{"id":8756,"date":"2014-11-24T06:53:22","date_gmt":"2014-11-24T06:53:22","guid":{"rendered":"https:\/\/acneeinstein.com\/?p=2350"},"modified":"2018-11-02T18:19:54","modified_gmt":"2018-11-02T18:19:54","slug":"low-dose-accutane","status":"publish","type":"post","link":"https:\/\/acneeinstein.com\/low-dose-accutane\/","title":{"rendered":"Considering Low Dose Accutane As A Last Resort? Here\u2019s What You Need To Know."},"content":{"rendered":"
Sometimes you are in a situation where there are no good options. Regardless of what some people claim, not everyone can cure acne with diet and natural ways. Many have tried strict diets and healthy lifestyle with little effect.<\/p>\n
After getting no help from natural treatments many consider taking Accutane. While there\u2019s no doubt Accutane is effective, it also causes potentially dangerous side effects. In this post I want to talk about low dose Accutane as a potential alternative.<\/p>\n
We\u2019ll go over some studies to see how well it works against acne and whether it causes as bad side effects as normal doses.<\/p>\n
Before we get started, we need to clear a few things. First, Accutane is a brand name for isotretinoin. And since Accutane is no longer available, I\u2019ll use the term isotretinoin in this post.<\/p>\n
Also, for reference, the standard dose for isotretinoin is 1 to 2 mg\/kg\/day for 15 to 20 weeks so that the cumulative dose reaches between 120mg\/kg to 15mg\/kg. The \u2018kg\u2019 refers to bodyweight.<\/p>\n
The low and very low dose regimens vary from as little as 2.5 mg\/day to 20 mg\/day. For the sake of comparison the standard dose for a person who weights 70 kg (154 lbs) would be from 70 mg\/day to 140 mg\/day. So we are talking of significantly smaller doses.<\/p>\n
The first question we should ask is whether low dose isotretinoin works? Studies clearly show that it does work. In fact, low doses seem to work as well as higher doses.<\/p>\n
Fortunately there\u2019s no grand medical conspiracy and doctors and scientists are actively trying to make treatments both safer and more affordable. That\u2019s why several studies have compared low dose isotretinoin regimens with conventional dose regimens. I won\u2019t bore you with details of each study. Because Dr. Marius Rademaker from New Zealand helpfully analyzed 30 years of isotretinoin research for his paper: Isotretinoin: dose, duration and relapse. What does 30 years of usage tell us?<\/a> I\u2019ll just quote the relevant part from his paper.<\/p>\n However, subsequent dose-ranging studies indicated that there was no dose effect in the 0.1\u20133.0 mg\/kg per day range, in that all dosages cleared acne in equal measure and at the same rate.<\/p>\n Rademaker, M. Isotretinoin: dose, duration and relapse. What does 30 years of usage tell us?<\/a> The Australasian journal of dermatology54, 157\u201362 (2013).<\/p><\/blockquote>\n In other words, low doses clear acne as quickly and effectively as higher doses.<\/p>\n Furthermore, a study published earlier this year showed that doses as low as 5 mg\/day can effectively treat adult acne.<\/p>\n Isotretinoin 5 mg\/day is effective in reducing the number of acne lesions, and improving patients dermatologic quality of life, with minimal adverse effects.<\/p>\n Rademaker, M, Wishart, JM & Birchall, NM. Isotretinoin 5 mg daily for low grade adult acne vulgaris\u0096a placebo controlled, randomized double blind study<\/a>. Journal of the European Academy of Dermatology and Venereology 28, 747\u2013754 (2014).<\/p><\/blockquote>\n 2.5 mg 3 times a week enough to keep sebum under control<\/strong><\/p>\n Another interesting study showed that very low dose isotretinoin can massively reduce sebum production. Some people tell me that their skin remains massively oily even after doing diet and lifestyle changes that should reduce sebum production. I suspect their skin is excessively sensitive to hormones and they have very few options to control how much oil their skin produces. As this study<\/a> shows, very low dose isotretinoin could be an option.<\/p>\n The researchers tested 3 different very low dose regimens. Here are the reductions in sebum production for each dosage (after 6 months of treatment):<\/p>\n Don\u2019t make too much of the differences in percentages. The 5 mg\/day group had much lower sebum production to begin with, so there was only so much it could go down. You can\u2019t say based on this that 2.5 mg\/day is more effective than the other doses. The conclusion from this study is that each dosage regimen effectively reduced sebum production.<\/p>\n These studies clearly show that dermatologists have been prescribing isotretinoin in needlessly high doses for several decades now. In all fairness, earlier studies showed that while lower doses could clear acne the risk of relapse seemed much higher. Later studies showed no increase in relapse risk with lower daily doses if the treatment is continued longer, as we\u2019ll soon see.<\/p>\n While you can\u2019t determine your own treatment dosage and duration, it helps to know what science says so you can discuss it with your doctor.<\/p>\n Here\u2019s what Dr. Rademaker wrote in his review paper regarding treatment duration that minimizes the risk of relapse.<\/p>\n In practice, dermatologists should continue isotretinoin until the patients\u2019 acne has cleared, and then for another 3 or 4 months: this may mean as little as 4 months of treatment for facial acne in some patients and over 18 months for significant acne on the trunk in others.<\/p>\n Rademaker, M. Isotretinoin: dose, duration and relapse. What does 30 years of usage tell us?<\/a> The Australasian journal of dermatology54, 157\u201362 (2013).<\/p><\/blockquote>\n Here\u2019s why you should continue the treatment even after acne has cleared. Isotretinoin works by suppressing the sebacious glands (the part of the skin that produces sebum). If you stop the treatment too early, the glands can recover and there\u2019s a higher risk that acne comes back.<\/p>\n Contrary to what earlier studies showed, it seems low doses isotretinoin permanently clears acne for most people. One study<\/a> showed 7.9% of patients relapsed over 5 years, another<\/a> showed 4% relapsed in 4 years (however, adults relapsed more frequently than teens and women more frequently than men), while a third paper<\/a> reported 9.4% relapse risk over 2 years.<\/p>\n These rates seem comparable or lower than for higher dose regimens. One high dose study<\/a> showed 32.7% relapse in 12 months. While another high dose study<\/a> reported 12.5% relapse over 3 years. Relapse rates in standard dose studies fall somewhere between 5 and 50%.<\/p>\n It\u2019s hard to directly compare relapse rates between different studies. Studies may use different definitions for relapse and rates vary with age, sex, acne severity and study duration.<\/p>\n The takeaway message from this is that low dose treatment doesn\u2019t necessarily mean your acne is more likely to come back later.<\/p>\n Most papers make the point that women with PCOS are much more likely to relapse than other groups. I suspect that, to some degree, this applies to all the adult women with hormonal-type acne.<\/p>\n Now that we\u2019ve established that low dose isotretinoin treatment is effective, let\u2019s look at the dangers and side effects.<\/p>\n Fortunately, we can count on Dr. Markus Rademaker again. He reviewed data from 1743 patients taking isotretinoin in his 2010 paper: Adverse effects of isotretinoin: A retrospective review of 1743 patients started on isotretinoin<\/a>.<\/p>\n His data shows that while most side effects are dose-dependent the most concerning ones aren\u2019t. Here\u2019s the graph I made from his data.<\/p>\n <\/a><\/p>\n The graph shows prevalence of side effects by dosage, and here\u2019s how the dosages are classified:<\/p>\n A few important takeaways:<\/p>\n Of the moderate\/severe side effects tiredness, mood changes and nose bleeding were quite a bit more common in high dose groups, muscle aching was over 10 times more common in the highest dose group vs. the lowest dose.<\/p>\n Side effects classified as severe or ones that required stopping treatment were equally common in each dosage group. It seems that some people, for whatever reason, react very badly to isotretinoin and risk getting severe side effects from even very low doses.<\/p>\n While I would love to say that low doses keeps you safe from all the really scary side effects you\u2019ve heard of that doesn\u2019t seem to be the case, at least based on this data.<\/p>\n Sometimes life hands you lemons that just don\u2019t turn into lemonade. Some people who are into natural health view the human body as perfectly designed and that it would run perfectly without any diseases if you just could return it to the original perfect state. For these people there\u2019s never any reason to take a drug like isotretinoin.<\/p>\n Alas, this view is both naive and completely ignorant of lessons from evolutionary biology. The body is far from perfect (reading The Greatest Show on Earth<\/a> quickly disabuses you of any illusions to the contrary), and some people will get acne regardless of how healthy they eat and live.<\/p>\n These people have to choose from 2 bad alternatives, either continue to live with their skin problems or risk taking isotretinoin.<\/p>\n The data shows that very low and low doses effectively clears acne with minimal side effects. Alas, it seems that serious, possibly even debilitating, side effects occur even at very low doses. Fortunately, they are extremely rare.<\/p>\n If you\u2019ve been cursed with skin that that doesn\u2019t respond to most natural treatments, I\u2019m afraid your options are very limited. Low dose isotretinoin likely will fix it. Botox<\/a> and microneedling treatments<\/a> can offer temporary help.<\/p>\n","protected":false},"excerpt":{"rendered":" Sometimes you are in a situation where there are no good options. Regardless of what some people claim, not everyone can cure acne with diet and natural ways. Many have tried strict diets and healthy lifestyle with little effect. After getting no help from natural treatments many consider taking Accutane. While there\u2019s no doubt Accutane … Read more<\/a><\/p>\n","protected":false},"author":1,"featured_media":10585,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"generate_page_header":"","footnotes":""},"categories":[91],"tags":[119],"acf":[],"_links":{"self":[{"href":"https:\/\/acneeinstein.com\/wp-json\/wp\/v2\/posts\/8756"}],"collection":[{"href":"https:\/\/acneeinstein.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/acneeinstein.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/acneeinstein.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/acneeinstein.com\/wp-json\/wp\/v2\/comments?post=8756"}],"version-history":[{"count":4,"href":"https:\/\/acneeinstein.com\/wp-json\/wp\/v2\/posts\/8756\/revisions"}],"predecessor-version":[{"id":10959,"href":"https:\/\/acneeinstein.com\/wp-json\/wp\/v2\/posts\/8756\/revisions\/10959"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/acneeinstein.com\/wp-json\/wp\/v2\/media\/10585"}],"wp:attachment":[{"href":"https:\/\/acneeinstein.com\/wp-json\/wp\/v2\/media?parent=8756"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/acneeinstein.com\/wp-json\/wp\/v2\/categories?post=8756"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/acneeinstein.com\/wp-json\/wp\/v2\/tags?post=8756"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
Treatment duration<\/h2>\n
Relapse<\/h2>\n
Dangers and side effects<\/h2>\n
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Conclusion<\/h2>\n