yours truly 'butted' in. Hope to do justice to the query as things stand...
First, i note that you have had acne for the past 17 years & am surprised you have not been put on roaccutane at some stage in the past.
Having said that, Roaccutane does have a host of side effects as am sure you are only too aware of. Hence, one has to be sure that during the course of treatment which may last anywhere from 6 mths to a year or more depending on the results, hematologiscal parameters monitored etc, one cannot afford to get pregnant as the foetus may end up with deformities. I am unaware of your marital status & if you are married, would appreciate first if you clarified with your husband if the practice of contraception et al & refraining from having children for at least 2 mths after stoppage of roaccutane is OK with you guys & then we can take this discussion further.
Also , as the physician rightly suggested, you will require to do a battery of hematological investigations : largely CBC (complete blood picture), LFT, Lipid Profile, Serum creatinine to name a few & then only start this medication (baseline)
The most cumbersome effect of this medication is "dry skin" & mucous membranes that can easily be rectified with emollients & vaseline.
Blood tests will have to be done at regular intervals as suggested by your dermatologist on the ground.
The acne scars too will benefit to an extent with roaccutane.
Please do get back to us with photographs of all the acne sites that are clear & both normal views & close-ups if possible; the healthcare magic staff would be happy to guide you on uploading should you face any difficulty.
With the photographs, i would be able to outline a more clear plan of action. Should you be satisfied with this answer & unwilling to upload any snaps, then i recommend fixing an appointment with your nearest dermatologist.
Await further queries or a closure & review on your part.
Good Luck & here's wishing you a clear acne free skin in the near future. Cheers.
Dr Praveen Rodrigues MD Dermatologist, Cosmetologist, Venereologist XXXXXXX Hospital, Bangalore, India

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Hi there. Am happy you found my suggestions useful & have decided to XXXXXXX up with your dermatologist. I agree it is time for 'you' now..& understand where you are coming from regds the photograph. Since you have anyways decided to see your dermatologist, it will not be required. Happy to be of help & am sure you will reap the rewards of spending the time to fix your face. Dont worry, whatever course of action is decided on the ground, am certain it will work for you. Cheers & Good luck once again. Please do give us a shout sometime down the line.
In the interim, would be great if you could 'close' this discussion & give us your feedback on the services!

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Thank you once again..it must be late evening for you in the states..apologies once again..but there appears to be some icon that you must press at your end that 'end's this discussion & renders a feedback/review. If not, the discussion remains open & any note you put down, registers as a follow-up even if you are buzzing to say thanks :( (apologies for the software glitch).
regds.
Dr Praveen Rodrigues MD

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