7 replies to this topic

[luc_nic]

Hi everyone

Can anyone help me out. Id like to know if taking 20mg a day for 6 months will be equal to 40mg a day for 6 months in terms of long term remission?

Basically is it JUST the cumulative dosage thats important, regardless of the time frame, or is there something else about a shorter higher dosed course that makes it more effective?

any ideas would be great!!! thanks

[luc_nic]

sorry i meant taking 20mg a day for 12 months not 6 months

[nomit]

Your dosage is typically determined by taking into account the severity of your acne, and weight (as isotretinoin is a fat soluble substance). Most people will be on courses of about 0.5mg/kg/day (upwards of 2mg/kg/day) for 6 months. Though you can get away with a 12 month, low-dose course (20mg/day, for instance), it's unlikely to make a huge difference when compared to a regular-length course.

For most people, 6 months of Accutane's side effects are more than enough, and their acne will have usually gone into remission by the end of it, anyways. That said, isotretinoin's adverse effect profile is directly correlated with its dosage, and so obviously those taking only 20mg a day will experience far less severe side effects.

What type of dosage you'll be put on is between you and your doctor. Usually, if your acne is nodulocystic and scarring is an immediate concern, an agressive high-dose course will be initiated over some 5-8 months. If your acne is persistent but ultimately mild-moderate in nature, a low-dose course for anywhere from 4-12 months.

I'm not sure if these studies will help you, but they may be of interest nontheless:

• http://www.ncbi.nlm....pubmed/21198520
  
• http://www.ncbi.nlm....pubmed/16546586

[luc_nic]

thanks for the reply nomit and the links to the studies.
i did a regular course course before at 30mg for 8 months (i weigh 55kg) ande it worked great. that was 4 years ago and im now having problems again. my derm is very easy going and i have alot of say in my dosage etc. im not experiencing any side effects at 20mg and would happily stay on for 12 months if it continues this way, but i wondered if id be less likely to have long term remission doing it that way instead of the aggressive high dose course as you described. my acne now is mild really but i get cysts now and again, it was moderate before my first course

[luc_nic]

any other thoughts?

[nomit]

High-dose, regular-term course has the best chance of producing lasting remission (especially since it's your second one). Just be aware that if you are going on a higher dose (typically 60-80mg/day), you'll experience much more severe side effects than you did previously - a good reason why many dermatologists prefer lower dose courses.

[luc_nic]

yeah thanks nomit.
i sometimes have problems with flushing and im a little concerned about developing rosacea from high doses of accutane. but at the same time im desperate to get my acne sorted. ive read that accutane is actually prescribed for rosacea in low doses due to its antiinflammatory properties, typically 10mg a day or a few times a week. seems some people take this dose long term too for a year or two at a time. any thoughts on this?

[nomit]

luc_nic, on 02 January 2012 - 05:33 AM, said:

yeah thanks nomit.
i sometimes have problems with flushing and im a little concerned about developing rosacea from high doses of accutane. but at the same time im desperate to get my acne sorted. ive read that accutane is actually prescribed for rosacea in low doses due to its antiinflammatory properties, typically 10mg a day or a few times a week. seems some people take this dose long term too for a year or two at a time. any thoughts on this?

Isotretinoin's effects on rosacea seem to be a little paradoxical, particularly in the case you mentioned (where it's prescribed to treat rosacea). Isotretinoin's mechanism of action isn't completely understood, and neither is rosacea's pathology. The exact manner by which rosacea is aroused by isotretinoin (or if isotretinoin is even the true cause) remains eluded, as is the exact etymology of rosacea and the manner by which it progresses. One recent study of potential interest to you examined the potential mechanism of action of isotretinoin (systemically): http://www.ncbi.nlm....les/PMC3219165/

As you seem to be aware, higher doses can increase your chances for developing rosacea. That said, rosacea and flushing are not synonymous, and the correlation between the two is practically non-existent. Flushing (in its benign form) won't put you at any higher risk for developing rosacea than any other patient.

Whether or not you think the potential for long-term clearance outweighs the potential for developing a progressive rosacea (in addition to the other, numerous side effects) is a decision for you and your doctor.

Good luck.

Edited by nomit, 02 January 2012 - 09:33 PM.