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Low-Dose Accutane Good for Mild Acne

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could the mods maybe stick this at the top so people can add other articles and studies specifically on low dose treatment? this would stop repeat posts on this subject and group all the info together?

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Low-Dose Accutane Good for Mild Acne

HEALTH NEWS BITE

Monday, May 15, 2006

People suffering from mild cases of acne can benefit significantly from small doses of Accutane and other tretinoin-based acne treatments, a new study finds. Conducted by researchers at Israel's Soroka University, the study found that low-dose Accutane was also an effective means of reducing the side effects of inflammation and dryness that have been associated with Accutane in past research. For the purposes of the study, "low-dose" was defined as 20 milligrams of Accutane daily over the course of six months. At that dosage, researchers found that a remarkable 95% of patients experienced either complete remission of their acne or significant improvement at minimum.

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Low-Dose Isotretinoin for Acne Vulgaris

Adverse effects are dose-related, so lower-dose isotretinoin is an exciting prospect.

Isotretinoin is indicated for nodular acne or severe acne that is unresponsive to conventional therapies. The usual dose is 0.5 to 1.0 mg/kg/day for 20 weeks, or a cumulative dose of 120 mg/kg. As side effects are dose-related, the idea of low-dose isotretinoin therapy for less severe forms of acne is attractive, but little data exist on the safety and efficacy of this strategy.

Investigators in Israel conducted a prospective, observational, open-label study of isotretinoin in 638 patients with moderate acne. Patients were divided into two groups. Group 1 contained 495 patients aged 12 to 20 years with a 2:1 female:male ratio. Group 2 contained 122 patients aged 21 to 35 years with a 3.5:1 female:male ratio. All patients received 20 mg/day of isotretinoin for 6 months. Patients were evaluated every 2 months through unblinded clinical examinations and laboratory tests. Pregnancy tests were done at baseline for women with childbearing potential. Follow-up was not explicitly reported but took place over a period of up to 4 years.

A total of 617 patients completed the study. In group 1, 95% of patients achieved considerable improvement or complete remission of their acne; 26 patients (5%) did not respond and either their isotretinoin dose was increased to 30–40 mg/day, oral erythromycin was added, or the low-dose isotretinoin was continued for 8 months until remission occurred. The mean cumulative dose in group 1 was 70 mg/kg. In the follow-up period, 20 patients (4%) relapsed. Polycystic ovary syndrome was subsequently diagnosed in 7 of the patients who relapsed.

In group 2, 93% achieved significant improvement or remission, and 7% did not respond. In these nonresponders, the isotretinoin dose was either increased or continued at the low-dose level for 9 months until remission was achieved. The mean total dose was 67 mg/kg. Seven patients (6%) relapsed; of these, polycystic ovary syndrome was diagnosed in two.

The most common side effects were mild cheilitis (91%) and mild xerosis (43%). Epistaxis was reported in 2.5%. There were no pregnancies and no reported depression or other psychological side effects. A slight and transient elevation of liver enzymes (5%) and serum lipids (4%) was seen. One patient discontinued the medication due to a marked increase in triglycerides.

Comment: Low-dose isotretinoin is an attractive proposition for the treatment of moderate acne, and one that seems supported by this large, independently funded study. However, the following conclusions can be made:

1. Low-dose isotretinoin should be studied in randomized, blinded, placebo-controlled trials with long follow-up periods to determine safety and efficacy.

2. Polycystic ovary syndrome should be considered in females with recalcitrant acne.

3. Serial laboratory and pregnancy tests are still requirements for low-dose therapy.

4. Conventional dosing remains better for severe and nodular acne.

5. The low-dose regimens require longer duration of isotretinoin exposure, which may lead to increased risk for exposure during pregnancy.

6. Alternative dosing and schedules may prove difficult in the U.S. under the new federal monitoring program.

— Mary Wu Chang, MD

Published in Journal Watch Dermatology April 25, 2006

http://dermatology.jwatch.org/cgi/content/full/2006/425/1

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Thanks for the post, Timmy! I have been wondering about this for a while and I just started a low dose treatment for blackheads and oiliness with my derm's approval. Everyone thinks Accutane is just for severe acne so I'm glad you posted this.

-Reema

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I think accutane is MUCH more benefitial using it for a longer period of time in lower doses rather than a shorter course in bigger doses.

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Ive ben on accutane 3 time already now and each time it has worked wonders, but then a few months later my acne was back.

After the third time tho my acne has hardly came back at all so i dont need to go on a full course of accutane again BUT i still get the odd breakout and my skin is EXTREMELY oily.

When ive been on accutane my oily skin had completely stopped.

So i would really love to go on accutane again just to stop my oily skin, but i HATED having such a red face from it lol. I could handle all of the other side affects, but my face went really red and it was embarasing.

SO i was just wondering if i went on a lower does for a longer period of time, would this stop my face from getting so red?

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That is brilliant news!

I am just about to start on my course of Accutane for my mild acne - 20mg.

I look forward to seeing the results!

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Would this make my skin smooth as well?

I hate the little bumps all over my face.

Turned out i was allergic to differin too! So no help there :S

I'm thinking that now maybe the little bumps may completely go away because i am no longer an oil slick (thanks spiro!), just a tad oily, and of course, on my nose (will that ever go away?? yeesh). But i know the little tiny pin head size bumps LOVE oil, so maybe now if i get rid of them they wont come back as easy?

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Yeah I'm on 40mg a day and I'm not as scared of all those scary side effects because its a low dose.

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can we cycle accutane? like go on low dose for about 6 months and then rest for 6 months...

i only have mild acne now but i want to stop this oily skin...

I second this, well I mean I want to know the same thing about cycling it. I would like to go on for the oily skin as well.. It's absolutely terrible how oily I get.. Which is terrible for acne...

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I think accutane is MUCH more benefitial using it for a longer period of time in lower doses rather than a shorter course in bigger doses.

Really interesting theory... This approach also helps reduce side-effect risks associated with high dosages, so if it's also the most effective way to use it, then that's awesome.

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