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Fehheh77

Seeking advice for low-dose accutane use

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My (22M) acne started about 7 ago and during those years, it got progressively worse. Not until late 2019 or early 2020, I started to take action. In the last two years, my knowledge about treating acne and acne scars improved as it became increasingly important to solve those problems. Important to note is that I already have numerous (though superficial) rolling scars on the cheeks and temples on either side of my face. 

I have previously used benzoylperoxide (2020, 2021), clindamycin (2021), doxycyclin (2022) and adapalene (2022), one after another, concurrently with a strict skin routine (La Roche Posay Effaclar). I am still using the LRP skin routine along with adapalene, but results are insufficient to control the acne. Since I am done with my last medication (doxycyclin), I am breaking out again. I constantly have several painful, deep and inflamed cysts in my neck, along with (smaller and more superficial) inflamed spots and white heads around the mouth, on the forehead, underneath the chin, underneath the jawline and on the shoulders. My cheeks and temples remain clear though.

As mentioned above, my current maintetance options are insufficient and are taking too much effort as well as a huge toll on my mental health, unfortunately. It is demotivating to spend years on controlling acne, but breaking out again every time. As discussed with my general practitioner, I am able to get an isotretinoin prescription to -- hopefully -- achieve long-term effects. After doing some research in the literature about isotretinoin dosage and duration with regard to remission, side effects and relapse rates, I found that 20 mg/day for a prolonged period may be suitable for me. The reasons for this are (1) the decreased rate of adverse effects, (2) the no difference in remission rates between high and low dose and (3) the fact that my acne is mild to moderate. The downsides of low dose are (1) the higher relapse rates and (2) prolonged period of use. 

I weigh 62 kg, so to achieve the 120 mg/kg cumulative dose, I need 62 x 120 = 7440 mg in total. Taking 20 mg/day, means 7440 / 20 = 372 days of using isotretinoin. 

Do you guys have any ideas? Or do you have experience with how to best use isotretinoin for optimal results and minimal side effects? 

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Before you try accutane, have you tried the regimen? Unless your acne is severe and widespread, you might want to give it a shot before doing accutane, which will permanently for the rest of your life, change your skin and body. It's a huge decision. Just don't want you jumping in before you tried the regimen.

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3 hours ago, Dan said:

Before you try accutane, have you tried the regimen? Unless your acne is severe and widespread, you might want to give it a shot before doing accutane, which will permanently for the rest of your life, change your skin and body. It's a huge decision. Just don't want you jumping in before you tried the regimen.

If have done routines similar to “the regime” before. It does not solve my acne. I have tried everything else from topicals to systemics. I am very prone to scarring. And everything has put too much pressure on mental health. I have done extensive research on isotretinoin and discussed it with my GP and Dr. Emil Henningsen. 20 mg/day significantly reduces the risk for severe side effects.

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Ok just making sure you are very sure. Side effects may be less at a lower dose, but the way accutane works is by reducing oil glands permanently, so it's a lifelong decision type of thing. In the right cases, it can be a godsend, so I'm not saying it doesn't have its place. But it should be entered into extremely cautiously, like anything else that changes your body forever should be.

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