Considering Low Dose Accutane As A Last Resort? Here’s What You Need To Know.

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’s 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.

We’ll go over some studies to see how well it works against acne and whether it causes as bad side effects as normal doses.

Standard and low dose definitions

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’ll use the term isotretinoin in this post.

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 ‘kg’ refers to bodyweight.

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.

Does low dose isotretinoin work?

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.

Fortunately there’s no grand medical conspiracy and doctors and scientists are actively trying to make treatments both safer and more affordable. That’s why several studies have compared low dose isotretinoin regimens with conventional dose regimens. I won’t 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? I’ll just quote the relevant part from his paper.

However, subsequent dose-ranging studies indicated that there was no dose effect in the 0.1–3.0 mg/kg per day range, in that all dosages cleared acne in equal measure and at the same rate.

Rademaker, M. Isotretinoin: dose, duration and relapse. What does 30 years of usage tell us? The Australasian journal of dermatology54, 157–62 (2013).

In other words, low doses clear acne as quickly and effectively as higher doses.

Furthermore, a study published earlier this year showed that doses as low as 5 mg/day can effectively treat adult acne.

Isotretinoin 5 mg/day is effective in reducing the number of acne lesions, and improving patients dermatologic quality of life, with minimal adverse effects.

Rademaker, M, Wishart, JM & Birchall, NM. Isotretinoin 5 mg daily for low grade adult acne vulgaris–a placebo controlled, randomized double blind study. Journal of the European Academy of Dermatology and Venereology 28, 747–754 (2014).

2.5 mg 3 times a week enough to keep sebum under control

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 shows, very low dose isotretinoin could be an option.

The researchers tested 3 different very low dose regimens. Here are the reductions in sebum production for each dosage (after 6 months of treatment):

  • 5 mg/day: 51%
  • 2.5 mg/day: 64%
  • 2.5 mg 3 times a week: 59%

Don’t 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’t 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.

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’ll soon see.

Treatment duration

While you can’t determine your own treatment dosage and duration, it helps to know what science says so you can discuss it with your doctor.

Here’s what Dr. Rademaker wrote in his review paper regarding treatment duration that minimizes the risk of relapse.

In practice, dermatologists should continue isotretinoin until the patients’ 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.

Rademaker, M. Isotretinoin: dose, duration and relapse. What does 30 years of usage tell us? The Australasian journal of dermatology54, 157–62 (2013).

Here’s 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’s a higher risk that acne comes back.

Relapse

Contrary to what earlier studies showed, it seems low doses isotretinoin permanently clears acne for most people. One study showed 7.9% of patients relapsed over 5 years, another showed 4% relapsed in 4 years (however, adults relapsed more frequently than teens and women more frequently than men), while a third paper reported 9.4% relapse risk over 2 years.

These rates seem comparable or lower than for higher dose regimens. One high dose study showed 32.7% relapse in 12 months. While another high dose study reported 12.5% relapse over 3 years. Relapse rates in standard dose studies fall somewhere between 5 and 50%.

It’s 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.

The takeaway message from this is that low dose treatment doesn’t necessarily mean your acne is more likely to come back later.

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.

Dangers and side effects

Now that we’ve established that low dose isotretinoin treatment is effective, let’s look at the dangers and side effects.

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.

His data shows that while most side effects are dose-dependent the most concerning ones aren’t. Here’s the graph I made from his data.

isotretinoin-side-effects-by-dosage

The graph shows prevalence of side effects by dosage, and here’s how the dosages are classified:

  • Very low: <0.25 mg/kg/day
  • Low: 0.26 – 0.5 mg/kg/day
  • Medium: 0.51 – 0.75 mg/kg/day
  • High: 0.76 – 1 mg/kg/day

A few important takeaways:

  • Even at high doses most people only experience mild side effects.
  • Lower doses cause significantly less ‘annoying’ side effects; dry lips, skin irritation, etc. (classified as mild/moderate).
  • Severe side effects are very rare, but the risk for severe side effects doesn’t seem to depend on dosage.

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.

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.

While I would love to say that low doses keeps you safe from all the really scary side effects you’ve heard of that doesn’t seem to be the case, at least based on this data.

Conclusion

Sometimes life hands you lemons that just don’t 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’s never any reason to take a drug like isotretinoin.

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 quickly disabuses you of any illusions to the contrary), and some people will get acne regardless of how healthy they eat and live.

These people have to choose from 2 bad alternatives, either continue to live with their skin problems or risk taking isotretinoin.

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.

If you’ve been cursed with skin that that doesn’t respond to most natural treatments, I’m afraid your options are very limited. Low dose isotretinoin likely will fix it. Botox and microneedling treatments can offer temporary help.

Don’t know how to get over acne? Let me help.

Feel like you’ve tried everything but acne still won’t budge? Read this page to understand why you get acne and what you can do to get over it.

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About Me

Hi, I am Acne Einstein(a.k.a. Seppo Puusa). I'm a bit of a science nerd who is also passionate about health. I enjoy digging through medical journals for acne treatment gems I can share here. You can read more about my journey through acne and how I eventually ended up creating this.

References

56 thoughts on “Considering Low Dose Accutane As A Last Resort? Here’s What You Need To Know.

  1. This is so me, I feel like I’ve come to the end’s road now. Up until now, I’ve been thinking what is still left for me to fix, wether it’s my gut, my mood, my inflation levels.. And I realised that, I’m still producing abnormal sebum levels. To the point where it’s rather gross. Even with green tea and DHT blocker my skin still produces quite a lot of oil.. I think that accutane might be a last resort.

    Also, I found a study that concluded that applying a topical retinoid (Any kind) after accutane treatment was over, reduced the relapse rate by 30%

    • Yep, I think sebum production is one of the least controllable aspects of acne. In some cases you can reduce it, but generally speaking there’s not that much you can do about it. I mean aside from isotretinoin and some invasive treatments that actually destroy the sebacious glands.

      I would expect that any topical treatment you use during/after isotretinoin reduces relapse rates.

    • Relapse rates are probably defined/measured by looking at how many people require another treatment to treat acne. So anything that keeps acne under control would, by this definition, reduce relapse rates. I think this is flawed way to measure relapse rates, but that’s what I assume is going on.

      • I am considering using low dose accutane. I took accutane previously and it cleared my skin up beautifully. Now 7 years later out of nowehere I am finding I have huge enlarged pores and some scarred pores on my nose and cheeks. I have very oily skin by nature but it has took off as of late. Do you think low dose accutane could help me reverse some of the enlarged and scarred pores? I have never had so many clogged and enlarged pores until just recently and I need to fix it before more clog. (I have been on a very consistent skincare regimen for months now with little improvement). I will say that I have been drinking alcohol at very excessive levels lately which I think could be what is actually doing the harm [new roomates 🙁 ].

        • Hi Jeremy! Sorry to hear acne causes so many problems for you.

          Nobody can say in advance whether Accutane will help you. Studies show it helps about 80% of the people who take it, so odds are it will help you. That said, it’s possible there’s some underlying issue that’s causing acne, like gut problems. If that’s the case Accutane of course won’t fix that and it’s possible your acne comes back later on.

  2. Hi Seppo,

    Hope you are well.

    Personally, I used Accutane when I was around thirty. It cleared the acne on my back but not my face. I never experienced any depression or excessive dryness etc. so I was lucky in that respect.
    I would never rule out using “conventional” treatments like Accutane and BP if it works for you. Just as more “natural” treatments work for others.
    Your web site continues to strike the right balance showing it is not an either/or choice. I do think isotretinoin gets a bit of a bad press which is not entirely justified. In the United Kingdom you can still, at the moment, get it on the NHS. One of the few things the UK got right.

    MichaelC

    • Hi Michael, good to hear from you again!

      I also didn’t experience any serious side effects from Accutane. Just temporary annoyances. I think this is the case for the vast majority of the people who take Accutane.

      I think that Accutane getting a bad rap is more of a reflection of the nature of internet than anything to do with the drug. Let’s say that 1 on 10,000 gets more serious side effects from Accutane. Given how many prescriptions are sold every year, that’s still hundreds of people. These hundreds of people then share their experiences on the various anti-Accutane websites. So it can give the illusion that Accutane causes wide-spread damage. But inside the echo chamber these people never hear from the hundreds of thousands of people who experienced no problems.

  3. Hi Seppo,

    I’ve been following your website for quite some time and although I’m not a member nor have I ever commented, this particular article really struck my interest.

    Like so many others, I’ve struggled with mild to moderate acne for years. 16 years to be exact (I’m now 28). It has been a relentless battle and I have yet to find my cure or something that will offer me long term remission. I feel as though I have exhausted so many options from dietary and lifestyle changes to hygiene and skin care.

    Upon the first visit with my new dermatologist 7 months ago, he suggested Accutane or its generic (I live in the US). I trust his judgment and I honestly believe that he suggested it due to my age, not the severity of my acne, which he classified as moderate. Of course, I declined out of fear. All of the horror stories out there scared me too much to try it.

    I’ve spent countless hours on the internet researching every remedy and so called cure, but I have yet to find something that truly offers me relief. To say that I’m tired of the struggle with acne would be an understatement. I’m beyond that and I feel like the only other option left is Accutane.

    However, for some reason I just can’t give up that maybe there’s still one more “natural” thing I can try. I keep going over everything thinking, “maybe I didn’t give it long enough or maybe I didn’t try hard enough. Maybe I need to be more strict and try it all again.” I feel so tortured. I’ve never tried antibiotics and I won’t do so, but I still have to make my way through numerous topicals before I know for sure whether or not they make a difference. Thus far Epiduo and Aczone have proven ineffective.

    I suppose my ultimate question to you and perhaps other readers is how long is long enough? How long should an individual try a diet and/or lifestyle change to know for sure whether or not it is working? For instance, I eliminated dairy, soy, corn, added sugar, caffeine, all vegetable oils and processed foods for 3 months with no improvement at all (I don’t drink or smoke so those weren’t items I needed to eliminate). I’m a little over a month into excluding gluten and there has been little change.

    Just when I think things are looking up, I break out. From experience, do you think that I should now combine all of those items in addition to gluten to see if together it makes a difference? That’s the mistake I made before; I didn’t give up gluten when I eliminated all of the other items. I just don’t know where to go from here. Where I get stuck is wondering if giving up dairy and the others didn’t work because I was doing something else that was affecting it at the time, so the positive effects couldn’t be seen. I’m not sure if that logically makes sense, but it has crossed my mind numerous times. It’s like I think that everything has to be in perfect harmony in order for my skin to clear and I’m just not sure if that is truly the case.

    The only time I have been clear has been on a particular brand of oral contraceptive, but I had to stop due to adverse side effects. I’ve had my hormones tested and they came back within normal ranges. I’ve been to an allergist and have only 2 food allergies (almonds and cashews). I don’t feel like I have digestive issues and I can’t pinpoint any one particular food that makes my skin worse. I’ve tried the candida diet and it was awful. I was just so miserable and I spent a great deal of money on antifungals and probiotics.

    No matter what I do I always have blackheads, whiteheads and random pustules. Although they are small and mild/moderate (depending on who you ask), my skin still feels so bumpy. I’m fair skinned and the marks left behind linger for months, so even if I don’t have an active breakout I still have left over hyperpigmentation. I’ve also tried Proactive, Exposed, Murad, etc and while they help a little it never prevents new blemishes from forming. I just spent $70 on a bottle of fermented cod liver oil and I’m now going to see if that will help. I’m just so tired of paying a fortune, getting my hopes up and then not seeing any results. I can’t afford to see a naturopath as the only one in my area costs $200 just for a consultation.

    The list of natural and holistic things I have tried is very long from bone broth to washing with manuka honey (again, very expensive!) to drinking green tea. I truly am at the end of the road. Perhaps other readers could comment as well. I’ve read some of Adel’s posts and I’m curious to know if he is going to try Accutane? I guess my only options are to continue with the restrictive diet, try Accutane or somehow accept that I will always have acne. I apologize for the lengthy post. Thank you Seppo for your sound advice and logical approach to acne. It’s refreshing to read a website that excludes fear mongering and judgment.

    • Thanks for your thoughtful comment, Amanda. I write this site exactly for people like you, and to prevent others from going down that path.

      I suppose my ultimate question to you and perhaps other readers is how long is long enough?

      There’s of course no correct answer to this, but perhaps a good rule of thumb would be when the cure becomes worse than the problem. And it sounds that in your case we are long past that point. I understand that acne is emotionally painful, but it’s probably not worth ruining your life over.

      How long should an individual try a diet and/or lifestyle change to know for sure whether or not it is working?

      This one is less subjective. I’d say that in most cases you should start seeing at least some improvements in the first month. It’s possible that in some cases it takes longer to repair the damage, if such is present, but in most cases a month or two should be enough to see some positive changes.

      Where I get stuck is wondering if giving up dairy and the others didn’t work because I was doing something else that was affecting it at the time, so the positive effects couldn’t be seen.

      This is possible but probably not very likely. If both dairy and gluten contribute to your acne, then giving up either should show some positive effect.

      It’s like I think that everything has to be in perfect harmony in order for my skin to clear and I’m just not sure if that is truly the case

      This is one of the central fallacies of the natural health movement. That you can somehow achieve perfect harmony with nature and your body. That ‘once you stop messing with your body’ it will return to perfect balance and health.

      This view is completely ignorant of evolutionary biology and.. well.. reality itself. The sad thing is that the human body is a mishmash compromises and quick fixes. Frankly speaking I’m amazed it doesn’t fall apart sooner.

      I think that once you understand just how wrong that perfect balance and harmony view is things should get easier to deal with. Since you don’t have to feel guilty for ‘abusing yourself’ (not sure if that’s the case, I get the feeling it might be).

      Reading The Greatest Show on Earth – The Evidence for Evolution by Richard Dawkins did the trick for me. It’s a mind blowing book that shows the evolutionary history of the human body and all the compromises that were required to take us here.

      Everyone would love if we would have complete control over our health and lives, me included. It’s a seductive illusion, and unfortunately it’s an illusion. Acne is one of those cases where we have some degree of control. Some people can get over it completely, others can do little over it. Genes do matter, regardless of how much the natural health types would like to think otherwise. So don’t blame yourself too much if you can’t get over it.

      Let me just be clear that I don’t know your situation and I’m not trying to diagnose or categorize you here. It just sounds like you might suffer from what I call as the emotional acne type. Again I’m generalizing here and I’m not sure how much this applies to you. People with emotional acne tend to go through a lot of emotional pain and suffering over acne and are thus willing to try extreme diets and regimens to get over it. In many cases driving themselves miserable and on the brink of an eating disorder doing so. Unfortunately this stress, anxiety and worry over acne can perpetuate it.

      These people often set impossibly high standards for themselves and there may be some self-esteem or other issues underlying the pain.

      So if any of the above rings true, and regardless of whether you choose to take Accutane or not, it would be a good idea to deal with those issues (we all have them). Because even if you manage to get over acne more than likely they are going to pop up in some area of your life.

      The best and easiest to use self-help tool that I know of is called rational emotive behavior therapy (REBT). It’s a science-based psychological tool for dealing with difficult beliefs and thought patterns that cause negative emotions. I suggest reading Reason to Change by Windy Dryden. It’s a sort of a self-help guide/workbook that guides you on using REBT on yourself.

      The University of Califonia’s Greater Good Center also has helpful articles and resources about positive psychology. https://greatergood.berkeley.edu

      Finally, self-compassion is another useful skill to practice. It sort of comes automatically when you practice REBT, though.

      Hope this helps!

    • One more thing. Please don’t take my previous comment to mean that there’s nothing you can do about your acne or that you have to resign living with it for the rest of your life. I don’t know your situation and so can’t really comment on this.

      I just commented on what I saw as the biggest problems you brought up. Also, I think it’s much easier to try and get over acne when you come to it from emotionally more positive place. I don’t pretend it’s easy, but I do think in most cases it’s possible.

    • Hi Amanda, I saw your comment since I usually check the website once in a while to see if there’s something new or not. 😛

      Anyways, I started Accutane about 2 weeks ago. I’m on my 3rd week now and so far I have to say it’s not so bad. I’m on 20-40mg. I’m saying that because I was told by my doctor to take 40mg but i realised that I would run out of the product if I kept taking two 20mg tablets before my next appointment. So I decided to take only 20mg until I get some more.. But it’s okay. The doctor has already prescribed 20mg to some other friends of mine and they cleared up permanently anyway. 😛

      But yeah back to the drug, I know it’s only my 3rd week, but my skin isn’t so bad. It’s definitely less oilier which is nice. My lips only started getting chapped by the end of the 2nd week (I suppose having a higher dose would have a more pronounced effect and it would probably occur sooner). Other sides effect are nose bleeds, ( I had one today, wether it’s because of Accutane or not, I dunno but most likely) dry eyes/bloodshot eyes, it only happened in one eye and I could definitely feel a difference regarding my eyes but with artificial tears my eyes are back to normal. 😛 And some mild back pain. Actually this drug does make me quite sore after a tough workout (which is how I workout) but again, it’s back to normal after 2-3 days. 😛

      I have high expectations of this drug actually, mostly because of the knowledge that I’ve gained. I know now what to discuss with my doctor regarding how to reduce the relapse rates and so. I’d say that the chance of not having acne again or very rarely, would be amazing. In fact, I’m kinda mad at myself that I did not do this any sooner. 2 and a half years ago, I told myself ”I’ll never take accutane” while I was wandering blindly in the natural health department… Yes I used Manuka honey too.. And COD liver oil.. Honestly, it didn’t work. I’m not saying it won’t work either for you but given the knowledge that you gain here.. You know that these two probably won’t be enough.. Omega 3 in the COD liver oil could help, it doesn’t hurt but still. The vitamin A content in the COD liver oil is too lower to have the same effect as Accutane… So I honestly do think that.. considering everything you’ve been through + you’re nearly 30.. I think Accutane may be the thing to go. I’m glad I started taking this before I turn 20. I’d much rather have taken this before I even turned 18 but yeah.. Better late than never.

      I hope you figure it out eventually.

  4. Thank you so much for your reply Seppo!

    I completely agree. My acne is probably primarily emotional. It’s interesting that you speak of perfectionism. That’s my personality exactly. I’ve often wondered if I were to clear my acne would my perfectionism manifest in another way? Would it be another physical attribute, say my hair that I would suddenly be unhappy with? Or would it manifest in a different way? I’m pretty sure my insecurities would find another outlet. I was a perfectionist in academics all through school and it carried on through college. I imagine it’ll continue to carry on through my masters program and further if I don’t get a handle on it soon. I’m certainly one of the people that could benefit from the therapy that you speak of, so thank you for the literature suggestions. I’ll certainly look into them.

    I don’t blame acne for my self esteem issues. I do believe that it is a large contributor, but I’m sure that it wouldn’t bother me nearly as much if I were more emotionally stable. My sister and my husband both have acne and neither one really cares. I mean I’m sure on some level they do care and would prefer that they didn’t have acne, but it has never held either one back. They don’t let it dictate their lives. I think that’s where I stumble the most; I let it control nearly every decision I make. I’m guilty of canceling plans if I have a big breakout, making every dietary choice based on whether or not I think it’ll cause a pimple, sticking to an extremely tiring and strict facial care plan etc. I feel silly admitting this and I’m not sure this is the forum to do so, but I suppose I’ll be transparent for the sake of others in hopes that it may help someone else to not feel so alone.

    I’m grateful for your website because there are so many others out there that perpetuate the perfect health belief. In fact, I just recently told my husband that ever since I embarked on this holistic, natural health journey that I’ve stopped having fun and I’m growing tired of trying to achieve a perfect balance. I have become completely wrapped up in the idea of toxins, cleansing, balance, etc. I’ve also somehow adopted that if something isn’t working you’re either doing it wrong of you haven’t given it long enough (I’m sure that’s obvious from my previous post). It’s not only emotionally exhausting, but it’s time consuming and expensive. Thankfully, I still know that logically not all of the theories make sense and I agree with you that I’m surprised we all function as well as we do.

    Another emotional issue that I have felt since seeking out alternative means is that of guilt. I feel so guilty for wanting to use conventional medicine. I’ve always been a believer in using medicine when necessary and since diving into the natural heath world, I feel a tremendous amount of guilt for going to the dermatologist and for even considering Accutane. After all, Accutane is deemed one of the worst things you can do. After all this healing, how can I possible poison my body with something as harsh as Accutane? These are questions that plague me when trying to come to a decision. I wish there were a simple yes or no when deciding, but I’ve waivered between the two so often that now I don’t really know how I feel about it anymore.

    Thank you so much Seppo for all of your help and for answering my questions. I think I’ll give gluten free one more month and if that doesn’t work then I think I’m done with the restrictive diets. I still plan to eat healthy and avoid processed foods when possible, but it would be nice to enjoy life a little more and that includes food. I sometimes miss the ignorance I once had prior to finding the natural health world. I truly was more blissful back then. In the meantime though, I’ll look into the therapy literature. Thank you again!

    • Happy to hear that you found the answer useful.

      I’ve often wondered if I were to clear my acne would my perfectionism manifest in another way? Would it be another physical attribute, say my hair that I would suddenly be unhappy with? Or would it manifest in a different way? I’m pretty sure my insecurities would find another outlet.

      They probably would. The thing is that acne, per se, doesn’t cause the insecurities. It simply brings them to surface. And getting over acne doesn’t usually fix the negative thinking patterns that cause emotional suffering. Not saying getting over acne wouldn’t help you feel better, but I don’t think it would fix the insecurities you speak of.

      In fact, I just recently told my husband that ever since I embarked on this holistic, natural health journey that I’ve stopped having fun and I’m growing tired of trying to achieve a perfect balance. I have become completely wrapped up in the idea of toxins, cleansing, balance, etc. I’ve also somehow adopted that if something isn’t working you’re either doing it wrong of you haven’t given it long enough (I’m sure that’s obvious from my previous post). It’s not only emotionally exhausting, but it’s time consuming and expensive.

      This is why I have love-hate relationship with natural health. On the positive side it can help people take more responsibility for their well-being and it can help many people struggling with chronic health issues that mainstream medicine can’t yet solve.

      But all of this is shadowed by the fact that they can’t moderate their own BS. I don’t know why the whole thing has turned into hate-filled, fear mongering machine. They could choose to promote positive message, but instead they choose to tell that more or less everything that’s not organic, pure and natural is horrible poison that’s going to kill you.

      My view is to do the things that have a reasonable chance to work (i.e. the stuff backed with scientific evidence), work on accepting what can’t be changed and then experiment with an open mind. That is try things that might or might not work but do so without horrible need for them to work. And of course use mainstream medicine where it’s appropriate.

      Another emotional issue that I have felt since seeking out alternative means is that of guilt. I feel so guilty for wanting to use conventional medicine. I’ve always been a believer in using medicine when necessary and since diving into the natural heath world, I feel a tremendous amount of guilt for going to the dermatologist and for even considering Accutane.

      There. Another perfect example of fear-mongering and guilt heaping natural and alternative practitioners like to dish on.

      I don’t know what to say to this. You know when Steve Jobs died people said that he had a sort of ‘reality distortion field’? Natural and alternative health types live within their own reality distortion field, except that it’s much stronger. They live in a world that’s dangerous and horrible. A world where doctors and scientists scheme to poison everybody on the planet. A place where humans don’t care for each other (except for the heroic natural health types who have discover ‘the truth’). A world that’s controlled and manipulated by a shadowy cabal of rich, evil and greedy men.

      A world where all of this is hidden with the willing participation of practically every single media outlet in the world. A world where people are sheeple and too stupid or drugged out to realize what’s happening. Again except for the heroic natural health types who have discovered the horrible truth and are trying to ‘wake people up’.

      I could go on, but I think you know what I mean.

      They have to create this elaborate and ever-expanding illusionary bubble because without it their worldview would come crumbling down. For example, why don’t scientists and doctors tell people about these supposed healing miracles? Because they are bought and paid for by the big pharma. That’s the only way these people can explain this contradiction.

      Anyone who threatens this fragile construct is met with outright hostility. If these people would seriously question what they believe they would be forced to conclude that their Sacred Truth is nothing but an elaborate illusion. That’s why they are so hostile against people who dare to question or challenge them. I get hostile comments and emails on most of my posts where I dare to question liver flushing, apple cider vinegar or other ‘sacred topics’.

      Another tactic is to blame the victim. If the supposed miracle therapy doesn’t work, then you obviously didn’t do it correctly. Or you weren’t strict enough. You gave up too soon. We skeptics like to say that alternative medicine can’t fail – it can only be failed.

      When you snap out of it, it’s easy to see that it’s the natural health types who don’t think, can’t think or don’t want to think. I’m often being told that ‘I need to be more open minded’, but it’s these people who are truly close minded. They are hostile to and actively reject any information that challenges their world view. That’s more or less the definition of close mindedness.

      Hope this helps!

    • Understand. I think the problem is that you don’t have sufficiently trained spam filters on your mind. With the fall of traditional media and rise of the internet there’s much less fact-checking and verification. Now it’s up to you to filter out the junk. This is not that easy and requires you to develop critical thinking skills.

      It would be helpful to learn some skepticism. It teaches these kind of thinking skills and how to figure out what’s right and what’s wrong. If you like to listen to audio content The Skeptic’s Guide to The Galaxy is a good podcast (free). Carl Sagan’s book Demon Haunted World – Science as a candle in the dark is a fantastic read.

      This pseudoscience bingo card is a handy shortcut. Basically, the more boxes you tick, the higher the likelihood that what you are reading is utter nonsense. And here’s a Food Babe version of the bingo card.

      Here are some other red flags you can watch out for:

      – Holistic, a meaningless term non-doctor ‘doctors’ use to fool people.
      – Toxin, chemical or free thereof. In 99% of the cases used by people with no clue of what they are talking about. A common fear-mongering tactic to bully people into believing they have to cleanse and detox.
      – Acupuncturist, naturopath, chiropractor, homeopath. These non-doctor doctors attend what I call the Hogwards School of Magical Healing where they learn long debunked ideas of health and healing. That said, not all alternative practitioners are useless. Some do practice sound and science-based healthcare and if you can find one they can probably help you more than conventional MDs can. Just don’t ask me how to find them 🙂
      – Organic/all natural. Nothing wrong with these as such, but they are usually only used by people promoting unscientific ideas about health.
      – Big Pharma/ doctors are only interested in prescribing drugs. Nobody denies that there are problems with the big pharma or that doctors could do more to promote healthy diet and lifestyle. But just because how scientific medicine is not perfect doesn’t mean alternative medicine works. It’s like saying airplanes are not perfect therefore flying carpets. Alternative medicine has to stand on its own merits.

      In all fairness I have to say that there are also a lot of problems with various skeptical and science blogs. I think that many are too quick to dismiss various unproven treatments and ideas.

  5. Hi Adel,

    So happy to see your response! That’s wonderful that you went ahead and decided to give Accutane a try 🙂 I wish you the absolute best! Have you started a blog anywhere for others to follow your journey? I know many Accutane users start one on Real Self or Acne.org, so if you do have a blog going please let me know. I’d like to follow your progress. It’s a little difficult to find others who have gone down the alternative health road and eventually were led to Accutane, so I’m curious to see how your experience turns out. It seems like many others go on Accutane, it doesn’t work for them and then they get into the holistic, natural approaches. It’s nice to see someone else who has tried the natural options first and then went ahead with a conventional option.

    I’m glad to hear that your side effects have been mild thus far. Have you had an initial breakout? From what I’ve read it seems to be pretty common. What are you most concerned about as far as side effects? I recently read that it has the potential to cause type 1 diabetes. Perhaps Seppo can offer some insight here. Are there any studies to suggest that this may be the case? Is it listed in the side effects? Diabetes, hair loss, intracranial pressure, vision loss and sexual side effects are the ones I’m most concerned about. I think I could handle the joint pain, dryness and chapped lips, but I guess I’ll never truly know unless I muster up the courage to try it. The side effects seem to be so different amongst users. I’ve read so many different side effects that I’m just not sure which ones are actually legitimate. I think some people end up blaming Accutane for all their ills. That’s not to discredit any real side effects people have experienced, I just think that sometimes they get blown out of proportion.

    Thank you for your input on the cod liver oil. I’m a little apprehensive to try it. I don’t think it’s going to be my cure all, but hopefully it’ll help. Best case scenario, it doesn’t make it worse. I have yet to try supplementing with zinc, however I do take a women’s multivitamin, so hopefully most of my nutrient bases are covered through diet and supplementing with vitamins. Have you tried taking zinc?

    Thank you for responding Adel. I think I first noticed your comments on The Love Vitamin (I could be totally mistaken and I apologize if I am), so when I saw you posting on here I figured it was worth asking you a few questions. I’m glad you’re taking charge of your situation at a younger age than I. I think you’ll have a great outcome! Recently I said that if I still have acne at 30 or the latest 35 I’d take the Accutane plunge. We’ll see what the future holds 🙂 Good luck on your journey!

    Thank you Seppo for allowing all of us to communicate with one another and thank you for creating a platform from which we can all share experience and scientific knowledge/studies 🙂

    • Hey Amanda. 😛

      I don’t know if I’m going to start a blog, I’m already pretty busy with college as it is, and honestly. I think one of the reasons that accutane gets a bad rep (other than the side effects) at the blogs, I mean when people see the things that you go through like extremely dry skin, initial breakouts that could potentially last weeks and so on. I think it causes people to think that this drug is some kind of atomic bomb. I’m taking this drug at a quite low dose, so my side effects won’t be as pronounced as they would be. In fact, if I didn’t have the box with accutane lying on my kitchen table, I would probably forget that I’m even taking it. I haven’t had any initial breakouts so far, I mean I did breakout kinda badly on my chin during the first few days but I think it was just a regular breakout. 😛 It’s gone now though. My skin is definitely less oily now it was pre-treatment. It also makes me feel happy because, if you spend a lot of around the site, you’ll know that inflammatory damage to sebum causes the whole acne cycle, protecting it with creams does help but I guess there’s only that much sebum you can protect. 😛 So I’m glad that my skin is reducing less sebum now. 🙂

      And yeah, I understand the whole ”tried accutane, didn’t work, let’s try something more natural” but in my case, it was the reverse.. I guess for some people, things can change doing a natural ”holistic” way. But for others like me, not so much… It helped immensely but nothing that truly made me happy. Also, I think that.. since the majority of the people finish their courses too soon.. their acne relapses at a higher rate. Therefor they give in and try something else. But I think that, with the knowledge of this drug that you gained here on this website, you know how to reduce the acne relapse rates, and that’s what I’m going after. I did some studying on my own and I’m going to do everything I can do to reduce the relapse rate.

      I think, as far as the side effects, I think it’s the permenant, severe ones that rarely happens like Liver failure and so on. I am taking a low dose as stated before, so side effects like chapped lips won’t be as bad as normally, according to the article Sep made, it doesn’t really matter, since some people just react to the drug very badly.. Again rare. 😛 Though, with a low dose, I think the chances of my liver enzymes going sky high is pretty rare. I guess the more of the drug you take, the more pressure your liver will have to deal with. So hopefully my blood tests are going to come back normal.

      Yeah I tried Zinc. 😛 I think I tried most things, It probably helped but not enough to clear me out. :S

      You probably did see my comments on the lovevitamin, it was where my journy kinda started 2 years ago. Granted, I stopped visiting the site in 2013, mainly because I didn’t seem to get the results that I wanted, and after I read Seppo’s book, I realised that I actually wasted a year of my life doing something that -even though it did help a bit- didn’t really do much for my skin.

      Just ask if you have any more questions. 🙂

    • I recently read that it has the potential to cause type 1 diabetes. Perhaps Seppo can offer some insight here. Are there any studies to suggest that this may be the case?

      I don’t recall ever seeing type 1 diabetes mentioned in any of the papers talking of Accutane safety and side effects. If it does happen it’s probably extremely rare – like practically all really serious side effects are.

      I looked at PubMed and there are a few case reports of people getting serious blood sugar issues after taking Accutane.

      https://care.diabetesjournals.org/content/32/8/e99.long
      https://ndt.oxfordjournals.org/content/11/4/753.1.long

      And a paper from 2001 showed Accutane causes reversible insulin resistance. But the increase in insulin and blood sugar levels reported in this study don’t seem that alarming and all the values returned to normal after treatment ended.

      https://www.ncbi.nlm.nih.gov/pubmed/11747145

      I’ve been recently reading papers dealing with ‘leaky gut’. It seems that people with autoimmune problems (like type 1 diabetes) also have somewhat leaky gut and it’s speculated that leaky gut is a factor in development of autoimmune diseases. Given that there’s a connection between leaky gut and acne it’s possible that the supposed link between type 1 diabetes and Accutane is caused by leaky gut and has nothing to do with Accutane.

      I wouldn’t say that Accutane can’t or doesn’t cause type 1 diabetes. It sometimes causes extremely serious side effects, but fortunately these are very rare.

  6. Thank you for replying again Seppo 🙂

    I think the reason that I found your site last year was because I went looking for scientific based information. It didn’t take me long to realize that most natural health sites are a little absurd and not soundly based in science or on research. I love research! I love asking questions and digging into studies. Sometimes it’s just difficult to find the studies I’m seeking. I try to go into them with an open mind and if the research goes against what I believe, well then perhaps I have to change my beliefs or at least be open to the idea that what I once held to be true may in fact not be or vice versa.

    I’m tired of running into remedies that don’t have anything backing them. For instance, in the article I saw on Yahoo, red flags went up immediately. Any time I see the word “toxins” it usually sounds an alarm to be skeptical. Also, the coffee enema was another red flag. Thank you for the list of other things to look for. I’ll continue working on my mental spam filter.

    A few months ago I went to an essential oil party and the fear mongering there was rampant. I couldn’t believe how some of the women were gobbling up the false information believing that they were going to immediately die or poison themselves with all of the “toxic chemicals” they were using. I mean these women were talking and agreeing that our skin is like a sponge and absorbs every toxin in our environment. I pointed out that if that were true we’d all most likely be dead already. You should have heard the responses. I get that certain chemicals can in fact pass through the skin as certain medications are administered through a skin patch (Ortho Evra for example), but if I were to believe that every single chemical were going to kill me I’d probably never leave my house. I’d probably be dead from all of the so called toxins lurking in my home lol. It’s hard to challenge certain individuals’ beliefs. With that being said, at times I found myself wondering if any of what the host was saying was in fact true. It drives me nuts because when people spout off fallacies it takes me hours of research to figure out if what they are saying is true. It actually does many of us skeptics a complete disservice and yet at the same time it helps us to shed some light on certain topics.

    The fear mongering is so off putting. I like to approach things rationally and I try to do so as much as possible, but it seems as though every natural health forum tugs on emotions to get the reader hooked. I think that’s why I’ve wasted money and time chasing after so called cures. What’s even worse is when they start to bring children into the mix. I have a 3 year old son, so this really gets me. I’ve tried to buy organic for several months now because I had bought into the notion that conventionally grown food was poison and how could I dare to poison my son?! There’s another word to be skeptical of; poison. When I mentioned previously that perhaps certain diet changes weren’t working because I wasn’t doing it correctly or I was doing something to render it ineffective, this is partially what I was referring to. I had been thinking “maybe it’s not working because all of my food is not organically grown. Maybe I’m still breaking out due to pesticide residue or GMO foods.” These are laughable thoughts now, but just a month ago I was seriously considering it as a reason. Thankfully I never believed that liver flushing would work, so I haven’t put myself through that. I think that my lungs, liver and kidneys are doing their job pretty well.

    It’s really nice to have your site as a sound resource for scientific based information. I enjoy engaging in rational conversation where people can approach things from a logical standpoint. I don’t mean to speak ill of Tracy, but I think The Love Vitamin is one such website that promotes some of the remedies that are costly with little pay off and aren’t often backed by evidence. Most of the information I have received is just theory and for me personally, it may have done more harm than good. That’s not to say that sites like hers aren’t helpful or should be shut down. That’s not how I feel at all. I just think that if an individual can’t think critically, he or she is going to go down a path that is tiresome and expensive. I feel a little embarrassed that I followed the candida diet with little payoff, drove myself crazy trying to rid my body of excess toxins all while believing I had done too much damage to my body to ever recover. I’d like to believe that I can think critically and that I’m fairly intelligent, but I suppose over the last year I have thrown all of that out of the window and let fear, irrational thoughts and bogus theories lead the way. I hope that this year I can get back on track and regain my sanity lol.

    I’ll read the studies you linked about diabetes. I’m still sorting through the information about leaky gut. I understand that intestinal permeability is a real thing, but is leaky gut syndrome a made up health issue? I think I read a science based website that noted leaky gut syndrome as quackery. I don’t think gut issues are a concern for me, but I could be way off. I’ve read over your post on the gut skin axis and I think I concluded that my gut was healthy, but I’ll reread it and see if there’s anything I need to work on.

    Thank you again Seppo. I really do appreciate the knowledge I am gaining from your site.

    • Don’t feel too embarrassed that you got sucked too deep into the natural health thing. Happened to me too, and it took me several years before I realized most of it is pure BS. Sounds like you have a leg up on most people when it comes to thinking critically about these things. So you’ll probably have no problems figuring this out.

      The essential oil party sounds all too familiar. The sad thing is that essential oils are among the most toxic and irritating ‘natural’ substances out there. Yet, they are sold as pure and healthy. Not sure that the participants of the essential oil party would appreciate the irony.

      I understand that intestinal permeability is a real thing, but is leaky gut syndrome a made up health issue?

      Intestinal permeability and leaky gut are pretty much the same thing. Intestinal permeability is the term medical research uses. Many skeptic sites say that leaky gut is a quack diagnosis. That’s mainly because the alternative and natural health types have abused the term for decades. It has become associated with quackery. Searching PubMed for articles with “intestinal permeability” in the title returns 1042 citations, as of today. It’s a legitimate and interesting area of research.

      I think Tracy is actually one of the more reasonable natural health types. She promotes a lot of “here’s what I did type of stuff”, but she doesn’t seem too dogmatic. I think she does realize that a lot of the natural stuff just doesn’t work.

  7. Hey Adel,

    I completely understand if you don’t start a blog about your Accutane experience. I remember the days of college and how busy they are, so I think it’s very wise of you to focus on your studies rather than on the Accutane 🙂

    I’m thinking about purchasing Seppo’s book, so it’s nice to hear that you’ve gained a lot from it. I too have stopped visiting The Love Vitamin. I check in every once in a while, but it’s not really something I go to if I really want to know the truth or science behind a proposed treatment. I really liked a lot of the info, but to be honest I don’t really have the time to try every single thing Tracy suggests, especially when there’s little evidence to back it. I’m glad to hear that this site has helped you.

    May I ask, what are some of the things that you’re going to do post Accutane in order to prevent a relapse? Is this something I will read in the members only section, so I’ll have to wait to find out once I purchase the book? Could you list all of the things that you tried prior to starting Accutane including diet, supplements and skin care? What has your dermatologist classified your acne as?

    There’s a lot of scrutiny of those who use Accutane for mild acne. Many of the blogs, sites and online forums about acne really discourage its use for mild or moderate acne. That makes my decision even harder as I have only mild, occasionally moderate acne. In fact, I have a dermatologist appointment next month to discuss where to go from here, but if my doctor were to see my face right now he probably wouldn’t even mention Accutane. In other words, my acne fluctuates greatly throughout the month and from month to month. Sometimes my skin looks pretty darn good. Other times it looks like a mess. It’s just so unpredictable and that’s yet another factor making me lean towards Accutane. I would just love for it to be consistent for once lol..

    Anyways, thanks for responding and answering many of my questions. It’s interesting how acne affects so many of us regardless of age, ethnicity, sex, etc. I’m really glad that your battle may be over soon and that you can live your 20s without worrying about your complexion 🙂

  8. Hey Amanda,

    It’s written in the article.. But from what I’ve read, to prevent an acne relapse, you would have to stay on the treatment for an additional 2-4 months, so the sebaceous glands continue to be suppressed so you won’t overproduce sebum again.
    I’m going to ask my dermatologist to be put on an extended duration. So instead of the usual 4-6 months. I’m going to ask to be put on the treatment for 9-10 months so instead of finishing in June since I started in December. I’m going to try and see if I can end the treatment in September.

    I’ve read in some study that using a topical retinoid cream, after accutane, reduces the relapse rate. I don’t know why, I guess your skin’s retinoid receptors are just quite sensitive to any kind of retinoid creams during and post-treatment. Wether it works or I can’t say.. It’s far too soon it even think about it. 😛

    I’ve done most things.. I’ve done:
    Juice fasting
    Regular fasting
    Intermittent fasting, Low carb (scientific proof that it works for some people, but didn’t work for me.)
    Honey
    Manuka honey
    Candida diet (Big no no)
    Antioxidant supplements (Those actually have scientific studies to back up the claim to help, even Seppo raves about them on the website, they do work but I want permenant results. And as I said, there’s only that many antioxidants that can protect your sebum from oxidation)
    Zinc (again, scientifically backed up, but nothing I can say helped)
    Green tea cream ( I still use it and it has actually helped lots, again, scientifically backed up)
    Antibiotics

    There’s more but I can’t bother to list them all. The ones that I didn’t add ”Scientifically backed up” next to, stay clear from them.

    And believe it or not, he didn’t classify my acne as anything. I was at his clinic for a laser treatment, (he has two) he was in the one that I was visiting that particular day. And his assistent (Who has been performing the laser treatments on me for my acne scarring) told him about me. (She personally thought that I could benefit form an Isotretinoin/Accutane treatment, because she had great success from it) So when he looked at me, with my many red acne scarring marks. He could see that, I definitely needed a treatment.

    I only have about 1-2 pimples now. I got one big but it’s going away and the others are really small. 😛 My skin is less oily now too which is super. So I’m happy with my decision for sure.

  9. That’s fantastic news Adel! 🙂 Only 1-2 pimples is amazing! I’m so very happy that you’re experiencing such great results! It’s nice to hear that your doctor could see from your scarring that you were a good candidate for Accutane. I’ve read that some doctors refuse to prescribe it unless acne is severe and/or cystic. Thankfully, we both seem to have found doctors that feel comfortable prescribing it at a low dose. I didn’t know that an extended treatment could ward off a relapse. That’s very interesting. I’ve done the calculations based on my weight and I think I would have to take about 40 mg a day for 6 months. I live in the states, so 6 months is the typical course, but I’m definitely going to discuss it with my dermatologist if I decide to take it. My main goal would be to get clear with fewer side effects and then stay clear permanently. However, being female may pose some issues as I will certainly have to go through the IPledge program. I’m not sure my doctor or my insurance will allow for an extended treatment because of that aspect. I suppose I’ll have to find that out if or when the time comes 🙂

    I’m still just not sure about Accutane. It’s odd because even though I have acne, I’m not super oily. I can certainly see how it’s helping your acne since you have very oily skin. Actually, I don’t even really know what type of skin I have because I’ve been using acne medication for so long. I tend to have an oily T zone and really dry cheeks, which is probably from the acne medication. Benzoyl peroxide dries my skin out terribly, makes it crack and turn red. Adapalene caused redness and a lot of peeling. I have yet to try Retin A or Tazorac, so we’ll see how those go when I try them. It’s just rough because even if those do work I’ll have to use them for the rest of my life. That’s kind of a pain in the butt, but I’d do it if it meant clear skin.

    Thank you for sharing what you have tried. I haven’t tried fasting, but after everything I’ve tried diet wise I think I’m going to refrain from trying that. I’ve tried many similar things though.

    I’m glad that you’re happy with your decision! It’s nice to hear a positive review of Accutane thus far.

  10. Accutane doesn’t only help acne by reducing sebum, it also helps by normalising kreatinization within skin and sheeding and inflammation. 😛 But i do hope you make a choice that’ll make you happy in the long run.

  11. Hey sep, I wanted to ask, do you think that taking a lower dose vs a higher dose, reduces the chances of serious elevated Liver enzymes?

  12. Really enhoyed the read.. I am really fascinated of your work..
    What else do you recommend if i take accutane to lower the chance of having a relapse?

    • I don’t think there’s anything that would make Accutane work better. Studies show that people who use topical treatments, or women who take anti-androgens, have lower relapse rates. But that’s just because those treatments suppress acne. The moment you stop using them acne would likely come back.

  13. Hi Sep, I wanted to ask. Do you think that, despite as my skin isn’t completely dry on accutane, but the oil is still being reduced enough for my skin type to be in the ”normal” range. You think my skin will still be cured of acne if I stay long enough on it?

    • I’m sorry but I have no way to answer this question. The prescribing doctor probably has enough clinical experience to at least give you an educated guess. Based on my reading of Accutane research, it seems that as long as the underlying condition that caused acne is still present, then the risk of relapse is fairly high. For example, studies show that adult with taking Accutane who don’t take birth control or anti-angrogen drugs have much higher risk of relapse.

  14. That kinda defeats the purpose of Accutane even having a cure rate, if there’s still something that causes acne.

    • My point is that acne is a symptom of some underlying issue (insulin resistance, hormonal imbalance, gut issues, food allergy, excessive stress, etc.) that shows up on the skin. Accutane cuts the chain of event that leads to acne, but if the underlying issue is still present then the likelihood that acne comes back is higher.

      • Hey Seppo,

        This is exactly why I’m so hesitant to try Accutane (aside from the many potential side effects of course). If Accutane simply cuts off the chain of events while using the medication, it seems as though the acne is just going to come back at some point after stopping the medication. This leads me to believe that it’s not a matter of if, but rather when. I’m wondering if perhaps the success rate of 80% that is often quoted is actually incorrect. It hardly seems as though 80% of people who take Accutane actually have a complete remission of acne. I don’t mean to come off rude, but if the underlying issue isn’t addressed, what’s the point of taking Accutane? How does anyone have success with the medication if acne is simply a symptom of an underlying issue?

        • You make a valid point, Amanda. Though I have to disagree with you a bit. A part of the problem in acne is skin’s sensitivity to hormones. Several studies have compared the hormone levels of women with and without acne. Those studies consistently show that women with acne have, on average, higher androgen levels than women without. But those levels are still within the normal range. Accutane seems to reduce skin’s sensitivity to hormones so that those slightly elevated hormone levels don’t cause problems anymore. Whether this correction is temporary or permanent, I can’t say.

          That said, Accutane is usually only given to people with moderate/severe acne. And I believe that in these people acne is not just a matter of how sensitive the skin is. There probably are some underlying issues that can be corrected.

          I’m not quite sure how they have determined the 80% cure rate, more specifically, how long they followed these people to determine that 80% remained clear. Most like from 2 to 5 years.

          • Thank you for the reply Seppo. What you said makes a lot of sense. I keep forgetting that the skin’s sensitivity to hormones is also a factor in acne. I’m not sure why I keep dismissing this piece of the puzzle.

            I think you’re correct in that researches only follow people for approximately 2 to 5 years after an Accutane course. In fact, I found a study indicating that after 2 years the success rate drops to about 60% and by 5 to 7 years it’s at about 40-50%. This leads me to believe that the majority of people will indeed relapse. I also read a few studies that indicated that the age at which the course was taken as well as gender both affected relapse rates. In one study it indicated that younger patients and male patients were more likely to relapse. I honestly would have thought the opposite would have been more likely; older patients and female patients. The one exception seemed to be females with PCOS. They seemed to have a very high relapse rate regardless of age.

            I still don’t know where I stand on the Accutane debate. It seems rather tempting, but given the statistics it doesn’t seem worth the risk. Of course, this is just my personal opinion. I simply feel bad for those that go through the course hoping for complete remission only to later relapse. It truly seems like a roll of the dice.

          • Honestly Amanda, at this point. I’m almost 5 months in. I don’t regret being on this drug because I can definitely see improvements. The doctors told me that I tolerate the medication extremely well to the point where my skin doesn’t get super dry, but it just gets normalised.

            I’ve been thinking about it, and I think I may have found the underlying issue to my acne. (I think) It’s my gut. I have oral candida/thrush. Reading Seppo’s candida post. I can definitely see how it may contribute to my problem. I mean, my skin is by no means oily. I’m not stressed. But I think that I may still be under a lot of inflammatory stress. I mean I’m not going to lie, my gut is in a really shitty state now.

            I’m going to the hospital to have a FMT procedure to repopulate my gut with someone’s elses bacteria. I’m also going to take anti fungals the moment I’m done with the treatment because apparently my anti-fungals interacted with the accutane. Causing it to not work. 😛 So I’m kinda stuck on accutane. But I figured that, I’ll still stay on accutane for 10 months just so the glands won’t recover as quickly. And when I’m done, I’m going to use anti fungals and then ”hopefully” have the procedure done so I’ll have the gut of a healthy person. 😛 I mean it’s the only thing that I can think off that still contributes to my problem.

            Also regarding taking accutane, honestly.. I think you need to forget everything you’ve heard of accutane and go for it. I know it may sound a bit direct. But it’s stupid to let people who have no idea what they’re talking about, to tell you to not take accutane because it’s ”poison” and so on according to them. Besides, regarding the side effects, you can always go off the medication if something happens.

  15. You think insulin resistence is such a big deal doing accutane? Considering the sebacious glands are suppressed, I would think that anything that has to do with sebum alterations, IGF-1 etc, don’t matter, because the skin doesn’t over produce oil. Leaving only abnormal inflammatory markers to deal with. Which could be interesting to check out.. I stopped taking NAC a while back, but before my gut went all highwire, my skin responded nicely to accutane. This is definitely something I’ll have to check while being on this drug… Having lower levels of sebum can definitely help me keep the antioxidant need down, but then I’ll have to work on the inflammation itself by targeting my gut issues.

    I’m going to the doctor tomorrow to discuss some stuff. I hope things go out well.

    • That suppression doesn’t last forever. That’s the reason acne sometimes relapses. We don’t have good data to show how long the suppression lasts and whether it varies from person to person.

      Anyway, please try the gut healing supplement regimen I emailed to you. I had really good experiences with it. Much less bloating and digestive issues nowadays – I can even eat some onions and not get a horrible breakout the next day. I told you earlier that it seemed the regimen made my skin somehow more sensitive to acne. Turns out that was because of milk. I was still using milk in my protein shakes and green smoothies. It seems the gut healing regimen altered my gut in a way that I can’t tolerate milk or dairy products anymore. Never had any problems with them before. But it’s a trade off I’m happy to make.

  16. So basically, accutane works by suppressing the sebaceous glands right? Don’t they recover at one point even after an extended course on the drug?

    • That’s one of the ways Accutane works, but I wouldn’t be confident that that’s the only way it works. Yes, sebaceous glands to recover, at least to some degree, after stopping Accutane. I think that’s one of the reasons some people relapse.

  17. What do you make of older studies that showed that higher cumulative reduced relapse? I just talked with my dermatologist. I’m going to be on 80mg for 10 months apparently. 😛 So My cumulative dose will be higher than the usual 120mg/kg for sure

      • Hey Amanda, sorry for not replying to you. I haven’t been on this website since I may or may not have found the cure to my skin.

        You see, I was told to take 80 mgs of accutane by my dermatologist, since I was 4 months in but I was still breaking out. One day, my mom came home from the supermarket and she brought some packaged foods with her from the store. I ate some of it, I noticed that my stomach was growling and rumbling lots while I was eating it, but I didn’t mind, I still ate it. The day after, I broke out in 10 or so (small) pimples.

        I had the biggest ”Aha!” moment there. I figured… What if I’m eating something that is irritating my gut? I decided to test it by trying to stick to foods that clearly don’t irritate my gut. I really tried to feel how my gut would react. I’ve been clear on Accutane for 1,5 months now, even going down on 20 mg! I think I may have found out why I broke out in the first place, and during accutane. I think I’m sharing the same problem with Seppo, I’m eating something that is irritating the gut lining or something.

        Either way, I’ve been at the hospital and I did a breath test (for sibo) and I even sent some stool tests and so on. Sadly, I won’t be getting the results until the end of September since I missed my appointment. 😛 But until then, I’ll continue on accutane ’til I run out of my last package. And then until my appointment, I’ll continue on my diet, where I try not to eat something that is irritating my gut, and I’m going to try out the gut healing regimen that Seppo sent me via E-mail.

        Fun note: My skin actually broke out in acne this week. 4 small pimples.. I’ve noticed that my bowel moments while at the bathroom has been kinda strange. I don’t know why, I may have ate some bad food without me noticing it. Either way.. This is big for sure. 🙂

        • Hey Adel,

          No worries about responding. We’re all busy, so no big deal 🙂

          That’s great that you think you’ve found the cause of your skin troubles! I wish you so much luck getting clear! I hope that you’re able to heal your gut thus healing your skin.

          What do you think the individual food culprits are? Are there specific foods that you notice cause problems? Seppo mentioned that Strawberries and Onions are an issue for him. Are you noticing your issues coincide with healthy foods or mainly processed foods?

          Let me know how your results for your breathe test turn out. I’m curious to know whether or not you have SIBO.

          • It wasn’t SIBO, they told me my tests came back fine. I’m not allergic to gluten, but I’m still going to take it easy when I eat wheat and so on.

            It’s mostly processed foods that triggers my gut disturbances. Though I ate some chicken before and my skin acted crazy for some reason. I guess it had some bacteria or something in it that I couldn’t digest well. 😛

            When I’m done with accutane. I’m going to clear out the candida i have in my mouth. Then I’m going to try the skin healing regimen that Seppo recommended. He said it worked a lot for him.

  18. Hi seppo

    First of all want to say how much I enjoy your outlook on skincare. Holistic yet critical. Very forward thinking.

    I am considering accutane as a “last resort” because I am a 23 yr old male and have had acne since puberty. My parents, being naturally anxious people, were always prompt to bust out aggressive 10%bp creams and have topical antibiotics prescribed which always seemed to fix issues temporarily. After being clear on and off, I went down the rabbit hole of natural health for about 9 months during which I started devel

  19. Hi Seppo .
    Is topical Isotretinion more effective than BP?
    Reading your post Accutane doesnt seem sooo dangerous so now im thinking if i should do Doxycycline or Accutane if i can no longer hold on to my present regime/ routine . Please give me your opinion

    if i were to take either of the two should i stop or can i continue my supplements . milk thistle , estroblock . selenium . cod liver oil. vit c . vit e ,curcuminoid.
    . Thanks as always .

    • Yes, topical tretinoids are considered to be more effective than BP, but combination of the two works even better.

      I’m sorry but I can’t advice you with regard to prescription drugs. This is something you have to talk with your doctor. I’m generally not in favor of antibiotics as they don’t have any positive long-term effects. That being said, if your skin is prone to scarring or have other such concern, then antibiotics could be a viable option.

      You have to ask your doctor whether those supplements have any effect on the drugs. That being said, I get the feeling from your posts that those supplements aren’t doing much?

  20. Yes seppo .
    Its been 4 months and though theres been improvement i still have quite a lot of pimple like clogged pores/ clogged pore pimple??? so to be clear i keep adding new supplements . I read your zinc post and now i have placed an order .Hope it works .
    As always thank you so much for your time and advices

  21. Hey Sep – Just wanted to write a few stuff here

    I completed my accutane course a few months ago (I think late august). Which means that I’ve been on accutane for about 9-10 months give or take. Basically, I realised that no matter what I was still breaking out while on the treatment – but when I found out that what I ate determined how my skin looked – My skin improved immensely. 3 2.5 months later. And I’ve noticed my forehead and nose are starting to get oily again.

    At first, I was freaking out that my skin would be breaking out again. But that hasn’t been the case, I’m currently traveling and I’ve been eating stuff like cereal, bread and stuff that ( I think) would have broken me out. But nothing happened. I broke out yesterday for the first time in ages because I drank dairy products + ate some chocolate (though I’m not sure about the chocolate being the culprit). But the pimples were insignificantly small and they’re basically gone now.

    I can definitely say that my skin can take much more of a beating considering I haven’t taken any antioxidant supplements in weeks ( I just started again yesterday) and I haven’t had a proper skin care routine in ages (I’ve used a retinol cream and sunscreen and that’s it)

    I’m not really asking for advice, but I figured I might as well write my results. I’m going back to my old skin care routine with Paula’s choice products and I’ll be wary of what I eat from now on.

      • The oil glands are slowly becoming more and more active now though, yet, no signs of acne unless I eat something that I know will break me out

  22. I have been taking accutane for awhile and it has work but my dermatologist says that because the antibiotics kill the good bacteria as well as the bad it wouldn’t be wise to stay on it. I guess I will give accutane a try.

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