LowDoseA typical full dose of Accutane (isotretinoin) is 40-50mg per day and the typical length of treatment is 15-20 weeks in order to achieve the recommended cumulative dose of 120mg/kg of bodyweight over the course of a cycle. However, as the years go on, researchers have been conducting more studies on low-dose Accutane (isotreinoin) to see if they can get the same results with less side effects. Generally speaking, the research is showing that even at a low dose of 20mg per day, people see good results, albeit not as impressive as when the full dose is used, and also with a higher incidence of relapse.

However, one recent study published in Advanced Biomedical Research is particularly interesting. In this study, they gave patients a low dose of 20mg per day but kept the patients on this low dose for quite a long time (10-22 months) in order to achieve the usual recommended cumulative dose of 120mg/kg of bodyweight. 96.4% of patients “demonstrated complete clearing of their acne, defined as no acne or occasional isolated lesions.” Relapse was low as well. “In a 5-year follow-up, relapse accrued in…7.9% of patients.” Side effects were, “…mild, and only 6 patients (out of 146) discontinued study medication because of severe adverse events.”

This is the first study where patients receive a low dose of isotretinoin, but are kept on this dose until the cumulative dose reaches the full 120mg/kg. Results from this study look impressive, and relapse rates are low. The authors admit, however, “The only pitfall is it is longer than 10 months duration of treatment period.”

Perhaps it is time to take a second look at how Accutane (isotretinoin) is administered.

References:

  • Rasi A, et al. “Efficacy of fixed daily 20mg of isotretinoin in moderate to severe scar prone acne.” Advanced Biomedical Research. 2014; 3: 103.

Screen Shot 2014-06-18 at 11.07.42 AMPrevalence: Acne is prevalent in Asians. According to an article in Pediatric Dermatology, “Acne remains one of the most common dermatologic diagnoses in children of all races.” The authors of this article found that the most common reason that Caucasians visit the dermatologist is acne, while the most common reason that Asians visit the dermatologist is dermatitis (inflammation of the skin), with acne not far behind. Another study in the journal Acta Dermato-Venereologica looked at people of all ages in six cities around China and found not suprisingly that younger people experience more acne, and that males had more acne than females. However, they also found that prevalence of acne was lower in Asians than in Caucasians and far lower in Asian adults than Caucasian adults (1% vs. 13%).

Hyperpigmentation: The literature echoes what I have always said, which is that prevention is key when it comes to the dark/red spots that acne leaves behind. According to authors of an article in the Journal of the European Academy of Dermatology and Venereology, “The primary treatment of PIH (post-inflammatory hyperpigmentation) is prevention and treatment of the underlying inflammatory condition.” The Regimen is the best way to topically prevent acne and it works remarkably well in people of Asian heritage. The authors go on to note, “In addition to prevention, there are a variety of medication and procedures used to treat PIH. Although topical skin-depigmenting agents remain the treatment of choice for PIH, lasers and light sources may be an affective adjunctive therapy or alternative for treatment failures. When treating PIH, any treatment options selected should be optimized and utilized carefully because the treatments itself may worsen the PIH.”

Accutane: A 4-year retrospective study in The Journal of Dermatologic Treatment looked at how well Accutane (isotretinoin) worked for Asian skin. They concluded: “This study reaffirms the overall safety and efficacy of oral isotretinoin in Asian patients with acne vulgaris.” “Safety” is a relative term here since we know that Accutane can and will cause severe birth defects if taken when pregnant. If you are Asian and considering Accutane, do it only in close contact with a trusted physician.

References:

  • Eimpunth S, Waniphadeedecha R and Manuskiatti W. “A focused review on acne-induced and aesthetic procedure-related post inflammatory hyperpigmentation in Asians.” Journal of the European Academy of Dermatology and Venereology. 2013; 27(1): 7-18.
  • Henderson MD, et al. “Skin-of-color epidemiology: a report of the most common skin conditions by race.” Pediatric Dermatology. 2012; 29(5): 584-9.
  • Gan EY, et al. “Isotretinoin is safe and efficacious in Asians with acne vulgaris.” Journal of Dermatologic Treatment. 2012; 24(5): 387-91.
  • Kundu RV and Patterson S. “Dermatologic conditions in skin of color: part 1. Special considerations for common skin disorders.” American Family Physician. 2013; 87(12): 850-6.
  • Shen Y, et al. “Prevalence of Acne Vulgaris in Chinese Adolescents and Adults: a Community-based Study of 17.345 Subjects in Six Cities.” Acta Dermato-Venereologica. 2011; 92(1): 40-4.

CrowdsourcingResearchers published a very interesting study recently in The American Journal of Clinical Dermatology to gauge how accurate data from crowdsourcing is when it comes to the efficacy of acne treatments. The researchers asked 662 online acne patients to tell them how well their treatments were working and then compared this to results from clinical studies. I found a few interesting things.

Responses from the crowd seemed to vary quite widely with clinical studies. For instance, only 46% of respondents from the crowd reported any improvement from tretinoin (Retin-A) compared with 80% of subjects in clinical trials. 64% of the crowd reported improvement from Accutane (isotretinoin) compared with upwards of 90% of subjects in clinical trials. 41% of the crowd reported improvement from tetracycline oral antibiotic therapy compared with 57% of subjects in a clinical trial. 38% reported improvement from doxycycline oral antibiotic compared with 50% of subjects in a clinical trial.

You may be noticing a trend here. As the authors of this particular study note, “For most…treatments, medication with high efficacy in clinical trials did not produce high effectiveness ratings based on the crowdsourced online data.” Why might this be? Could it be due to the inaccuracy in respondent responses outside the parameters of a clinical setting? Or could it be because the people funding the vast majority of clinical trials are the companies who make the products? Lest I get too high on my high horse, I do not think it is always the case that data is skewed in favor of corporations and profits. For instance, over the past 20 years, hundreds of thousands of pieces of input from people here at Acne.org show Accutane (isotretinoin) producing improvement for way more than 64% of people.

Something I very often find disturbing from results of acne medications, whether the data comes from the crowd or clinical trials, is the poor efficacy of the medications themselves. Who wants to use a medication which only helps 50% of people improve, and only improve somewhat? This is why I want the world to know about The Regimen here at Acne.org. It reliably gets almost everyone completely clear. That’s the kind of results people want.

So where do we go from here? I firmly believe that the future of pretty much everything is in crowdsourcing, and medicine is no exception. We know from Wikipedia that when enough people get together to share their knowledge, crowdsourcing can be incredibly accurate and valuable. I think the same can be true for medical information as long as we achieve a critical mass of people inputting their data. That’s one of the big goals of Acne.org and I hope we see more of this in the future across the medical spectrum. Join Acne.org if you haven’t already and add your voice!

References:

  • Armstrong A, et al. “Harnessing the power of crowds: crowdsourcing as a novel research method for evaluation of acne treatments.” The American Journal of Clinical Dermatology. 2012; 13(6): 405-16.

In all the years I’ve been researching acne, I’ve consistently read in most dermatology texts, “there is no cure for acne.” Until a few years ago, I echoed this prevailing wisdom in my writing for Acne.org. However, during my rewrite of Acne.org for our mobile-friendly web site–which is coming soon–I decided to start referring to Accutane (isotreinoin) as a “cure” more plainly in certain circumstances. This is not to say that I feel any differently than I ever have about Accutane. My personal opinion is that it is best left for more severe cases of acne, especially if one tends to scar.

Merriam-Webster defines cure as “a complete or permanent solution or remedy.” This is what Accutane provides for the majority of people who take it. Clinical research shows long-term remission of acne symptoms in approximately 2/3 of people who take an adequate dosage (1mg/kg). Therefore, I feel it is time for me to plainly use the word “cure” in certain circumstances when referring to Accutane, while at the same time noting that it cures most people, but not all people.

A still unanswered question?: I do not recall reading any studies on Accutane (isotretinoin) which follow up with participants past the five year mark, checking in on remission. If any of you have read a study like this, please contact me to let me know. If we do not have good data on this, then we cannot comment with complete certainty on long-term remission. However, anecdotally, based on years of input from Acne.org members, the effects of Accutane tend to be permanent.

A note on the permanency of Accutane: The permanency of Accutane is a reflection of the drug’s power, but also brings urgency to the need to consciously enter into a careful decision-making process alongside a trusted physician if you decide to pursue Accutane treatment.

Hey you guys. I’m a little concerned that people are asking how well Accutane works for less severe forms of acne. Accutane is only approved for severe acne, and I think for good reason. It is a very powerful drug and in my opinion should be reserved for severe cases which do not respond to topical treatment. If it were me, I would try the Regimen first and follow it precisely and get cleared up that way. The exception would be if I had an extreme form of heavily scarring acne on my face, neck, and body. Perhaps in that case I would directly consider Accutane. I want to see you guys all happy and healthy for years to come. Please consider your options carefully.