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After years of mild-moderate cystic acne that persisted through over two years of antibiotics (doxy, mino, bactrim, etc) and every topical retinoid under the sun, I decided to go on isotretinoin at the age of 22. I am 155 LB male, exercise daily, eat healthy, etc. Majority of my acne is around the chin and mouth, occasionally on the cheeks. Been suffering from it for about 5 years total. 

Every dermatologist that I have ever seen has recommended accutane due to the limited efficacy of nearly everything else I have tried. I by no means have severe acne. Most people would not say that they consider me to have bad skin. Unfortunately, I am a perfectionist, and I spend way to much time and money trying to control my acne. Recently, I decided to go the accutane route, due to nothing else really working and the continuation of antibiotics not being a healthy option. I did a ridiculous amount of research, and noticed that increasingly dermatologists are prescribing lower, fixed dosages of isotretinoin and obtaining the same results for the patients, albeit in a longer time frame. However, the research I found indicates that this approach minimizes the occurrence and severity of side effects. Naturally, this sounded appealing. 

I found a dermatologist willing to prescribe along these lines, so I started two days ago. The plan is to stick with 20 MG (possibly edging up to 30 MG to speed the process) for a period of about a year or however long it takes to get to the minimum accumulated dosage. I noticed that there is very little firsthand information about this kind of dosing, so I will be posting weekly about my progress, in case others are trying to find more information about this approach. 




 

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Week 1:
No changes. Had about four active blemishes (small, cystic), all of which went away by the end of the week, as usual. Lips beginning to dry out a little bit, but very tolerable. 

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Week 2:
Experienced breakouts, but not in the way i am accustomed to. Most of the breakouts were on the cheeks, which is a place where i do get them in the past but not nearly as frequently as the chin/mouth area. Also, they were not cystic as they usually are. It was more just individual pores becoming clogged and slightly red, and after being emptied they cleared pretty quickly without much inflammation. Only change i have noticed so far is some light peeling around the mouth and lips, and the absence of any real cystic acne that was what drove me to try accutane in the first place. Side note- still using Epiduo Forte at night until my skin gets very dry. 

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Weeks 3+4

Experiencing mild breakouts, but not really cystic for the most part. Mostly deeper blackheads, whiteheads, etc. Nose has really started to dry out and has a rough texture, but beyond that and the lips there are few notable side effects. Also, its basically been like a continuation (maybe just a little bit worse) of the acne that I had for years, so i havent really had a horrible flare, which was my purpose in staying with such a low dose. 

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Hey dude, created an account just to chime in here. 

I’m in pretty much in the exact same boat as you. Male, 155lbs, 25 and mild to moderate acne. Exercise daily, eat like a Buddhist monk (vegan, with the exception of eggs) and consume very few drugs/alcohol. 

Started a 4-6month 20mg Accutane course 1 week ago now and similar to you, I researched the hell out of it before asking my doctor to get me on board. Based on my findings it’s the way to go. Will only potentially look at increase to 30mg to expedite the process. 

Also have have what is called Dermatitis Syccebdians (that’s not actually the word but something kinda like that) condition which they use Accutane to treat so we’re hoping to kill two birds with one stone.

So, 1 week in things are all pretty much the same expect for tolerable dry lips and a little bit of redness - could be slight sun burn. Currently winter where I am so the cooler dry climate could makes things a ltitle difficult down the line. 

Keen to follow your journey, will do the same to post each week if I remember.

 

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Week 5: 

Skin is on the mend. Was getting a lot of non-inflamatory pimples that would just sit under the skin on my cheeks, tried messing with a few and it definitely didn't help. After that mess healed up, ive pretty much been clear with the exception of a few of these non-inflamatory pimples just hanging out in certain areas. Figure that i'll wait for them to disappear or to come to a head. Beyond that, i have a lot of visibly clogged pores around the chin and mouth area, but they are only able to be seen if I stretch the skin out. Skin is already looking better than it has in months, which is especially notable considering that I was on antibiotics for three years before this. No bad sun sensitivity, hardly any real dry skin, slightly chapped lips. So far i'm thrilled with my results. 

On May 30, 2018 at 10:28 PM, Thorne said:

Hey dude, created an account just to chime in here. 

I’m in pretty much in the exact same boat as you. Male, 155lbs, 25 and mild to moderate acne. Exercise daily, eat like a Buddhist monk (vegan, with the exception of eggs) and consume very few drugs/alcohol. 

Started a 4-6month 20mg Accutane course 1 week ago now and similar to you, I researched the hell out of it before asking my doctor to get me on board. Based on my findings it’s the way to go. Will only potentially look at increase to 30mg to expedite the process. 

Also have have what is called Dermatitis Syccebdians (that’s not actually the word but something kinda like that) condition which they use Accutane to treat so we’re hoping to kill two birds with one stone.

So, 1 week in things are all pretty much the same expect for tolerable dry lips and a little bit of redness - could be slight sun burn. Currently winter where I am so the cooler dry climate could makes things a ltitle difficult down the line. 

Keen to follow your journey, will do the same to post each week if I remember.

Best of luck to you man. If you get impatient like I did, check out some of the studies on low dose accutane that outline the timeline for improvement. By 12 weeks pretty much every study notes big changes with way less side effects, but a few show good results even sooner. 

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I am a 30 year old male and weigh 207lbs and I too am also on a low dose fixed 20mg's a day dosage. I am almost nearing the end of my 2nd month on accutane and still breaking out...especially on my neck area and it is extremely embarassing for me...especially when i go to work. You are lucky to have results so early in your treatment and i definitely envy you for that lol. I too came off of 2 years of antibiotics (Doxy and then minocycline) and am now on accutane and have had acne for about 15 years now. My only side effects so far is dry skin and lips...thats about it though.

My derm says that if i stay on 20mgs a day, my treatment will be about 2+ years...and that just has me baffled. If you guys are reaching a cumulativr dose, how can your treatment be for less than a year?

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On June 2, 2018 at 11:47 PM, Ludadubz said:

I am a 30 year old male and weigh 207lbs and I too am also on a low dose fixed 20mg's a day dosage. I am almost nearing the end of my 2nd month on accutane and still breaking out...especially on my neck area and it is extremely embarassing for me...especially when i go to work. You are lucky to have results so early in your treatment and i definitely envy you for that lol. I too came off of 2 years of antibiotics (Doxy and then minocycline) and am now on accutane and have had acne for about 15 years now. My only side effects so far is dry skin and lips...thats about it though.

My derm says that if i stay on 20mgs a day, my treatment will be about 2+ years...and that just has me baffled. If you guys are reaching a cumulativr dose, how can your treatment be for less than a year?

It could be the weight difference that is making it take a little longer, but I think I jumped the gun in saying that Im getting completely clear. Still breaking out around the chin and mouth area. However, I wouldnt say its that much worse than it was normally. As for the cumulative dose thing, I think that science has debunked that as a factor in relapse rates. Most countries besides the USA do low dose more often, and they typically say that what matters is the length of time after you get clear that you continue to take it that really matters. Therefore, I doubt I'll stay on for the full year and a half it would take to reach cumulative dose. 

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On 6/6/2018 at 4:43 AM, AL525 said:
It could be the weight difference that is making it take a little longer, but I think I jumped the gun in saying that Im getting completely clear. Still breaking out around the chin and mouth area. However, I wouldnt say its that much worse than it was normally. As for the cumulative dose thing, I think that science has debunked that as a factor in relapse rates. Most countries besides the USA do low dose more often, and they typically say that what matters is the length of time after you get clear that you continue to take it that really matters. Therefore, I doubt I'll stay on for the full year and a half it would take to reach cumulative dose. 

______________

I agree with the above. I'd say for your size maybe 30mg daily could increase speed of results? I'm looking at an increase to 30mg myself on month two to get things happening a little faster. 

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Week 2:

Still have the usual dry lips, (very tolerable) and dry chin, nose and mouth. Not experiencing any other noted side effects. 

Good News!

I have noticed is that the severity of any pimple has been noticeably reduced. While there have been a few pimples (also focused around mouth and chin) they have come and gone quickly and are far less frequent. I dare say the Isotretinoin is beginning to work it's magic. Touch wood. 

I have not experienced what I would call an 'initial breakout'. Perhaps I'm a lucky one, or it's yet to come, but I have a feeling it wont. I never suffered terrible breakouts in the past in comparison to what I have seen others go through but I would get really gnarly cystic pimples around my nose, hence the reason I'm actually taking this medication. When I went to the Doc the other week I had a sizeable one developing and the crazy thing is it never came to a head, and after a week was completely gone ?! 

I'm heading overseas for two weeks and will be sweating out in the tropics so will be interesting to see how things go over there. Main thing will be to keep skin covered from sun, I have noticed increased skin sensitivity since starting my course.

Pro Tips - Increase speed of results

1. Stop eating diary. Improved my skin by about 50% in a month prior to any medication. No shit. My girlfriend and I both immediately breakout whenever we touch diary products, it's actually insane. That stuff is meant for growing calfs and the hormones present in there trick your body into thinking it's still going through puberty.  While it would be best to stop all animal products I have found that eating eggs (daily) chicken (once a week) red meat (once a month) does not negatively affect my skin. The moment dairy is introduced BAM! 

2. Opt for a lower GI diet. Don't care what anyone says on the matter. Diet most certainly DOES effect your skin. I have carefully tested this over the last 3 years using a method called the 'elimination diet'. Basically you take one thing out of your diet and monitor results over a set period (two weeks say), very arduous process but this is what I have learnt. Try removing (or drastically reducing) processed wheat (white breads, breakfast cereals, cheap pasta etc). It might be hard to wrap your head around at first but if you consume a lot of these things but I guarantee you'll notice a difference when they are reduced or ideally gone. Good alternatives are: Sprouted Breads, Oats, Quinoa, Durum Wheat Pasta, Long Grain White and Brown Rice (Both are low GI).

3. Use quality skincare products! The thing that I have been most surprised by is the amount of people on these forums using the absolute bottom of the barrel gear to try and treat the most important condition in their lives.
Stocking up on Cetaphil Lotion and Blistex is like putting crude oil into your Ferrari. Why anyone would do this when high octane fuel is available is beyond me. 
 

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Week 6:
Cheeks have for the most part cleared up, a few remaining clogged pores that sit under the skin, visible when stretched, but non-inflamatory. Any new acne has pretty much been confined to the mouth and chin area, which I here clears last, probably due to the thickness of the skin there. No terrible side effects still- just chapped lips and now more recently, a very dry scalp (flaky). The anti-inflamatory effects of the accutane are definetly kicking in, as all new acne has been significantly less inflamed (ie, less red, more just like a clogged pore). Id say for before vs. after (now): I would typically have at least 3-4 inflamed, cystic pimples on my face on most days before accutane, whereas now I might have 2 pimples, none of which are inflamed or cystic. 

14 hours ago, Thorne said:

Week 2:

Still have the usual dry lips, (very tolerable) and dry chin, nose and mouth. Not experiencing any other noted side effects. 

Good News!

I have noticed is that the severity of any pimple has been noticeably reduced. While there have been a few pimples (also focused around mouth and chin) they have come and gone quickly and are far less frequent. I dare say the Isotretinoin is beginning to work it's magic. Touch wood. 

I have not experienced what I would call an 'initial breakout'. Perhaps I'm a lucky one, or it's yet to come, but I have a feeling it wont. I never suffered terrible breakouts in the past in comparison to what I have seen others go through but I would get really gnarly cystic pimples around my nose, hence the reason I'm actually taking this medication. When I went to the Doc the other week I had a sizeable one developing and the crazy thing is it never came to a head, and after a week was completely gone ?! 

I'm heading overseas for two weeks and will be sweating out in the tropics so will be interesting to see how things go over there. Main thing will be to keep skin covered from sun, I have noticed increased skin sensitivity since starting my course.

Pro Tips - Increase speed of results

1. Stop eating diary. Improved my skin by about 50% in a month prior to any medication. No shit. My girlfriend and I both immediately breakout whenever we touch diary products, it's actually insane. That stuff is meant for growing calfs and the hormones present in there trick your body into thinking it's still going through puberty.  While it would be best to stop all animal products I have found that eating eggs (daily) chicken (once a week) red meat (once a month) does not negatively affect my skin. The moment dairy is introduced BAM! 

2. Opt for a lower GI diet. Don't care what anyone says on the matter. Diet most certainly DOES effect your skin. I have carefully tested this over the last 3 years using a method called the 'elimination diet'. Basically you take one thing out of your diet and monitor results over a set period (two weeks say), very arduous process but this is what I have learnt. Try removing (or drastically reducing) processed wheat (white breads, breakfast cereals, cheap pasta etc). It might be hard to wrap your head around at first but if you consume a lot of these things but I guarantee you'll notice a difference when they are reduced or ideally gone. Good alternatives are: Sprouted Breads, Oats, Quinoa, Durum Wheat Pasta, Long Grain White and Brown Rice (Both are low GI).

3. Use quality skincare products! The thing that I have been most surprised by is the amount of people on these forums using the absolute bottom of the barrel gear to try and treat the most important condition in their lives.
Stocking up on Cetaphil Lotion and Blistex is like putting crude oil into your Ferrari. Why anyone would do this when high octane fuel is available is beyond me. 
 

Couldnt agree more with the points on diet as well as the low quality products people seem to always use. You will definetly burn a bit faster on these meds, snag a good physical sunscreen. I use Elta MD UV Clear, the stuff works wonders and has nothing sketchy in it. 

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I've been considering going on a low dose too! Still can't bring myself to do it though because I've read so many people talking about long term side effects.

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19 hours ago, Christafari said:

I've been considering going on a low dose too! Still can't bring myself to do it though because I've read so many people talking about long term side effects.

Don’t let negative reviews scare you. I waited to do accutane for 3 years because of all the shit that I read about potential side effects, i did the same for another pill that prevents hairloss. People who have a bad experience with any drug are much more prone to voice their complaints than those who had a positive one. So for every negative review you read, take into account that there are probably ten other people who had a good experience who didnt have any reason to go write about it. 

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Ah no way, you took propecia? I suffer from mpb too! I was also out putt off of that medication too due to the ‘horror stories’. How did you get on with it?

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On 6/8/2018 at 4:11 PM, Christafari said:

Ah no way, you took propecia? I suffer from mpb too! I was also out putt off of that medication too due to the ‘horror stories’. How did you get on with it?

Ive been taking propecia for about four monts, even continued it with the accutane. I barely had mpb, just a slightly receding hairline that i figured id stop in its tracks. Ive had absolutely zero issues with the medication as well. Yet another example of the panic on the internet discouraging people from what are widely considered to be safe and effective drugs

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Week 7:

things are definetely starting to clear up. My face is getting far less oily than it used to, but not too dry either. The chapped lips have slowly improved. Im not really getting much cystic acne anymore at all, pretty much have had one in the last couple of weeks. Still some clogged pores around the mouth, but no inflamation so they arent red at all. I have noticed that the acne that i picked at left marks that are taking much longer to dissapear than they used to when i had oily skin. Word of advice for anyone starting- dont pick at anything unless its literally about to come out itself. If you can afford it, get a cortisone shot. 

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Week 9:
still no side effects, not even sun sensitivity (i am outside a lot on the weekends). Still getting the occasional pimple, stuff on chin is still clearing (had three medium sized pimples on chin/mouth area this week). Cheeks are almost entirely clear. Areas that were clogged seem to be coming up to the surface. Dermatologist said that betweeen months 3-5 is where the magic usually happens, but could be longer given my low dosage. Just taking it as it comes for now- my acne today is better than before i started so i couldnt care less how long it takes to fully clear. 

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Weeks 10/11:
Overall, no huge changes. Still getting small pimples around chin and mouth, as well as some small things that have come up as my skin dries out around the cheeks. Nothing big, nothing inflammatory. Chapped lips, but no other side effects. A litte hyperpigmentation, especially around cheeks where i had some breakouts early in the process, but nothing too terrible. 

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I wish there was more low dosers out there who can talk about their experience during the treatment. I am about to start Month 4 this Friday and I still am getting new spots almost daily and I am wondering if I should increase the dosage or not? I to have searched extensively on the internet at low dose studies and they say people clear up just as fast as conventional dosing people do....

I'm afraid that fi I raise the dose, it will just cause even more breakouts, but it might clear me up quicker, but there is no evidence that raising the dosage will provide faster results...shit sucks to not know these things since everyone is different and has different results at different times of treatment.

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I am now about 12 weeks in and ive been getting a lot of new pimples around the mouth and chin. Cheeks are almost completely cleared up, getting a little but more sensitive to the sun as well ive noticed. The acne around the chin comes up really fast. One hour, im clear, the next, there will be a few on the way. The chin and mouth area was always the worst for me, so i assume this is to be expected. Either way, its just about as bad or slightly less bad than it ever was for me without accutane, and i cannot stress enough that this is really the only baseline that matters since this medication is practically guaranteed to get results at some point. 

On 7/11/2018 at 1:49 PM, Ludadubz said:

I wish there was more low dosers out there who can talk about their experience during the treatment. I am about to start Month 4 this Friday and I still am getting new spots almost daily and I am wondering if I should increase the dosage or not? I to have searched extensively on the internet at low dose studies and they say people clear up just as fast as conventional dosing people do....

I'm afraid that fi I raise the dose, it will just cause even more breakouts, but it might clear me up quicker, but there is no evidence that raising the dosage will provide faster results...shit sucks to not know these things since everyone is different and has different results at different times of treatment.

I can relate, its frustrating to see it continuing this far into the treatment. However, if you had been on a high dose, there would undoubtedly have been some breakouts and redness that would have been pretty intense. In my opinion, if your acne now is similar or better than it was before you started, then who really cares. Yes it would be nice if it worked faster, but youve gone this long with the skin youve got, you can make it another couple of months. Hang in there 

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Just though I would chime in as I just came off Isotretinion. So I was on 10mg/day for 2 months then 20mg/day for 8 and a half months (which I just finished 1 month ago). I'm 21 and weigh only 57KG so that dosage for me I think worked well considering in some situations I would get bleeding eyes around the tear ducts, any more like 30mg and I'd think that would be unbearable.
For the most part I had two breakouts. The first within the first week of the 10mg and the second within about the same time as starting the 20mg. A month off and my skin has started to "feel" oily again. But little to no pimples (like literally only 1). I can rub a oil absorb sheet across my face and it'll still soak up excess oil but far less than what I had before. My dry eyes and lips are gone completely and my skin is easier to manage. 
However my biggest concern is that it'll revert back to what I had before. I would say stay away from refined sugars because I'll drink a can of soda and an hour later my whole skin would feel like there is oil underneath the skin but can't get out (due to smaller pores?). So I'd avoid sugary foods if you can. It feels scary that it might revert back because I took pictures of before hand and now which I feel finally since my early years my skin is normal again.  
 

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14 hours ago, JasonL1 said:

Just though I would chime in as I just came off Isotretinion. So I was on 10mg/day for 2 months then 20mg/day for 8 and a half months (which I just finished 1 month ago). I'm 21 and weigh only 57KG so that dosage for me I think worked well considering in some situations I would get bleeding eyes around the tear ducts, any more like 30mg and I'd think that would be unbearable.
For the most part I had two breakouts. The first within the first week of the 10mg and the second within about the same time as starting the 20mg. A month off and my skin has started to "feel" oily again. But little to no pimples (like literally only 1). I can rub a oil absorb sheet across my face and it'll still soak up excess oil but far less than what I had before. My dry eyes and lips are gone completely and my skin is easier to manage. 
However my biggest concern is that it'll revert back to what I had before. I would say stay away from refined sugars because I'll drink a can of soda and an hour later my whole skin would feel like there is oil underneath the skin but can't get out (due to smaller pores?). So I'd avoid sugary foods if you can. It feels scary that it might revert back because I took pictures of before hand and now which I feel finally since my early years my skin is normal again.  
 

Thanks for chiming in, seems like its impossible to find anyone else who has done this kind of dosing. At what point were you really starting to get fully clear?

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I would say within the first two months is when it cleared up then as I upped my dosage it broke out again, pushing more and more out. I had blackheads on my nose that took several months more but eventually they all just fell out one by one like a scab coming off a healed wound. that took the longest to clear up but as for acne it was probably all clear within about 3 months with blackheads being clear around 4-5months. It does take time but even with all the dryness that I had to experience (eyes,lips,bloody nose) I didn't once feel like going back to what I had before. It was horrible before. Everything is back to normal now though in those areas (eyes,lips, nose) and only took about a month so they do revert back though you'd doubt it being on it for so many months. 

Edited by JasonL1

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Hey guys can I join? I started 20 mg daily of accurate April 24th. I also am still breaking out. I get dry lips and my skin is a little dry as well. I think it’s working but from all my research it seems like it takes a long time to see full results. Also I am 33 who has suffered from persistent acne since the age of 15

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