33yo Male, roughly 85kg. Approx. 8 years low dose.

There aren't many anecdotes on long term low dose isotretinion use so here's my experience, I'd be interested in any general feedback from MD's.

My skin issues started at around 14, extreme amounts of oil and moderate acne. I never really had severe cystic type but tried every treatment under the sun including antibiotics and topicals with limited success.

Fast forward to18/19 and I was referred to a dermatologist who agreed that I suited Accutane (my younger brother who had severe acne had had good success with it). I ran a full course under supervision and had good success, though it didn't last. I forget the dates now but maybe a year or so later I went on another full course, yet again I was clear for a time but around a year later the issues were there again.

The hyper oiliness was always the first thing to come back, the acne was reduced to my face only (had been pretty bad on my back prior to accutane) but still would get the occasional cyst. I went though a period of trying various topicals and although I could keep the acne mostly under control, nothing at all helped the oil. I was also incredibly prone to infected ingrown hairs and seb-derm on the scalp and in the ears.

I came across studies of low dose accutane and wanted to try it, but couldn't get derms to agree. Tired of being now around 24yo and still feeling bad about myself I obtained accutane from the most reputable online pharmacy I could find and started on 20mg a day. After about 12 weeks I was completely clear and oil-free, all my other issues related to oil were resolved too.

From then until now I've mostly been on 80mg a week (20mg mon to thurs, lowest effective dose after experimentation) with occasional breaks until symptoms reappear, the only side effect I've had constantly is dry lips. I workout reguarly and still drink at weekends (probably more than I should but thats a seperate issue), I've had bloodwork done on average annually and had no problems. I have no side effects that I can attribute to accutane, I try and eat healthy and take milk thistle, NAC and fish oil reguarly.

I still can't reduce the dose without being mirror shiny at the end of a day, I've taken breaks and tried topicals but all symptoms of excess oil reappear. On this maintainence dose, I can wash my face with water and use a basic moisturiser and still have flawless Matt skin at the end of the day.

I don't like taking medication like this but really don't see a better way, I'm too old to be a greasy teenager and it badly affects my state of mind otherwise. I don't want to risk my health for vanity, but don't feel like I'm enjoying life otherwise.

Anyway, that's my story. Comments welcome.