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Okay, so I'm doing it. Finally.
I'm buing my first box of pills tomorrow and starting from Monday. I'll keep you updated on how it is going, because I know that there are many people interested in low dose isotretinoin and that there isn't enough information about it. I'll write about the first effects after a first week of treatment. Now, I just want to share some backstory with you, so you'll have a better understanding of what I'm doing and why.
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I'm 17 years old, female. I've had perfect, non-oily, flawless skin without even one spot until i turned 16. Then things got worse. My face started to get oily (not super oily, but still, I need to fix my make up three times a day), I started getting blackheads and closed comedones and also inflamed spots. My acne woud be considered very mild - on my worst days I've had about 10 spots. My blemishes can be located almost everywhere on my face - usually forehead and upper parts of my cheeks but I also sometimes get them on my chin and nose. I almost never had any spots on my jaw and lower cheeks. I have no cysts or nodules and my spots do not leave scars. Still, even though I know that many people have much worse acne than mine, I feel disgusted with myself. I cannot enjoy life anymore, I'm always anxious and afraid of what my skin will look like the next day. Four months after my ance had started I was diagnosed with BDD (Body Dysmorphic Disorder).
I've tried many things, along with topical antibiotics. Zineryt worked perfectly for two months, then I switched to Clindamycin and that didn't do anything at all. My second course with Zineryt was also a mistake. I've also tried BP, azelaic acid, glycolic acid and topical retinoids - nothing works for long and some of them really irritate me. I know that probably I'll grow out of acne because I have the typical teenage kind of it. Still, I don't want my teenage years to be ruined by my BDD and anxiety. I'm managing my disorder through therapy and self-control. But I also want to manage my skin.
My dermatologist was never really afraid of Accutane and she suggested it very early into my treatment. I was reluctant at first but now, after a year of strugge, I want to try it. My starting dosage is 25 mg per week for the first month (5 mg pill every day for five days, then a break during the weekend - if my skin gets too dry, I can change it to 20 mg per week, so 5 mg pill every day for four days and three days break). After a month I'll get down to 15 mg per week (5 mg pill three times a week) and I'll continue this dosage for as long as I need to. I'm planning to take Accutane for a year and then see how I look and feel.
My derm said that on such low dose I shouldn't experience any side effects apart from skin and lips dryness and sun sensitivity. There also shouldn't be an initial breakout because my acne is mild and mostly non-inflammatory and the dose is so low. I need to take blood tests twice a year so not really often.
For the first month I'll use glycolic acid peeling every second day along with accutane and erythromycin cream for spot treatment. Later, I'm planning to stop using any topical products apart from a moisturizer and sunscreen.
So, wish me luck 
) I'll keep you updated.
5th day
No more Accutane this week. I'm having a two days break (Friday and Saturday) and then I start taking pills again on Sunday. Of course, I'm doing that because my dermatologist told me so - she said that this break can prevent me from experiencing too much side effects.
Does it work? Well, it does. I shouldn't see any difference because I've taken only 25 mg in total but the truth is, there's a difference. My face is almost clear. There's one small, persistent pimple, that appear a week before I've started Accutane and lingers there for almost two weeks - I hope it'll go away soon. There are also a few small, almost unnoticeable spots on my upper forehead/scalp and one deep, blind pimple near my ear (it can be Accutane related because I've never got things like that before). All of the other spots have faded very quickly. I've decided not to use any topical products except for a moisturizer because I don't want to irritate my skin. Even on such a low dose, my skin became dry. Not very dry, it's not flaky or peeling off, just kind of tense, I don't know how to explain it but I can feel that it's drier. Also, I do not get as oily as I used to. I still need to powder my nose during the day, but i noticed that oil appears later and there's less of it. As for the side effects, my lips started itching today, mainly the lower lip. They are also a little bit more red, especially the place where lips connect with skin (haha, I really don't know how to explain it). But it's not unbearable. Also, I've had slight joint and muscle pains, probably because I've been running after taking my pill (I was in a hurry and I needed to get somewhere in time, haha, I'm not doing any sports so I get tired easily). Apart from that, everything is alright.
14th day
End of the second week. Face is still quite clear, waaay better than before Accutane. That persistent pimple I've had on my cheek went away and now I'm only dealing with a small red mark. No inflamed acne on my cheeks, chin and forehead. I have a few small clogged pores but they are drying and going away very quickly, without turning into inflamed zits. Right now I'm experiencing a mild breakout on my nose - two zits, one is fading and one is fresh, red and quite visible, but nothing awfully big or painful, just a regular nose pimple. I also have a small spot between my nose and lips and a couple of small pimples next to my ears, where my hair starts - I blame my new shampoo. Overall, I'm not 100% happy but it's definetely working.
As for the side effects, they are a lot milder than in the first week. No joint pains or headaches at all. I've experienced some dryness, especially between my eyebrows and around the lips, but nothing that a normal moisturizer can't fix. Lips are a bit itchy but it's slowly getting better. I haven't notice anything else.
It's been 55 mg in total, 5 per day with a two days break every week. No topical products apart from erythromycin cream for spot treatment and a moisturizer (Xerial 5 Visage) . As a cleanser, I'm using Cetaphil Dermacontrol Wash because my skin is still more oily than dry. My derm sad that when I notice that my skin starts to get too dry, I should switch to Cetaphil Gentle Skin Cleanser.
27th day
It's been almost a month! I'm sorry for the long break but I've been to the countryside for holidays (without internet). I can say one thing: people with mild but persistent and depressing acne who feel that nothing works but their skin is not bad enough for accutane - ask for a small dose treatment, really. It works. After almost a month I only get one or two small spots that go away within a day or less without even forming a head. No painful deep pimples, no big whiteheads. Side effects are really unnoticeable. Skin is a bit drier, especially on the lips, but that's about it. Nothing terrible.
During my trip to the countryside I didn't use any topical products - not even a moisturizer. I only washed my face with a cleanser. My face looked great, only a little bit dry but when I started using moisturizer again everything went back to normal.
Also, I'm not getting oily anymore. I actually stopped using makeup, not even powder, because I look fine without it and it's just a waste of time. My hair is also less oily and I only wash it every two-three days, not everyday, like I used to.
it would be hugely helpful to post a picture of you before you started, I am not sure how much Accutane to take, as I class myself as having mild acne too, but some people on these logs literally have almost flawless skin to begin with and class themselves in the same boat as mild acne x
it would be hugely helpful to post a picture of you before you started, I am not sure how much Accutane to take, as I class myself as having mild acne too, but some people on these logs literally have almost flawless skin to begin with and class themselves in the same boat as mild acne x
i'm sorry i haven't answered yet, i was away from home.
unfortunately, i don't have any pictures of me before accutane because i never took pics of myself without make up, good light etc. anyway, i'll try to help. as i said, my acne was very mild - so something even less severe than mild. it was very persistent though, small blemishes took many weeks for me to go away and my face was literally never clear. i also used to get some deep, painful pimples sometimes (rarely), even though i don't know if they can be called cysts because they were a lot smaller than other people's cysts are. my skin was also really oily. i mean, i often see people with severe acne and skin not even half as oily as mine used to be.
overall, my skin caused me emotional discomfort, even though i know that by most of this website's users it would be considered almost flawless. my derm said that ultra low dose accutane is meant for people with very very mild acne which doesn't respond to other treatment (or responds only for a short time) and causes emotional problems. it can work with regular mild-moderate acne but it would take much longer to clear up and there is a lower chance that it clears up forever. if your acne is mild but not "almost non-existent mild", you can still success with a low dose, just not an ultra low one. 10 mg per day or even 20 mg per day is still considered a low dose and it results in less side effects than 40 mg or higher. it's always a good idea to talk to a dermatologist about it and work out a perfect dose (that works but doesn't give excessive side effects).
2 months, 5 days
(sorry for the long break)
i'm taking 5 mg every other day since the beginning of august, which is 15 mg / 20 mg per week. i'm experiencing no side effects apart from slightly dry lips. my face is not oily anymore but it's also not annoyingly dry. i feel like this is a perfect dose. during the last week i've had a mild breakout (three or four small spots on the cheeks and nose) but nothing very bad. before accutane my blemishes lasted for weeks, now they go away after a day or two.
at the beginning of august i've developed something of a cystic pimple on my chin - not big but it deep inside my skin, hard when i touched it and it hurt for a couple of days. later it didn't hurt anymore but it also didn't dissappear. after two weeks i went to my derm and she gently extracted its head (very small, my deep pimples usually have a little pus but big inflammation). it's not red anymore but there's still a small bump under my skin, visible when i smile very widely. my derm said that things like that can take even a couple of months to heal totally. but it's not very visible right now and i kind of got used to it.
also, before accutane i used to have occasional mild body acne from time to time - some spots on my chest, neck and back. my back was almost never totally clear, there was always a spot or two. nothing severe, but still. now, while on accutane, i haven't got a single blemish on my chest or neck since june. as for my back, i get an occasional small singular spot that goes away within two or three days (i've had maybe two of them during the past month).