Ultra Low-Dose Accutane Users, Help!accutane low dose prescription help ultra isotretinoin maintenance
Posted 13 September 2012 - 10:18 AM
Posted 13 September 2012 - 10:53 AM
I'm new here but, sadly, not new to acne. I'm 32 and have suffered with mild to moderate acne and extremely oily skin since I was about 15. As a fitness and grooming consultant (at Smart Body Image) the last thing I need is a face full of acne when meeting clients.
My skin has been consistently clear for the first time since 2011 when I finally decided to give ultra low dose accutane a try. To cut a long story short, I've managed to get my accutane dosage down to 10mg twice a week with the addition of Isotrex every other day and a salicylic acid cleanser morning and evening.
What I wanted to highlight is that, despite having extremely oily skin, I've been able to normalise my oil production with only 10mg twice a week. I think the Isotrex plays a small part in reducing oil production but I can tell you from a recent trial that it's nowhere near as effective as the accutane.
Having said that, I did find I needed to increase the dosage to 20mg twice a week (with everything else the same) when I lived in a tropical climate but I guess that's to be expected.
The only side effects I experience are dry lips. I used to have dry eyes too (even before accutane due to Blepharitis MGD) but I've found that taking a high dose of Omega-3 (usually from Flaxseed) keeps that under control.
Anyway, hope that helps somebody.
Thanks for sharing your story and results. It's always good to hear someone who has had success with the long term, low dose treatments!
40mg twice a week is ridiculous. The chance of accutane curing your acne is directly proportional to the size of the dosage, you should be doing 40mg a day.
Listen, many others, myself included, have already gone the standard dose Accutane route; the one that's supposed to "cure" the damn thing. Well, it didn't work for me and I was on exactly 40mg a day for the 7 month duration of the course. Acne came back and I did my research on other methods. Long term dosing of Accutane at low doses, e.g, 20mg twice a week (or even less in some cases) has shown significant results in clearing acne. Is it as successful at long term remission of the acne? Maybe not. But my goal isn't the long term remission, I want to be clear for one or two years so that by the time I stop taking the pills I wont have acne any more (hopefully).
Low dose Accutane is the norm is most countries other than the United States. Obviously it isn't too ridiculous. Please don't come here and criticize what quite a few people are partaking in.
I want this thread to offer advice or help to other LOW DOSE Accutane users. There's no place for criticisms unless absolutely constructive.
Posted 13 September 2012 - 10:57 AM
40mg twice a week is ridiculous. The chance of accutane curing your acne is directly proportional to the size of the dosage, you should be doing 40mg a day.
That's not entirely accurate. According to the clinical data, the chance of curing acne is proportional to the total cumulative dose relative to your body mass.
The recommended dosages are therefore based on your body mass and achieving the required total cumulative dose in a certain period of time.
There is no clinical data to prove that lower dosages over a longer period of time can also cure acne, nor is there any to disprove it. Since the side effects are much more tolerable at lower levels, it makes perfect sense to try a low dose regimen.
Additionally, it is well documented that oil levels return to their previous levels (or close to their previous levels) following cessation of treatment with accutane so, if excessive oil production is the major problem, a low dose, long term regimen is by far the better option in terms of quality of life for the patient.
Posted 18 September 2012 - 12:57 AM
10mg/day the first month. Started to see some clearing and mild side effects.
20mg/day til March (7 Months). This was the bulk session of my dosage. I build up alot of accutane in my system to attempt to end my acne completely.
20mg 3/week (March - Present). I realized 8 months was a long time to be on accutane, even if it is low dose. My acne was 98% gone, with occasional clogged pores being my only issue. I decided to lower the dosage to 3 20mg pills per week (Tues Thurs Sun). This is my current dosage. It has kept my acne away, I average 2-3 pimples a month that go away extremely quick.
I have 2 20mg pills left, then I'm stopping. I'm getting Lasik surgery done in a month and you don't want to take Accutane while getting that surgery done because of how it dries the eyes. I'm nervous about stopping this drug that has essentially ended my acne problem that was killing my self confidence for years. I figure it's good to give my body a break and see how I react. I could always return to an ultra low-dose in a few months after my eyes have healed.
I recommend low-dose accutane to anyone who has persistent acne. Severe acne might be more responsive to normal doses. It was the best decision I ever made for my acne. Some people have great results with 20mg/week with time. It's not gonna be an instant cure, but you will progress. Anyone who is worried about side effects: There's a great product called HYDRAPLENISH that battles most of accutanes side effects without interfering with the medicine.
Posted 18 September 2012 - 10:40 AM
Would be interesting to know how it works for you too, having been clear on a low dose accutane regimen.
Posted 18 September 2012 - 11:25 AM
Edited by AKanel, 16 August 2015 - 09:56 AM.
Posted 21 September 2012 - 09:14 AM
Edited by AKanel, 16 August 2015 - 09:56 AM.
Posted 16 November 2012 - 10:36 AM
A little about me. I used to be considered to have moderate acne that was only on my face. I have also taken 6 months of accutane from September of 2010 and stopped in April of 2011. My face was pretty much clear after finishing accutane but would get a few cystic acne here and there. My derm said that it was normal. For the past four months I began to break out. First it started with small white pustules and a lot of weird looking bumps on my chin that seemed like mini dried up white heads. I never had that before!! Anyhow, I tried a bunch of topical stuff and two different antibiotics with no success. For the past month though I broke out on the right side of my face like I've never seen before!! It looks beyond hidious. Anyhow, I went to the derm over here (moved from the states to Egypt) and he is putting me on accutane. In the US I took 40 mg for pretty much the whole 6 months but I remember there were months at the end of my treatment that my derm made me take 2 40/mg pills. Anyhow, my derm here has me on 20 mg/day. Its much lower then before and have been contemplating about just taking the same dosage I took before but reading your posts, I'm tempted to try the low dose of 20mg/day and just take it for a longer period of time.
I have an advantage here because I don't have to keep going to the derm to get a prescription and don't have to do the whole ipledge thing. I already take b/c for acne and am not sexually active anyhow, so I'm not worried about preg. Therefore taking it long term shouldn't be a problem.
I was wondering if anyone here has some advise on what side effects I should see with a lower dose? Before I had the dry lips and some joint discomfort. Don't recall anything else. But its a different generic of accutane, so I'm a bit worried about getting different side effects.
Also, how long should I begin to see results? would it be quicker compared to my first try at accutane?
Any other pointers that anyone can think of would be just great!
Hope to hear from someone considering I'm posting kind of late.
Posted 16 November 2012 - 11:12 AM
If you want my opinion, definitely take the opportunity to do a lower dose course. To answer your questions:
- In terms of side effects, at that daily dosage, albeit lower than most courses, odds are that you will still see the same side effects as you did while on 40mg per day, just less severe. But, there are a few things you can do to lessen the side effects significantly, for example taking a hyaluronic acid supplement which all but eliminates the joint and lower back discomfort and even helps with the skin dryness (it is the same ingredient in the HydraPlenish that GatorsFan mentioned a couple posts up). Another thing you can do, which is common knowledge in my book, is drink a ton of water! Water helps with everything when it comes to moisture levels of the body, don't stop drinking the stuff all day! Also, vitamin E and vitamin K supplements help greatly to balance out the large amounts of vitamin A derivative in your body, thus again, reducing side effects.
- When it comes to how soon you should see results, just remember it varies greatly from person to person! Some people see significant results in 3 - 5 weeks, while others are left waiting until a few or more months in. One thing that has been documented in studies, though, is that the end result, around 6 or 7 months in, low dose accutane has shown about the same clearance percentage as higher dose courses, all with less side effects and a minimal initial purging, if any. If the studies are correct and the stories of people on this website hold true, mine included now, the route with less side effects should sound SIGNIFICANTLY better.
- Would it be quicker? Like I said above, everyone is different, but generally the end result between those on high dose and those on low dose is generally the same. That said, the beauty of low dose accutane is that the body responds so much better to a slow, gradual accumulation of the drug in your system.
Just an update on myself, now that I am around 4 months in, I rarely break out anymore and when I do have lingering flare ups, they heal relatively quickly! It's a nice feeling and I only look forward to having even better skin in another two months. The last remnants of comedogenic acne and minor clogged pores still need to make their exit!
Also, secretsky see if your dermatologist wouldn't mind prescribing a couple months of cephalexin antibiotic when you start your course. It was the one antibiotic that ever helped me get clear and fast! This was a beauty for me because it allowed me to get clear of inflamed acne in the beginning of the course and just let the accutane set in without worrying about any initial purging or anything of that matter! It may seem scary taking an antibiotic and accutane in the beginning, but I noticed no extra side effects except for increased happiness knowing my face was clearing right off the bat!
Take care and let me know what you decide!
Posted 24 November 2012 - 06:53 AM
And Thanks for the tips that you gave me though! I have been taking vitamin E and Vitamin D with calcium (I have low vit D). I drink as much as I can. Whenever I can get a sip in. I use Cerave moisturizer and aquafor for my lips. So I got myself covered since I do have experience of some of the side effects from the last time I took it.
I have a few more questions though, if you don't mind.
When you started accutane how would you classify your acne? Are you under the supervision of a Dermatologist? I personally used to get 3-4 cysts (I mean huge ones) every so often when I first went on accutane. The reason why my derm put me on it was because it was persistent and nothing else worked. Plus I was going off of insurance and would no afford any sorts of medications in the future. Hense the first round of accutane of 40 mg for most of the time then 80 mg the last few months. I have recently moved overseas (Egypt) and things here are much different from what I am used too. I can actually walk in to the pharmacy and just get isotretinoin!! WOW, I was shocked. Nothing here is regulated but hey, in a way it works for me, right?! How ever I DID go to a derm here and he also prescribed it for me but at 20mg. But because its easy to get a 'pack of pills' I thought to just go back and get more to take my original dosage of 40 mg which was why I posted on this blog ) You see, also my acne is worse then it was when I first took my first round in the US. My whole left side of my face is FULL of cystic acne. I never had that before. I'm thinking that 20mg will barely break the acne plurge at this rate if 40mg didn't kick it out of me in the first place. You see what I mean?
I am 9 days into taking accutane. The first week I rotated between 20mg/day to 20mg twice a day (total of 30 mg in a day). Then yesterday I decided to just stick with teh 40mg since I've already gotten three new cystic buddies. So, are you saying that if I stick at a low dose I may not get the acne flare up that I already seem to be getting? Now I'm thinking to just stick to 20mg and see how it goes...hmmm. I'll have some thinking to do I guess.
I will say however that the acne that DID exist is no longer painful and are just bumps (kinds hard though). I haven't picked at anything even though I'm so damn tempted too but I'm worried about scaring. Why?! because some of my acne that did go away since starting still has a red mark even though pimple is gone. I NEVER had that before when my acne healed. So it seems that accutane has a longer 'healing' process as well, but I could be wrong. It just seems that way for me.
So how many mg do you take? Do you take it daily? When did you start to see a significant improvement in your acne? Do you have any tips for the red marks by any chance?
Well those are all the questions I can think of right now. Thanks again!
Posted 28 November 2012 - 09:57 AM
- When I took my first course of Accutane back in 2010 (normal dosage course) I had moderate/moderately severe acne, characterized by inflamed pustules and papules with 3 or so cysts at a given time. All of the acne was located on my cheeks, so I was not plagued all over. Also, I have been lucky in my life to have a completely clear back and chest, which I have always been thankful for.
- Since my first course, yes I have been under the supervision of a dermatologist. She alone has been the one prescribing me medications and helping me in any way she can.
I am sorry to hear that your acne is worse now than it was before =[. My acne came back after the first course but was not as consistently bad as it was before and cysts were all but completely eliminated. I still had bad periodic breakout of inflamed acne, but they were not as severe as before.
When it comes down to how much you think you should take, it depends on whether you are looking for remission of your acne (which a lot of us "second coursers" know isn't always the case) or for long term clearance with long term low-dosing. Studies like that from Dr. Plewig HAVE shown that it doesn't matter whether you are taking 40mg or 10mg, or even less in some cases, clearance of your acne can be achieved around 6 - 8 months. However, it is during that time frame that high dose courses are ended and typically show permanent remission of one's acne. If you are like me and don't have confidence in your acne going into remission, I would keep it around 20mg a day or maybe 40mg every other day, and then once 6 months comes around and you see that you are clearing those final pores, drop it even lower maybe to 20mg twice, or even once, a week and continue on that road with clear skin as you see fit.
There are many people in the Acne.org community who have had amazing success with long term, low-dose Accutane. There are even instances on this site where individuals have taken 10mg a week for upwards of 5 years (gulp!) with no noticeable side effects. I am in no way advising that, but it just goes to note.
Now that I am at my 5 or so month mark (I've lost track a little) I too can say that I am - with the exemption of lingering comedones and the occasional pimple - acne free thanks to only 100mg a WEEK. So, basically, during a given week I may take it every day, I may take it every other day, it all depends on side effects for me. That's part of the beauty of a low dose course is that you can control it more. It took about the 4/5 month mark to really notice that I was not really breaking out anymore and for weeks now, I have been a happy camper.
As for my advice on the red marks, I would suggest using an alpha hydroxy product, like Dan's AHA+ which helps with the resurfacing of the very top layer of the skin. It could assist in speeding up the fading of those marks. If not that, believe it or not, anything that hydrates the skin, heals the skin, so drinking a lot of water and maybe even looking into the Hyaluronic Acid I talked about in an earlier post would help you!
Hope I could help again!
Posted 29 November 2012 - 03:01 PM
My advice: tolerate the high dose, eventually your acne will reduce- it will take months (maybe 7 or 8). Roacctune is such a powerful drug and it dries up your oil glands. No acne can survive that. Just keep going on, at the high dose that you have been prescribed. Eventually you will notice that while you are still getting pustules and acne which LOOKS just as severe, the pressure may not been built up underneath those pimples. It will take months, but stick to the high dose and be stubborn. When your face is eventually clear (maybe after 7 months), THEN stay on the high dose. Keep it clear. Once your skin is stabilised and you can count on your face being clear, THEN go onto the lower dose.
Since the age of 12 I have had severe cystic acne, mainly on my forehead, cheeks and then it progressed to my back.
The dermatologist put me on the contraception pill Diane, which only made me gain 13kg and didn't affect my acne.
When I was 15 I went on my first course of roacctune. I was taking 40mg a day for 9 months.
At about the 6 month mark i was completely clear.
As soon as I went off it the acne came back - just as bad.
I went on another course, finishing when I was 17.
After about 4 months it came back again.
This time I went on a higher dose of 60mg a day for about 9 months. But i realised I was running out so I rationed it a bit and made it last longer. It trickled down to a very low dose, maybe 40 or 60 mg per week. Then I ran out.
About 2 or 3 months later the acne came back.
This same cycle happened over and over again for 8 years.
When I was living in London the NHS wouldnt prescribe it to me. I was beside myself. I was going to fly home to australia to see my dermatologist just to get prescribed it, and then return to London. (I swear the pollution in london was making it worse).
I ended up going home and the next day I went straight to my derm who prescribed me 60 mg per day. But advised me to "take it how it works for you" so i ended up taking a lower dose, higher at the beginning until I got the acne under control and then slowly trickle it down to a low dose to maintain the clear skin.
I ran out, it started coming back. I moved cities but my derm referred me to a new derm and she was shocked and appalled that I had been on an official dose 60mg per day. She said thats what she would put a 100kg male on.
I hadn't had any side affects. Cracked lips were the worst it ever got, and I just needed Carmex lip balm for it. Once I had run out of Carmex for about 4 or 5 days and my lips became cracked and started bleeding. Nothing else would work on my lips.
Now that I'm on the lower dose, I just get dry lips, I take Carmex with me everywhere. I can go about 3 or 4 days without it, but I do need it (even on this low dose). Luckily you can buy it everywhere.
I am officially on a dose of 10mg per day now, but realistically I take somewhere between 120 - 200 mg a week. Just before my period I take about 40mg per day for a week.
I am worried what will happen when I run out of the roaccutane and have to take the normal dose I have been prescribed 10mg a day.
I am so grateful for accutane. I has saved my life. Far from leading to depression, it has saved me from depression. I now take pride in my appearance and I feel confident. It's the most horrible feeling in the world trying to hide and cover your face.
I cannot recommend it highly enough, this has turned my life around and changed me from being a shy, introverted child who hated herself, to a confident woman. I am able to stand up and be proud, in my workplace, at my uni, and in my social life. I am not afraid of what people will think of me, or how many pimples I will wake up with in the morning.
Edited by catiecatie, 29 November 2012 - 03:09 PM.
Posted 02 December 2012 - 10:01 AM
Your situation seems very similar to mine. The acne I have is located on my cheeks and lower chin too. I mean, I wouldn't call it bad, but I just never use to have this many all at one time. It would just be about 4-5 every month over my face. Now its about 11ish, hence me saying its worse. I also don't have any acne anywhere else on my body except cheeks and lower jaw.
I did get the cephalexin though. It seems to be helping with the acne. The swelling has gone down some what and I only have one new buddy that seems to be disappearing quickly. I hope it continues to go this way honestly. Since I last talked to you, I only have two of the cysts that existed left (besides my new buddy).
Did you by any chance notice that while on accutane your cysts came to a head? Mine never did before, they were just hard painful bumps. I dont' know, this times acne episode just seems different from the last time I took accutane. As bad and disgusting as this sounds, I actually popped those pimples that came to a head. I normally don't do that, but they were just not going away and I really couldn't help myself. The other thing that's annoying me are these small white bumps. They seem to be getting a bit more to the surface so they look bigger. Any pointers on that? It doesn't seem like pimples honestly, it seems more like a case of milia. I wonder if accutane gets rid of milia or not?
I think the change in environment has significantly affected my acne. Which is why I have it a bit worse then I used too while in the US.
I have now, from your advise, gone down to 20mg/day along with cephalexin.
Hey, how long did you take cephalexin? Did you stop taking it already? I'm asking bcs I went out and got the cephalexin myself. Remember, things aren't regulated here. So I am just curious how long you stayed on it.
One more thing, you had mentioned a question of sexual dysfunction. I've also read people say they've lost total interest in sex. Since you've been on it for almost 5 months now, did you notice any difference? I'm just curious because I did notice that I'm much 'drier' then I normally am even though I'm not sexually active. And I thought it could be from the accutane. Plus, I'm in a relationship and we may go to the next level. So I'm just curious.
Thanks again for your responses. And please keep in touch! It's nice to talk with people who are in the same boat as you )
Catiecatie, thanks for your input. I appreciate that. I see your point of view and in some ways I do agree with it, but since I already took the FULL dose of accutane and it didn't really do much, I'm thinking a low dose may get rid of the acne I have and if I stay on it long term, then it will eventually stay away. Besides medically speaking its the total mg/kg that you take in the end that matters, whether you begin with 40 or 20. If you take 20mg then you'll just be taking the accutane for a longer period of time. You can goodle 'low dose accutane' and you will find that their have been many studies to prove that it is just as effective as a high dose. Except the side effects may not be as bad as with a regular dose.
Take care all, and thanks again!
Posted 02 December 2012 - 11:39 AM
I didn't really have any cysts come to a head. Any real cysts on my first course got larger at first and then simply sunk into the skin. Maybe what you believe are cysts are actually just extremely inflamed sub-surface pustules. But again, Accutane's effects can be different for everyone, so they may in fact be cysts that are coming to a head. In terms of the white bumps, I would assume that they are either tiny pustules coming the surface, or they are comedones that, again, are coming to the surface. Keep an eye on them, but I would suggest a delicate glycolic acid like Dan's AHA+ (that I had mentioned in my previous post) to help them purge faster.
Keep in mind that, yes, your environment can greatly affect your skin, acne, complexion, etc. And one of the larger causes of environmental effects of skin can be severe changes of climate. Give your system time to adjust to the new environment and it should calm down. I experienced this same thing when traveling to dry climates in Europe, like Greece, from Florida.
The sexual dysfunction issue I was having was merely something in my head, I have remedied it since the post about it. I was reading things online and had a bit of a hypochondriac moment thinking that something was actually happening to me. The male equivalent to being not as wet, is being not as "hard" (pardon the terminologies everyone). Literally ONE time I had less hard member than usual and I got myself all worked up about it, worrying that I was going to be a 19 year old male popping Cialis. This luckily was not the case and both my girlfriend and me are happy about that =P. Trust me when I say this, don't get worked up about being drier on occasion. If anything goes for fluids in the body it's drinking more water. Drink plenty, way more than you're used to and you should be fine! Also, I don't know if you are, but don't get yourself worked up about stuff like I did, it only makes it worse. Talk to someone about it if it's a problem, particulary the person you are in a relationship with, it helped me realize I was being crazy lol.
So, continue on the track that you're on and you will be a happy camper soon. You can only look forward to it!
Posted 04 December 2012 - 08:14 AM
How much dosage are you currently taking?
I'm currently on 20mg a day until the end of December. In January I will only be taking 20mg twice a week and continue on that course for another month, at which point I may drop to 20mg once a week for maintenance.
Posted 04 December 2012 - 01:58 PM
It's honestly nice to have someone to relate to going through my second course of Accutane. I appreciate it, a lot!
So, I've noticed that I'll wake up one day and see a 'good' face in front of me, and then another day its just HORRIBLE!! I got a few more bumps on my face, but they don't hurt at all, its weird.
Yeah, water is a big issue for me. Its a struggle to get a lot of water in my system with a busy schedule. But I'm trying my best.
Again, because of where I am now, my resources are limited. I do however have a face wash that has glycolic acid and I also have a lotion that is 3% glycolic acid. Do you think those would be ok to use while on accutane? Glycolic acid wasn't harsh on your skin? How many times a week did you use it?
I'm dieing for a clear face right about now. Blah, it just looks hidious its not even funny. All these bumps! I'm praying I see more improvement SOON!
Well, thanks again. And I hope we can stay in touch to share our progress )
Posted 04 December 2012 - 02:14 PM
In regards to the AHA (glycolic acid) I was able to use Dan's formula which has 10% glycolic acid with no problems. It actually helped to moisturize my face when it getting more dry. When I was using it, I would put it on every night in place of my Vanicream Lite lotion. I have incredibly sensitive skin and AHAs are nice because they are generally easy on an individuals skin.
Just stick with it! Once your face is clear you'll look back on those weeks where you felt like nothing was changing and be so happy that you stuck with it and fought on!
I hope only the best for you.
Posted 04 December 2012 - 10:14 PM
Posted 07 December 2012 - 12:47 AM
Words of encouragement will really help today!!