Please... No one knows? = (

Hey,

If you wanna do low dose here are some studies. They are more about taking a low dose continuously. I am currently taking 60mg week, which is about 8.5mg week. I'm not sure about the remission part. I have previously had 2 courses at 60mg and relapsed, hence I did not want to go down that path again.

Source: http://www.blackwell...33.2000.03626.x

'Microdose' isotretinoin

* R.A. Palmer
* S. Sidhu
* P.G. Goodwin

* Department of Dermatology,
Christchurch Hospital,
Fairmile Rd,
Christchurch,
Dorset BH23 2JX,
U.K.

S ir, It is our experience that some adults with acne vulgaris respond to extremely low doses of isotretinoin. Such low doses, used continuously, may be a good way of treating patients who relapse quickly when they cease taking standard doses of isotretinoin.

The dose of isotretinoin used to treat acne vulgaris is often 0A5a1 mg kg-1 d-1, for approximately 4a6 months, to produce a cumulative dose of > 120 mg kg-1. 1 Adult patients with acne tend not to have severe disease and are often successfully treated with relatively low doses, such as 0A25 mg kg-1 d-1, 2 or 0A5 mg kg-1 d-1 taken 1 week in 4 for 6 months. 3 The lowest dose we could find in the literature is 0A1 mg-1 kg-1 d-1A4 We retrospectively report eight patients with acne vulgaris, controlled by continuous treatment with a single 20 mg tablet, taken once or twice a week; we calculate they are receiving doses of 0A04a0A11 mg kg-1 d-1. Details of their treatment are shown in Table 1.

These patients developed acne between 14 and 32 years ago. Prior to treatment with oral isotretinoin they had acne of moderate severity. Two patients had predominantly truncal acne, which is known to be associated with a relatively high relapse rate after isotretinoin therapy. 5 With treatment (20 or 40 mg d-1), all patients became clear or almost clear of acne. At least six of our eight patients experienced side-effects, such as dry lips, which were severe in some cases.

After stopping treatment they relapsed, often within a few weeks, on several occasions, developing acne of mild severity. Usually, conventional measures of treating relapse (topical therapies and systemic antibiotics) were not used, because their efficacy was perceived by dermatologist and patient to be inferior to oral isotretinoin. Relapse was treated by restarting oral isotretinoin, at successively lower doses. All patients currently have no acne or minimal acne while taking a single 20 mg tablet once or twice per week. They report enormous psychological benefit. Stopping this treatment results in recurrence of mild acne.

Two of our patients have reported mild dry skin or eczema, thought to be due to treatment with 'microdose' isotretinoin; the others have no symptomatic side-effects. Isotretinoin therapy can elevate serum hepatic enzymes and lipids and cause adverse skeletal effects, including diffuse idiopathic skeletal hyperostosis. The latter may be detected with a lateral cervical or lumbar spine radiograph. The patients with the highest cumulative doses were investigated for these side-effects when their cumulative doses were between 174 mg kg-1 and 310 mg kg-1. In the four patients tested, no relevant abnormalities were found. However, a previously reported patient with perforating folliculitis 6 now treated with this regimen has a slightly raised serum cholesterol (5A79 mmol L-1, normal range 3A30a5A20); her pretreatment serum cholesterol is unknown. Treatment is on-going in all patients.

Continuous treatment with 'microdose' isotretinoin has several theoretical advantages over intermittent standard-dose treatment. In the latter type of regime, patients restart treatment when their symptoms return; therefore by definition, they are not continuously free of disease. The incidence and severity of symptomatic side-effects is very low. Continuous treatment with a 20-mg tablet once per week in a 70-kg adult produces a cumulative dose of under 15 mg kg-1 year-1, which is sufficiently low to be unlikely to cause long-term side-effects, but is an unlicensed method of administration. It costs approximately A52 per year, and can produce enormous psychological benefit.

We recommend that dermatologists consider the continuous use of very low doses of isotretinoin, particularly for adult patients who have repeatedly relapsed after stopping standard doses.
References

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

check out the faq by biggs

Thanks guys. Much appreciated. I want to start with 10 mg and possibly work up to 20. If it makes my acne at least become mild then thank gawd.... I actually don't mind having spme pimples here and there but not moderate scarring acne.

Hi elkhoundgold,

I had an appointment with my derm on Monday (it's been 2 months since I started Accutane). He has bumped me up to 100mg week (which works out to about 14mg/day). I am around 160lbs. I was under the impression we were doing a low-dose long-term maintenance course, but he is actually trying to put my acne into remission on this low dose. It is the European way of using Accutane, a low dose for a long time. He said once I have got to the stage where I haven't had any new pimples for a 2 month period, he will stop the Accutane and see if this has put me into remission. So it is possible to achieve remission on a low dose such as 10mg - it just takes longer.

On 60mg I have still been breaking out, so hopefully 100mg/week will be able to keep me completely clear, and then if I stay clear on it for a while, I can stop and test if it'll give me remission. My side effects have been extremely mild on 60mg week, just slightly dry lips and dry skin. My previous 2 courses on 60mg/day absolutely sucked all the moisture out of me - my lips and skin were bone dry, it's much more mild on the lower dose.

I understand in the US they do not prescribe low dose as much. I am in Australia, I'm not sure how widespread low dosing is here, but my derm prescribes both high and low dose.

Thanks guys. Much appreciated. I want to start with 10 mg and possibly work up to 20. If it makes my acne at least become mild then thank gawd.... I actually don't mind having spme pimples here and there but not moderate scarring acne.

Hi elkhoundgold,

I had an appointment with my derm on Monday (it's been 2 months since I started Accutane). He has bumped me up to 100mg week (which works out to about 14mg/day). I am around 160lbs. I was under the impression we were doing a low-dose long-term maintenance course, but he is actually trying to put my acne into remission on this low dose. It is the European way of using Accutane, a low dose for a long time. He I'm once I have got to the stage where I haven't had any new pimples for a 2 month period, he will stop the Accutane and see if this has put me into remission. So it is possible to achieve remission on a low dose such as 10mg - it just takes longer.

On 60mg I have still been breaking out, so hopefully 100mg/week will be able to keep me completely clear, and then if I stay clear on it for a while, I can stop and test if it'll give me remission. My side effects have been extremely mild on 60mg week, just slightly dry lips and dry skin. My previous 2 courses on 60mg/day absolutely sucked all the moisture out of me - my lips and skin were bone dry, it's much more mild on the lower dose.

I understand in the US they do not prescribe low dose as much. I am in Australia, I'm not sure how widespread low dosing is here, but my derm prescribes both high and low dose.

 

 

Thanks guys. Much appreciated. I want to start with 10 mg and possibly work up to 20. If it makes my acne at least become mild then thank gawd.... I actually don't mind having spme pimples here and there but not moderate scarring acne.

Wow this is very helpful. Maybe this will work as the acne isn't severe but it is very painful for me, particularly during the summer dry winter months. Edit: what side effects did you have on the lose dose that were the worst