28 replies to this topic

[axe114]

I know there are a few topics dealing with this but after reading so many I am still left with questions. 2 weeks ago I finished my second course of Accutane. I was on a low dose of 20mg/day for 11 months. Total cumulative dose was 120mg/per kg. Side effects while on it were minimal - usual muscle aches, dry lips and eyes etc.

Now, 2 weeks later, I feel a bit of oil coming back and have noticed a few small pimples and comedones appearing.

Just wondering would I be able to commence 20mg every few days or even 20mg per week for maintenance to keep the oil occasional pimples at bay? I've read a few people have has success with regimens like 10mg every second day or as low as 2mg a day. The reason I ask about 20mg every few days or once per week however is because I have a box of 20mg pills left over- the derm advised me that my treatment was complete before that box was finished.

[brokenreality]

Hmm, I thought Accutane users had to be on it for only 5-6months. I've never heard of being on it for that long.

Is your case more mild? =/ I thought it was dangerous to be on it that long, but then again you're taking a low mg... May I ask you why your doctor didn't put you on a higher dose?

-Michelle

[axe114]

As it was my second dose and my acne was more mild, the derm decided a longer term with a low dosage was the way to still get the same cumulative dose as one would achieve on a higher dose over 5-6 months. It was also was to reduce the side effects.

[wicky]

axe hows it going with the low dose and what did you decide to do? I just started on a low dose of 20mg once a week to help my comedo type acne. Im wondering if it will help and how long before I see results

[axe114]

I took a week of 20mg once a day to re-introduce it to my system now will reduce to 20mg per week and see how it goes. I'll keep you posted.

[wicky]

hows it going? mw skin is flakey already..ugh

[Hector12345]

Hello everyone,

This is my first post on this forum, Im Hector (26yo) I live in Lima-Perú and english is not my first language so... expect to find a lot of mistakes in my writings.... XD

well...I have been dealing with bad acne since I was 14 yo... I had acne on my face, on my chest on my back... even on my legs and shoulders.... I tried everything... (Antibiotics, adapalene, benzoil peroxide, etc etc) i even took Isotretinoin 3 times but on low doses (20 mg every day for about five months each treatment aprox).... but sadly, acne and extremely oily skin came back after 6 months... the positive thing is that it was not that bad as it was before... but even if theres just a few pimples on my back, they cause hiperpigmentation since im latin and my skin is darker (Hiperpigmentation spots can be there for years...)

So i felt really depressed when my last isotretinoin course finished and after some months i saw a few pimples ruining my back again... leaving their mark for years.... I thought my problem would be over... Im 26 and Im not a puber anymore.... but WTF this problem came back....

Thats why I start reading abouth long term treatments with isotretinoin, I read a lot of forums where people are doing this ...mostly on their owns, without a doctor prescription.... and they were having good results... even with really low doses like "2mg per day" others on "one 10mg pill per week" ...Then i found some reasearch where they stablished that this micro dose regimen was safe, and I also found that some dermatologist prescribe it.

So i thought, this is my last chance to fight acne, to get a normal life and to become happy again, like i used to be before fucking acne came to my life. I even considered to take another isotretinoin normal regimen and take another and another and another until my acne gives up (Without prescription) . But luckily i found this Microdose regimen....

I bought 60 "20mg" pills and i taking one pill per week since a month ago.... Now my skin is less oily and my acne has desapeared... Finally im seing a light at the end of this damn tunnel... Im gonna take this dose for about a year and if everything goes well im gonna tell my brother to take it too... i feel really bad for him.... he is dealing with the same acne than me... when i see him, its like watching myself years ago... depressed, isolated.... I persuade him to go to the dermatologyst and he gave him isotretinoin... everything is gonna be happy for him until 6 monts after the treatment... when acne and oily skin come back.

Hope this Microdose treatment will help everyone one day, and i hope that our experiences and suffering can help to make this regimen popular, thats the only way traditional medicine can focus on this, research and confirm long term microdose safety!

Bye!

Edited by Hector12345, 17 November 2011 - 07:50 PM.

[Conde de Montecristo]

I couldn't agree more. I am also on a 20mg routine, but daily. Side effects = minimal, basically dry lips, but nothing serious. I weight 76kg.

Why didn't I think about that 10 years ago? ( I am 31). I would have avoided a lot of scars.

In spite of being on accutane twice in the past (full treatment), long term micro/low doses seems to be a light at the end of tunnel.

Most likely people will say that it's wrong to do that endless... but you know what... I know what I have suffered in the past with millions of creams, oil and breakouts... Now scarring. I am tired of that.

[wicky]

Conde & Hector....how soon did it take before you saw results? I started 20mg once a week on October 1 and Im no better. I went on this dose
to help with the overactive sebaceous glands in my chin that were producing so many clogged pores. I thought I saw results 3 weeks ago but
in the last week my skin got severly dry and hundreds of clogged pores surfaced overnight...I dont know how to treat because I feel like I have
all this dead skin and gunk on my face after washing gently with CeraVe or other sensitive cleansers. I need to use a washcloth to gently
remove but am I making things irritated and worse? I had to pick at least 20 clogs out tonight and now I dont know what to apply to the area?

[Conde de Montecristo]

Wicky:

Day 7 so far. I used to have at least a pimple every 4 days (usually behind ears, neck, sometimes back or chest). Not a single pimple showed up since I started.

I do have sebaceous filaments on my nose. So far it didn't diminish the amount of junk. I am waiting for a month to complete and then, maybe I will jump to 40mg daily (20mg AM and 20mg PM)

Some advices:

1) Simply don't pick at all. Try to educate yourself. I know how it can be a temptation.
2) I don't use any creams anymore, just a cleanser/exfoliator on the nose 3x a week, usually after steam bath which i recommend 3 or 4x a week, It really help.
3) I think 20mg once a week is an extremely low dose treatment. I would try 10mg or 20mg daily. Maybe that's the problem. You should try all combinations, everyone is different.

Edited by Conde de Montecristo, 18 November 2011 - 08:16 PM.

[luc_nic]

hey conde...how long do you plan on taking 20mg a day for? ive just started my second course and although im starting at 10mg a day its just to ease it gently as it were and im working up to 40mg a day. i had thought about long term low dose following my first course but i didnt do it in the end as my derm said he doesnt usually prescribe that way. are you under a derm or doing it yourself?

[josie8888]

I know there are a few topics dealing with this but after reading so many I am still left with questions. 2 weeks ago I finished my second course of Accutane. I was on a low dose of 20mg/day for 11 months. Total cumulative dose was 120mg/per kg. Side effects while on it were minimal - usual muscle aches, dry lips and eyes etc.

Now, 2 weeks later, I feel a bit of oil coming back and have noticed a few small pimples and comedones appearing.

Just wondering would I be able to commence 20mg every few days or even 20mg per week for maintenance to keep the oil occasional pimples at bay? I've read a few people have has success with regimens like 10mg every second day or as low as 2mg a day. The reason I ask about 20mg every few days or once per week however is because I have a box of 20mg pills left over- the derm advised me that my treatment was complete before that box was finished.

H hey just wondering did you get any hair loss with the low dose??? x

[wicky]

not yet but I'm still awaiting the amazing results everyone is talking about. Its been 10 weeks at 20mg once a week and my chin is still clogging up. They are coming out but they are coming back....ugh

[josie8888]

hey i had the same skin .. i had average/bad acnee and the thing that bothered me most is the oil as it melts your make up!! ive been on a higher course or 40mg a day ( that worked like a mirical but caused hair loss ) a year later my oil came back with then caused the redness to skin... (which i hate!!!!!!!!!!! ) and ive been on the low dosage 20mg a week .. the 1st week i took 20mg in morning and 20mg at night to really kick start it... i would advise you to take it higher dose untill the oil and spots go.. and then you can literally take 1 a week and it will maintain it my bro takes 1 a month and that maintains his... that just proves how strong and effective actuane really is... the only side effect that worries me is the hair loss as i lost half of my very thick hair on the higher dose which started at the 3month mark!! scary stuff

[Conde de Montecristo]

Josie8888: I started with 20mg daily but now I am on 20mg a week and it is perfect. That way I can avoid dry lips and maintain my skin perfect.

This is the way. Wish you success!

[wicky]

I have sebhorreic dermatits as well and mine is so bad right now. Im wondering if its the accutane as that is suppose to help SD...any takers?

[Hector12345]

Montecristo: Nice to know that you are taking a safer dose....

Wicki: I think it took about a month and a half until i notice that my skin was less oily... before that, my acne actually got worse... but that indicates that the pills are working... just like with the regular dose.. then my acne slowly start to desapear... now its almost 95% gone... its not a problem anymore...

Josie8888: I didnt experienced any hair loss... i`ve taken isotretinoin 3 times, 20 mg per day for four months each... maybe i didnt notice....

TO ALL WOMEN: (PLEASE BE AWARE OF THE RISK OF TAKING ISOTRETINOIN AND GETTING PREGNED)

Edited by Hector12345, 09 December 2011 - 09:19 AM.

[Hector12345]

Low Dose, High Rates of Success

Ultra-low dose isotretinoin is all many acne patients need

San Francisco - Low and ultra-low doses of isotretinoin are an effective therapy for many acne patients. This safer and cheaper solution can even be used continuously.

Gerd Plewig, M.D., believes that the doses of isotretinoin typically used in the United States and Europe are far too high. For many patients, as little as 2.5 mg twice a week, which he describes as "a drop of rain on a dusty road" is adequate.

Dermatologists all over the world already are treating some patients continuously with low doses of isotretinoin, according to Dr. Plewig, director, dermatology and allergy clinic, Ludwig-Maximilian University in Munich.

"When you talk to doctors in this country and other countries of the world, they use 10 mg twice a week or three times a week, which is a low or ultra-low dose. But nobody ever bothered to show and demonstrate that it works," he said. Thus, he and his team performed two clinical trials to assess its efficacy.

Study Spotlights Low Dosing In the first trial, 28 patients with acne conglobata and inflammatory acne took a low dose of isotretinoin: 20 mg/kg, 10 mg/kg, or 0.5 mg/kg body weight daily for six months. In the second study, 11 acne patients took an ultra low dose of isotretinoin: 2.5 mg to 5 mg daily or 2.5 mg twice a week for six months. Both trials involved multiple endpoints, including clinical grading, lesion counts, counts of follicular filaments (believed to be precursors to lesions), bacterial colonization, patients' opinion of seborrhea levels, two objective measurements of sebum levels (Sebutape and Bentonite clay), qualitative assessment of sebum using high power, thin layer chromatography, and biopsies to assess size and configuration of sebaceous glands.

Trials Yield Significant Improvement Results of the first trial in which low doses of isotretinoin were used revealed significant improvements in all parameters tested. Numbers of follicular filaments, and lesions dropped, as did levels of bacteria and sebum. Sebaceous glands shrank, as well.

At the end of the second study, which investigated ultra-low doses of isotretinoin, efficacy was maintained on many of the parameters. There were significant reductions in numbers of active lesions and follicular filaments as well as objective measures of sebum levels. Patients' ratings of seborrhea improved, and levels of P. acnes on the skin diminished.

"The endpoint or the lowest point of a retinoid being effective for the treatment of seborrhea, persistent low grade acne, or maintenance therapy for patients with bad acne probably is around 2.5 mg or 2 mg, or maybe even 1.5 mg," Dr. Plewig said.

The best candidates for low and ultra-low doses isotretinoin therapy, Dr. Plewig said, include patients with severe acne who were controlled with higher doses and require a lower-dose maintenance therapy, individuals whose facial acne has persisted from adolescence into adulthood, and people with sebaceous gland hyperplasia. "Some patients come only because of their oiliness. ... For these patients, I think the low or ultra-low dose is very good, and it's cheap, too," he said.

Severe Patients Still Receive Low Doses Dr. Plewig keeps doses of isotretinoin relatively low in patients with severe acne. "I pretreat patients with severe inflammatory acne with systemic corticosteroids to begin with...about 1 mg/kg body weight for about seven to 14 days, taper it off, and then give an antibiotic, usually an erythromycin, a macrolide," he said. "And then I start with the isotretinoin [0.2 mg/kg to 0.4 mg/kg body weight]. It is so much better. We used to start immediately with isotretinoin or tried antibiotics, but often it takes too long, the patients are miserable, and it is so much better for them because you can have a faster final result, a better final result with cooling down the skin first, then adding your active treatment."

Continuous Use Offers Versatility A great benefit of using lower doses of isotretinoin is that it can be used continuously. There are other important advantages, as well. "In terms of pharmacoeconomics, it is cheaper to use lower doses, it is better tolerated by patients, has fewer side effects, fewer laboratory abnormalities, and of course the patients like it when they have continuous elegant treatment," Dr. Plewig said.

Despite the safer side-effect profile with low-dose isotretinoin, Dr. Plewig emphasized that, at any dose, the drug should still be considered teratogenic and be used with great caution in women of childbearing age.

http://www.dermatolo...il.jsp?id=65528

Prof. Dr. Dr. h. c. G. Plewig
Klinik und Poliklinik ;>für Dermatologie und Allergologie
Ludwig-Maximilians-Universität München
Frauenlobstraße 9 – 11
D-80337 München, Germany
Tel.: +49-89-51 60 60 00
Fax: +49-89-51 60 60 02
E-mail: Gerd.Plewig@;derma.med.uni-muenchen.de


Background: Excessive seborrhea, coarse-pored skin, minimal acne and oily scalp hair comprise a well-known clinical entity. It causes considerable concern, has social impact, and affects the quality of life in some individuals. Some patients seek treatment for seborrhea. No effective topical sebosuppressive medication is available. Oral isotretinoin is the only remedy for men. In women, oral isotretinoin is the most effective remedy, followed by antiandrogens.

Patients and methods: Eleven patients in three groups were treated for 6 months with very low dose isotretinoin. The influence on seborrhea was measured during oral treatment with 5 mg/d, 2.5 mg/d, or 2.5 mg 3× weekly.

Results: Sebum production, measured with Sebutape®, was reduced by up to 64 %. Acne lesions regressed by as much as 84 %. Follicular filaments were reduced by 66 %. Microcomedones were reduced on average up to 86 %. Quantitative bacteriology showed a reduction of Propionibacterium acnes but no increase of Staphylococcus epidermidis. Biopsies revealed a 51 % reduction in sebaceous gland size. With Bentonite™, a reduction of lipids was demonstrated with 2.5 and 5 mg isotretinoin/d but not with 2.5 mg 3× weekly. There was a shift within the lipid fractions: triglycerides dominated, followed by squalenes and free fatty acids.

Conclusions: Good results were achieved in all patients. The small number of patients did not permit a statistical analysis of the three isotretinoin doses studied, but there was a tendency toward better results with the two higher doses.
Zusammenfassung

[Conde de Montecristo]

I am taking 20mg twice a week now. (monday and friday at lunch time).

My sebaceous filaments in the nose are gone for good. Unbelievable. I really wasn't expecting this.... after so many failures.

Besides, dry lips are completely manageable due to low dose. It is not dry at all.

[luc_nic]

hey conde
hows it going?
im so interested in this. im 24 and took a full course 4 years ago which worked great but a couple years later i started breaking out. im currently on 20mg a day to get cleared up and im debating whether to up to 40mg and do another full course or go for something like you are doing and stick with that. how long do you plan on taking it? i figure id have to for some years. my acne is mild mostly, moderate at times.
any advice/feedback really would be great! love the profile pic by the way lol