I have really been wondering about this... People seem to relapse regardless of dose or duration... so what gives? If you look around there is actually a lot of people that are saying that high dosage during a short period does not offer any guarantees so why do dermatologists insist on this?
http://www.bpac.org.nz/BPJ/2013/November/acne.aspx
http://www.ncbi.nlm.nih.gov/pubmed/16546586
"Contrary to what earlier studies showed, it seems low doses isotretinoin permanently clears acne for most people. One study showed 7.9% of patients relapsed over 5 years, another showed 4% relapsed in 4 years (however, adults relapsed more frequently than teens and women more frequently than men), while a third paper reported 9.4% relapse risk over 2 years.
These rates seem comparable or lower than for higher dose regimens. One high dose study showed 32.7% relapse in 12 months. While another high dose study reported 12.5% relapse over 3 years. Relapse rates in standard dose studies fall somewhere between 5 and 50%.
Its hard to directly compare relapse rates between different studies. Studies may use different definitions for relapse and rates vary with age, sex, acne severity and study duration.
The takeaway message from this is that low dose treatment doesnt necessarily mean your acne is more likely to come back later.
Most papers make the point that women with PCOS are much more likely to relapse than other groups. I suspect that, to some degree, this applies to all the adult women with hormonal-type acne."
I am actually considering doing this, that is, now that my acne is gone to lower dosage to see what happens and then eventually go off it.
Has anyone tried this?? I haven't heard that people with low dose (over just 6 months) have had any relapse even though the derms tell us that they will.
Would be nice to hear from people with experience with this... although I'm guessing that for people it actually worked for aren't really around here anymore.
Hi
This Friday will be a week since I started tane
Before agreeing to try tane my Dr and I agreed to a low dose plan
(however we didnt clarify what low dose was)
I was surprised when I went to get my script she rec 40mg a day (Im 130)
That to me what not low dose
She said I cold try 20mg if I wanted to try to avoid IB but she strongly suggested increasing to 30 if not 40mg and even higher
she stated if I didnt increase my dose..the meds would NOT work
I have been reading more and more on low abut low dose treatments and when I have my appt this Wed plan to discuss it with her again
she also started most insurance companies will not pay for tane longer than 5-6 mnths so they like to get in the cumulative doses when they can!
Kim
Body WeightTotal mg/daykilogramspounds0.5 mg/kg1 mg/kg2 mg/kg*
*See DOSAGE AND ADMINISTRATION: the recommended dosage range is 0.5 to 1.0 mg/kg/day.
408820408050110255010060132306012070154357014080176408016090198459018010022050100200
Yeah, I'm at 20 mg/day (have been for six months) and I am completely clear except for a small whitehead (I think). I didn't have an IB it just got better and better and by month 4 I was basically clear with maybe a whitehead every two weeks if I picked. I didn't really get any new pimples during my course only whiteheads that turned into a pimple or they fell off. Scars are worse though.
I want to go down now even further, to 10 mg/day for two more months and then stop altogether. But my new derm (UK), before it was Norway, wants me to increase to 50 mg for three more months to get the cumulative dose... But I can't take that...
And it may be that it is unnecessary too, I just want to know about anyone else who have done this...
Maybe it is a positive sign that no one has any info on this, since it worked and they didn't come back! Haha, well I can always hope 
When I was on 20mg my skin looked good
Now it looks like crap!
I wonder what would have happened if I stayed on 20mg..I dont know if I would have broken out anyway
If I stayed on 20mg to get the cumulative dose I think I would need to stay on the drug for 14 mnths?
That does seem a little nutty!
Im going to talk to my Dr tomorrow
I dont like the nasty breakouts Im getting and the red scar left behind
I want too avoid that at all costs!
Dryness is just starting to kick in
I know the studies say low dose is just as effective at higher doses, but does that mean the treatment went on longer...or ended at the normal 4-6 mnth mark
Thanks for any info
Kim
wanted to add I couldnt view your links
here is an interesting one
Keep ya posted
Pls do the same
Kim
Well the idea was that you should do low dose (20 mg/day) until you cleared (usually 3-5 months) and then continue with a lower dose (5-10 mg/day) for 2-4 months more. In this study, the test subjects did not have the acne come back even though they never even reached the cumulative dose of 120mg*kg. They compared it with how many failed the 'normal' accutane course and there was no correlation with how much the dose was and duration to remission of acne.
Therefore, they said that it isn't a matter of dose and/or duration but of other factors (hormones, severity of acne, PCOS).
I have been pretty much clear (1 whitehead in about a month) so I am lowering my dosage now to 10mg/day... I'm just gonna try it because I'm so tired on this med!
I would bring a couple of studies to your doctor and ask whether they would consider this especially if your acne is mild or mild-moderate... I know some are doing it but it is quite new.
Yeah I'll keep you updated
People can get initial breakouts on 20mg too, so I don't know. It might just be an initial reaction to the meds, don't touch it and put a lot of vaseline on it so it can always be moist (dryness causes long-term scarring)
Thanks for the info
that is what I wanted to clarify (duration when taking low dose)
Sorry If i read it in your earlier post or l overlooked it, but you say u are lowering your dose
Are u changing the dosing on your own,..is your Dr on board with this regimen
I have a GUT feeling since my Dr already said low dose doesnt work and If I dont go higher I wont be 'cured'
She wont be on board
So I was actually all set to do my own thing..meaning take the higher script but keep my dose at 40mg or even back down to 20mg
The only issue is if I do this, I will not be monitord the last few mnths with check up and b/w
pg is NOT an issue at all...so I dont know if its worth the risk
I still plan to discuss it with her
kim
I'm doing it on my own now, because when I started going to my new doctor in the UK (who had never even heard of low-dose) she wanted to bump me up to 40 mg/ day which I just wasn't okay with. I lowered it even more, and if this doesn't work out I can just increase dosage later.
Yep, I take the whole prescription, just because I don't want to argue with them, and then don't use all of it. Might sound stupid but from what I understand some Derms just prescribe the 'policy dose' and not individually. It clearly states that they believe that it would be better to individually tailor a dose and duration depending on the severity of acne and how the patient is responding to the medicin, so I really don't get it why they force on such a high dose that will just create a myriad of other problems as well.
(with regards to the fact that you might not be monitored the last few weeks) Yeah I know, I haven't really thought of that yet. But, I am hoping I won't have to take the whole dose just until I feel like I am completely cleared.
You should def discuss it with her, hopefully she'll be on board!
Good luck!
Thanks
For now Im sticking to 40mg even though she wants (think) Im taking 60mg
Im doing OK..some redness..some weird bumpy skin
I dont know if jumping from 20mg to 40mg caused these issues or if they would have come anyway
I have tight skin (dry) bt not peeling
I also just got hit with dry lips but nothing terrible..cant fatom 60mg than 80mg (which is what my derm goal)
Part of me really really believe low dose is jus as effective as traditional doses
BUT i also want this to work..dont we all!
and only want to go down this road ONCE
GL
keep me posted
kim
Yeah now I'm at 10 mg (20mg/ every other day) my family made me they don't like the fact that I am on this med. I've been at this for three weeks, and that whitehead that has been sitting there for awhile is now a pimple. Such an odd feeling, I haven't had one in at least a month. Not fun. Hopefully it'll go down though.
Ohh I don't think I could take 60mg! That's so scary, I already have some eczema just with 10mg (the same as with 20mg though) and I'm so scarred that I'll get more dry eyes, and skin.
It'll be tough in the beginning, especially if get an IB. Hopefully you won't though, it only happens to some people.
Make sure you keep your skin constantly hydrated because once it gets dry then it'll be really hard to get it back. These 'dry patches' will form and you won't be able to get rid off them. Use vaseline, I sleep with it all over my face haha.
Yes I know that is the general consensus. However, new information is emerging... My derm think the same (as you do), however, private dermatologists in Europe have another opinion (low dose work just fine without horrible side effects). I know of a couple of people who have gone on 10mg/day and cleared. I also know that a friend of mine was put on an extreme dose but then in month 3 had to go off because her 'liver enzymes' had shot through the roof. I don't dare to take that kind of dosage and my parents will not be okay with it. The things is, that it doesn't seem to matter what dose, if you'll relapse you'll relapse because of some other reason (which is what this study showed).
Sorry remind me if you plan to increase from 10mg a day and/or how long you will take the med?
until clear?
it seems most people clear and stay on an additional 2-3 mnths
Im still on 40mg
No side effects EXCEPT breakouts
My skin is works now than it was before I started
when I was on 20mg the firts 2 weeks my skin was crystal clear
I didnt plan to increase but got anxious about the tane not working or relapsing down the line
I dont know if this would have happened anyway, since i stopped antibiotics, BP and retin-a
or if it has to do with the increase
these breakouts are pretty brutal!
Right now I just want my skin to clear and things it stabalize
So staying on 40mg until the NY and will re-evaluate
Hope things are going well on your end