A study with ultra low dose of accutane.

‘Microdose’ isotretinoin
R.A. Palmer S. Sidhu P.G. Goodwin
S ir, It is our experience that some adults with acne vulgaris respond to extremely low doses of isotretinoin. Such low doses, used continuously, may be a good way of treating patients who relapse quickly when they cease taking standard doses of isotretinoin.

The dose of isotretinoin used to treat acne vulgaris is often 0·5-1 mg kg 1 d 1, for approximately 4-6 months, to produce a cumulative dose of > 120 mg kg 1. 1 Adult patients with acne tend not to have severe disease and are often successfully treated with relatively low doses, such as 0·25 mg kg 1 d 1, 2 or 0·5 mg kg 1 d 1 taken 1 week in 4 for 6 months. 3 The lowest dose we could find in the literature is 0·1 mg 1 kg 1 d 1· 4 We retrospectively report eight patients with acne vulgaris, controlled by continuous treatment with a single 20 mg tablet, taken once or twice a week; we calculate they are receiving doses of 0·04-0·11 mg kg 1 d 1. Details of their treatment are shown in Table 1.

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These patients developed acne between 14 and 32 years ago. Prior to treatment with oral isotretinoin they had acne of moderate severity. Two patients had predominantly truncal acne, which is known to be associated with a relatively high relapse rate after isotretinoin therapy. 5 With treatment (20 or 40 mg d 1), all patients became clear or almost clear of acne. At least six of our eight patients experienced side-effects, such as dry lips, which were severe in some cases.

After stopping treatment they relapsed, often within a few weeks, on several occasions, developing acne of mild severity. Usually, conventional measures of treating relapse (topical therapies and systemic antibiotics) were not used, because their efficacy was perceived by dermatologist and patient to be inferior to oral isotretinoin. Relapse was treated by restarting oral isotretinoin, at successively lower doses. All patients currently have no acne or minimal acne while taking a single 20 mg tablet once or twice per week. They report enormous psychological benefit. Stopping this treatment results in recurrence of mild acne.

Two of our patients have reported mild dry skin or eczema, thought to be due to treatment with ‘microdose’ isotretinoin; the others have no symptomatic side-effects. Isotretinoin therapy can elevate serum hepatic enzymes and lipids and cause adverse skeletal effects, including diffuse idiopathic skeletal hyperostosis. The latter may be detected with a lateral cervical or lumbar spine radiograph. The patients with the highest cumulative doses were investigated for these side-effects when their cumulative doses were between 174 mg kg 1 and 310 mg kg 1. In the four patients tested, no relevant abnormalities were found. However, a previously reported patient with perforating folliculitis 6 now treated with this regimen has a slightly raised serum cholesterol (5·79 mmol L 1, normal range 3·30-5·20); her pretreatment serum cholesterol is unknown. Treatment is on-going in all patients.

Continuous treatment with ‘microdose’ isotretinoin has several theoretical advantages over intermittent standard-dose treatment. In the latter type of regime, patients restart treatment when their symptoms return; therefore by definition, they are not continuously free of disease. The incidence and severity of symptomatic side-effects is very low. Continuous treatment with a 20-mg tablet once per week in a 70-kg adult produces a cumulative dose of under 15 mg kg 1 year 1, which is sufficiently low to be unlikely to cause long-term side-effects, but is an unlicensed method of administration. It costs approximately £52 per year, and can produce enormous psychological benefit.

We recommend that dermatologists consider the continuous use of very low doses of isotretinoin, particularly for adult patients who have repeatedly relapsed after stopping standard doses.

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27 thoughts on “A study with ultra low dose of accutane.

  1. gust,

    sotty i really couln’t understand how you wrote the numbers and days like 1 d1 what does that mean?

    the article i posted earlier said that 2.5 mg twicew a week helps

    what does the this articel say the lowest once a week dose can help, in addition to ther treamtns together. thanks

  2. 0·5-1 mg kg 1 d 1

    It means 0.5-1 mg per day and Kg

    so if weigh 80 Kg , you take 40-80 mg per day.

    with a single 20 mg tablet, taken once or twice a week; we calculate they are receiving doses of 0·04-0·11 mg kg 1 d 1.

    If you weigh 80 Kg that means 3.2 – 8.8 mg per day.

  3. gustav,

    hey so basically 20 mg a week is enough to help clear and stay clear ?
    do you know how much % sebum is reduced that way?
    or if you can use a mild topical like everyother day to increase dead skin turnover?


  4. There is no answer for you. Everyone responds different to Accutane. I have no idea how you would react. I’m sorry.

  5. gustav,

    i thought he main point of the articel and the other article that said 2.5 mg twice a week.

    that it helps ?

  6. gustav,

    i found out that taking 2.5 mg 3 time s a week helps prevent the reoccurence of follicle hyperkeatrinzation. which is very important.

    alos, i tried to get the study with the one you gave the website address but need paassword, though i want to know what it says.

    if you found out any other info. on this topic please post and so will i .thanks

  7. taily //

    i found out that taking 2.5 mg 3 time s a week helps prevent the reoccurence of follicle hyperkeatrinzation. which is very important.

    Were did you find that? Please share the information. Any link?


  8. And I don’t understand how anyone can take 2.5 mg. Who sells 2.5 mg? Not Roche anyway.


  9. i emailed dr. plewig who did the other ultra low syudy on this board. he told me that. he said that the publication is under review and should be in a journal soon.

    what id do i doin’t know where you can buy 2.5 mg. so i buy the 10 mg and just cut it.

    and also do a papain mask twice a week to remove the shedding dead skin from the accutane.

  10. taily //

    That sounds great. Can you email that letter to me. I think I will print it and take it to my doctor. [email protected]

    So that means that he has done a new study. ?[/i]

  11. I don’t think you can buy 2.5 mg.

    I don’t know if they(accutane) will get bad if you cut them. Maybe we should try to ask someone who knows.

  12. How on earth would you cut Accutane to give yourself 2.5mgs? They’re capsules not tablets. Once you cut into them the powder will just fall all over the place.

  13. How on earth would you cut Accutane to give yourself 2.5mgs? They’re capsules not tablets. Once you cut into them the powder will just fall all over the place.

    Wondering the same thing 😀

  14. My derm talked to me the last time I saw her. She said if things don’t clear up better, she would let me try it.

  15. i dunno if i understood this properly…
    so 20mg once a week could clear ur acne?

    but how long would u have to take the pills for?

    and would this not be dangerous?

    how bout the side effects? this sounds really interesting.. how can i convince my derm? is there a jurnal somewhere that has this study?

  16. so u think its best to try a full course of tane before starting this?

    and what about having laser treatment etc done while on a course like this?

  17. Hi Reza 🙂
    How come you haven’t started the accutane yet?I thought you’d had it for ages now? 🙂

  18. That sounds like a great idea. I think that they should have people do that who have just got done with accutane. Like have them go for the full course at the regular dosage for their weight then gradually decrease the accutane. Don’t you think that would help your acne not come back instead of like stoping the accutane cold turkey? Does that make sense?

  19. don’t cut the pills in half, that’s ridiculous.
    You can take one pill every-other day. It’s the same – there is the same amount of medicine in your body.

    80mg a day for 4months is the same as 40mg a day for 8months. The lader of the two will usually cause less side-effects (obviously).

    Alrighty, so if a 13 year old has horrendous acne…obviously there’s a chance it’ll come back, even after accutane. So a doc puts him on 20mg every other day for around 6-12 months…Better eh?

    by the way, don’t quote me on everything – get more opinions.

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