Anti-androgen effects of Accutane (DHEA as potential treatment for post-drug dry-eye syndrome)

isotretinoin
accutane
#1

The meibomian glands produce a lipid film that covers the eye to prevent rapid evaporation of tears.

These glands are considered to be an androgen-dependent organ and androgen deficiency has been found to be a major cause of meibomian gland dysfunction:

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Dysfunctional and atrophied meibomian glands were observed in Post-Accutane sufferers of chronic dry eye, many years after treatment:

These patients all took isotretinoin in their teens and gradually developed dry eye symptoms that persisted for several years after discontinuing the medication. Before presenting to University of California Berkeley’s Dry Eye Clinic, these patients had pursued multiple treatment modalities, such as warm compresses, fish oil supplements, and artificial tears, but with limited success.

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Rats treated with Accutane had similar meibomian gland defects, with a highly significant decrease in the percentage of AR positive cells after 12 weeks. Administration of eye drops containing DHEA largely prevented the structural abnormalities, the changes in cell proliferation, and the decrease of AR-expressing cells.

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Full-texts:
A. Moy, N. A. McNamara, and M. C. Lin, “Effects of Isotretinoin on Meibomian Glands,” Optom Vis Sci , vol. 92, no. 9, pp. 925–930, Sep. 2015.

M. A. A. Ibrahim and W. M. Elwan, “Role of topical dehydroepiandrosterone in ameliorating isotretinoin-induced Meibomian gland dysfunction in adult male albino rat,Ann. Anat. , vol. 211, pp. 78–87, May 2017.

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Accutane/Isotretinoin during puberty
#2

Thanks @Dubya_B thanks for sharing this research!

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#3

We can use these types of eye drops??

#4

I don’t think DHEA drops are available to consumers yet, although a compounding pharmacy should be able to make them in countries where DHEA is not a controlled substance.

These drops could possibly work for PFS and post-Accutane Syndrome patients with dry eyes, but the study was performed with rats “during” treatment. Whether this translates to be a part of the post-drug condition we have come to call “Post-Accutane Syndrome” is anybody’s guess.

Another treatment besides DHEA drops was mentioned, but it appears to be an antibiotic that may have its own share of unwanted effects:

Topical azithromycin (1%) rubbed on the eyelid margins twice a day has shown off-label-use success in improving meibomian gland secretion quality, eyelid redness, and overall symptomatic relief.

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#5

wow interesting Azithromycin topical. I use to take the pack when I would get sick.

#6

Hmm. Didn’t realize that azithromycin is the active constituent in z-packs. That should be easy enough to get prescribed.

About DHEA drops. On second thought, they should be available through any compounding pharmacy if one can get an off-label prescription for it, even if it is a controlled substance in your country.

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#7

More evidence for meibomian glands being fatty-acid -> lipid processing cells under androgenic control:

F. Schirra et al. , “Androgen Control of Gene Expression in the Mouse Meibomian Gland,” Invest. Ophthalmol. Vis. Sci. , vol. 46, no. 10, pp. 3666–3675, Oct. 2005.

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In summary, our results show that testosterone regulates the expression of a number of genes in the mouse meibomian gland and that many of these genes are involved in the production, metabolism, transport, and release of lipids, as well as in steroidogenic pathways.

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#8

^This is a very interesting study and important regarding the necessity and regulation of androgen and AR in meibomian gland function. Dry eyes is of course a very common symptom in PFS. Although this is mouse cells, Sullivan did a study since on human meibomian gland cells and confirmed androgenic regulation of gene expression. I’ll make notes on them later so will probably make a topic.

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#9

Does this imply that taking DHEA orally might help relieve other symptoms of PAS?

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#10

I believe that this just goes to show that it makes sense that dry eyes is a very common symptom in people with PAS. Many people who have PAS, including myself, have normal/high androgen levels, and supplementing DHEA would only aid in the production of more androgens. If the current theory about how 5AR-WS occurs holds true, then increasing androgens wouldn’t help at all since we aren’t able to utilize them properly.

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#11

I think its about androgen capability of gene regulation

#12

@Dubya_B One of the papers also mentions a topical DHEA cream. Anyone tried this? I have a severe dry eye issue and it interferes greatly with my work.

#13

Are you doing warm compresses with digital massage, lid wipes, and artificial tears already? If not, look up that regimen.

If you have, you should try restasis out. It may help. Finally, you could always go to a specialist to fit you in a scleral contact lens. This is like a cereal bowl for your eyes, with liquid always inside the contact lens. It is a comfortable lens to wear. It may help you.

#14

The DHEA eye drops are not available for consumers, to my knowledge. You may be able to have some made by a compounding pharmacy.

#15

this

anecdotally but can confirm i only got PAS after using accutane off from TRT


TRT before PAS, but i went off on my 2-3rd accutane cycle

i got PAS and PSSD thats right

PAS gave me IBS, and CFS with low libido

PSSD 6 months later gave me ED and mental deficit made me research and discover the condition

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