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Low dose for moderate/severe adult cystic acne

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Hey guys,


I'm 30, female, had fairly mild acne for years and years that never bothered me too much - a couple of really little spots at a time pretty consistently, an occasional inflamed/cystic spot. A little annoying but nothing to really worry about.


About 4 months ago I had 4 big, really deep-seated cysts on my jawline come up literally overnight. Then since the start of the year my skin just basically exploded with cysts all over my jawline, cheeks and neck. I only get a new one maybe every two-three days on average, but they're pretty much ALL big, deep, inflamed ones that take like a week to stop hurting and then another month to fully heal. So I've always got a lot of redness and bumps from the old ones hanging around as well as the few 'active' ones. 


I went to a GP about 2 months ago who gave me Doxycycline. That did nothing.


Then I tried a cosmetic doctor 6 weeks ago who gave me Duac and Retin-A and an expensive face wash. That also did nothing except make my face itch and flake.


I decided enough was enough. I'm not going to keep messing around, experimenting, hoping to find the magic bullet. I wanted the drug that works. I wanted my life back.


Made an appointment with a Derm last week, went in ready to argue my way into an accutane prescription. Luckily though, I didn't need to argue at all! She took one look at me and said topicals weren't going to help the type of acne I have and suggested Oratane (the isotretinoin/accutane brand we have in Australia). 


She's put me on a really low dose though. 10mg every other day for a month, then 10mg 4x per week for the next month. Then I see her again to review but she said we'd work up to a maximum dose of 10mg/day. She said I'd be on this for 9-10 months.


I'd already read a lot about accutane so I knew this was a really low dose and that it wasn't going to get me anywhere near the 120-150mg/kg cumulative dose that I'd read about. I asked about it and she said this dosage would clear me just as well and just as quickly, with significantly reduced side effects including the initial breakout. She said that the latest working theory is that it's the length of time the oil glands are suppressed that keeps the acne from returning, not the cumulative dose. I found some articles later that seemed to support this, but have seen very few low dose logs for the type of acne I have, so figured I'd make one for the sake of anyone in my shoes in future to refer to.


So, I'm one week in. So far haven't noticed any change in the acne, and the side effects are basically none. I felt quite tired the day after the first pill, and I'm a little dry I guess ... I probably wouldn't have even noticed if I wasn't looking for it.


I'll put up some before and during pics once I notice a difference.


Anyone with similar acne on low dose? How has the treatment worked for you so far?

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Not sure how low dose treatment would work for other cases but i'm pretty positive about it for 'control' at least.

I've been taking 20mg once/twice a week for a year now, depending on how my skin is responding, weather, etc.

My main problem was excessive oiliness, and some big pimples here and there, probably due to too much oil, i've tried the cumulative dose treatment in 2014~, 20mg a day for 6 months, no side-effects other than dry skin/hair, which is actually good! Just need to stay hydrated and use moisturizer.

Few weeks after i stopped taking isotretinoin my skin was just as oily as it was before so i talked to my derm about trying low dose to keep my oiliness in check, since no other medication had helped even a little bit, and she agreed.

I'd say low dose treatment is worth to anyone who didn't get the expected results from cumulative dose and 'permanent cure', and should be less painful to go through to those who had bad side-effects.

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Feeling cautiously optimistic. I've only gotten one new cyst in the last week, and it isn't a particularly big/deep one. Some non-inflamed 'mini bumps' (closed comedones?) have come up, but not a lot, and they don't really bother me anyway because when you compare them to the cystic/nodular acne... lol, it's nothing. I've noticed the dry lips and skin this week, a little annoying but certainly very tolerable. Hoping for another good week and a chance for the old spots to keep healing!

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Update -

this drug is a miracle! No new major spots since the last post, just one or two smaller ones that've already cleared up.
My serious acne is DONE. I have NOTHING active, and haven't had for days. Just waiting on the redness and bumpiness from the old ones to subside now but it's already at a point where it's stopped being on my mind and getting me down all the time. I don't have good skin, but I don't have skin that you'd look twice at anymore. Feel like I've got my life back! Will put up pics at some point but just wanted to share my excitement.

ALSO, this is on a 10mg every other day dose - the side effects are virtually none. My acne was moderate/severe cystic, and I still got this result. This dosage is apprently quite common outside of the US... I don't know why American derms make their patients sufffer so much with the high doses when lower doses work???

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