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Thread: Low dose accutane

  1. #1
    Senior Member TheMediumDog's Avatar
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    Default Low dose accutane

    I'm going to ask my derm to prescribe low-dose accutane. I've read all the reports I can get my hands on, and just want to check I've got things about right, from those who've used accutane.
    I'm trying to lower the level of inflammation in my skin. The medications I currently take (antibiotics) keeps it in check, but barely. And accutane has some good reports for generally combating inflammation.

    10mg every other day seems to be the dose rosaceans have success with. Or slightly more or less (5mg every other day, 10mg every day etc), depending on how they react. That right?

    Quite a few people seem to say that, in the first week(s), their rosacea looks a little worse - they look a little redder, more blotchy, etc. But that this generally subsides after a while. Again, is that right?

    And initial breakouts (acne) follow the same sort of course.

    I suppose this is my question - I know that different people have different reactions, and for some it is really rough, but I don't feel I've got a handle on the proportions. Is it successful for most rosaceans, and not for an unlucky few; or successful only for some? If it goes bad, can it go really bad, even at the low dose?

    Thanks.

  2. #2
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    Hi TheMediumDog,

    I recently tried 20mg tabs and I could tell they were too much for my skin...I was getting burning, skin prickling sensations and had what I think may have been a dermatitis type reaction....or it could have been an initial breakout???

    I am in the process of getting the 20mg compounded into 5mg tabs. I can tell that on one hand the accutane has the potential to cut inflammation big time but at the 20mg it seems to be a gamble as to whether it will help or hinder. I am 55kg by the way.

    I reckon the lower the dose, the lower the potential for the IB to be bad...but play it by ear. If you feel your skin is getting hypersensitive or is flushing/burning more then back off. But also be prepared for existing bumps and any underlying congestion to flare up a bit.

  3. #3
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    Hi-

    You've done your research and what you said is about right. About 5mg to 10mg a day is good for Rosaceans. Do you have acne or pustules or mainly redness? If mostly redness, I'd be cautious taking Accutane. While it does reduce redess a little at very low doses, it most helpful for acne, pustules, and papules, very clogged pores and such. If you have a bit of both, then low dose may work good for you.

    You've probably read my log, and yes, in the beginning the first few weeks your skin may tingle or get a little pinker and oilier. Your oil glands are in the process of shutting down and what's stored in your pores will come up. It's not as scary as it seems, but the lower the dose and milder the acne, the lesser chance of having bad breakouts during the first month or so. Mine was very mild. After month one or two, my face was really soft and acne diminished. However, as I went up in dose in later months, my face and body skin got drier (and other body parts ;) ) so I just kept everything moisterised. Eye drops (rewetting if you wear contacts) and non-Visine drops are good if you don't. You need to keep your eyes lubed as well. Back/body aches at times, but mild. Ask your Derm. about vitamin D, probiotics, biotin, vitamin E. Drink lots of water or fluids and eat well. Your hair can dry out too - so keeping it hydrated and not washing much will help.

    Good luck and let us know how it goes.

    Yvette

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    Senior Member mattdog323's Avatar
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    Default hey

    my experience with accutane was not good even at 2 10 mg tabs Evey three days it was far two strong it causes u to flush and makes ur skin go redder ur derm will tell u that,

    i think its a myth an anti inflammatory drug what a crock the people that make it dont even no how it works a very dangerous drug it gave me rebound flushes for 4 months which where very strong.

    read the forums where people say it ruined there life's,

    I cant see how people take it any thing that makes u redder and makes ur skin more sensitive to the environment and makes u flush WILL WORSEN ROSACEA,

    Alot off people say also that it can slow the entire disease process down,
    Like i said the manufacturer doest even now how it works,Other than the fact it may or may not shrink glands,

    just be care full.

  5. #5
    Senior Member chenoarae's Avatar
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    Quote Originally Posted by mattdog323 View Post
    my experience with accutane was not good even at 2 10 mg tabs Evey three days it was far two strong it causes u to flush and makes ur skin go redder ur derm will tell u that,

    i think its a myth an anti inflammatory drug what a crock the people that make it dont even no how it works a very dangerous drug it gave me rebound flushes for 4 months which where very strong.

    read the forums where people say it ruined there life's,

    I cant see how people take it any thing that makes u redder and makes ur skin more sensitive to the environment and makes u flush WILL WORSEN ROSACEA,

    Alot off people say also that it can slow the entire disease process down,
    Like i said the manufacturer doest even now how it works,Other than the fact it may or may not shrink glands,

    just be care full.
    mattdog -

    I am sorry to hear that you had a bad reaction to accutane. And while it is always best to have opinions and reviews from all angles, it is unfair to say that low dose accutane will worsen everyone's rosacea - particularly when there are many accounts from different people saying that it helped. These accounts can be found not only on the RF, but acne.org and I'm sure other sites as well.

    It is true that many say high dose accutane can worsen (and some believe cause the onset of) rosacea-like symptoms, but many have found success with low-dose (you're not calling Yvette a liar I am sure).

    Additionally, I agree with you that it is crazy that the scientists who developed the product do not know how it works. But do you have any idea that the same is true of hundreds, maybe thousands of other drugs? It is interesting to be sure. Certainly it can be said that western style medicine has a long way to go.

    As always with any drug, you must weigh potential costs against potential benefits.

  6. #6
    Senior Member J-Mill's Avatar
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    Default Other than what was already said

    Quote Originally Posted by mattdog323 View Post
    my experience with accutane was not good even at 2 10 mg tabs Evey three days it was far two strong it causes u to flush and makes ur skin go redder ur derm will tell u that,

    i think its a myth an anti inflammatory drug what a crock the people that make it dont even no how it works a very dangerous drug it gave me rebound flushes for 4 months which where very strong.

    read the forums where people say it ruined there life's,

    I cant see how people take it any thing that makes u redder and makes ur skin more sensitive to the environment and makes u flush WILL WORSEN ROSACEA,

    Alot off people say also that it can slow the entire disease process down,
    Like i said the manufacturer doest even now how it works,Other than the fact it may or may not shrink glands,

    just be care full.
    If you are suggesting that the manufacturer doesn't know how it works for Rosacea it is not, nor has the manufacturer asked for it to be, approved treatment for Rosacea. Accutane is used off label to treat a host of skin diseases, but it is only approved for serious cystic acne vulgaris in most countries.

    As for why it works for acne, it significantly reduces sebum output, skin cell build up and inflammation in the sebaceous glands. As for other disorders it is thought to work through its anti-inflammatory ability.

    As with any treatment, there can be side effects that appear counterintuitive. Some people flush outrageously even on micro-dose accutane (I am thinking 5 mg a week). However, some people develop acne as a side effect to taking doxy/mino-cycline, whats up with that???

    Overall the reports on using low dose accutane have been positive for Rosacea. Some people have had negative experiences to be sure.

    Sorry your experience was bad, fortunately there are many other treatment options.
    "Get busy living or get busy dying."

  7. #7
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    Hi -

    I agree everyone's skin is different where Accutane is not a "one size fits all". For me, I didn't have much side effects at all (worsening of my Rosacea included) and was pleased with the outcome. I'm fair, sensitive, normal to oily skin type. For those that are normal to dry and more sensitive, more caution should be used when taking. Here in the U.S. we don't have the 5mg pills, so eventhough you were taking 10mg every few days, it's really not the same taking 5mg a day (though a compounding pharmacy will likely be able to take 10mg pills and make you two 5mg pills if you look around). You really do have to be watchful with the drug and at first sign that you are noticing prolonged flushing, extreme dryness, etc. you need to talk to your Derm. about reducing or stopping the medication. What J-Mill says is true, Accutane is not part of a Rosacea protocol, it's used more rarely and not all Dr's are willing to prescribe it.

    I think it's important to weigh the pro's and con's on taking the drug and start off really slow and very low dose. I was scared to take it in the beginning too. I read a lot of good posts about it and was terrified of the few bad posts. I went with my decision to start treatment really slow and if I didn't like it or it got too hard I would stop. After one month on Accutane, seeing my skin soften and clear, made me continue on. It was life changing! I think Accutane can be helpful for Rosacea with acne/pustules if at very low doses and under a good Derm's guidance.

    Regards,

    Yvette

  8. #8
    Senior Member TheMediumDog's Avatar
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    Thanks.

    Its good to hear all sides. My main concern is with any possible negative effect on my rosacea. I don't really get acne too much, so I'm not expecting too significant an IB (hopefully).

    From reading between the lines of some reports, it looks like some people might have experienced negative effects on their rosacea just through not adjusting their skincare.

    But still, others just seem to react badly full stop.

    I suppose I'd like to be able to tell the difference between:

    1) A temporary worsening of rosacea symptoms, in the first weeks, as I'm getting used to the drug.

    2) Indications (from flushing etc) that I should lower the dose.

    3) Evidence that its just not going to work, that its just not for me.

    I'm thinking that a little extra pinkness/flushiness/flaring of p&p's etc, is OK, but anything really significant signals 2) or 3). I haven't really read of anyone saying their rosacea got really bad in the first few weeks, and then this subsided of its own course.

    Yvette: To answer your question, I'm not really aiming for reduction in redness (IPL took care of that). I'm looking to lower the general level of inflammation - which leads to daily flushing, a hot face, a tendency for p&p's etc.

  9. #9
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    Hi -

    If your mostly wanting to take Accutane to control/lessen inflammation then I'd really discuss this in depth with your Dr. How often do you have p/p? How many do you have now? Accutane can cause inflammation (even at low doses) as it's drying to the skin over time. When the skin is dry it can get pinker (though good moisterisers combat this). As you know, Accutane is prescribed for resistant or cystic acne though a few Derm's will prescribe it for Rosacea with p/p. Accutane reduces the inflammation from the p/p and acne. It clears out pores/blackheads/bumps.

    Your questions are somewhat hard to answer - very individual and atleast for me I didn't have any long lasting negative reaction. I will answer based on my experience.

    1) Yes. You may have a few mild headaches and bone aches or twitches the first week. Your face/skin may tingle a little. Your face will get a little oilier the first few weeks then drier. Your facial skin may turn a little pink at times then it diminishes. The lower the dose the lesser you may feel some of the symptoms.

    2) Prolonged flushing or redness is the clue. I had very mild pinkness the first month (nothing lasting) and then it went away. Then close to the end of treatment, something around 7 months or so, when my dose was higher, I felt flushy more often and pinker. Though it wasn't severe, it was enough for me to keep the dose at 20mg (this is what worked for me since I had mild acne) instead of 30mg. My Derm. said mild flushing in the middle or end of the course is normal - severe flushing and redness isn't good.

    3) If you feel the side effects are outweighing the results. I had mild sides - the results were amazing to me. I didn't let the side effects bother me since I had super clear skin. I felt great about that. I took each day of treatment one day at a time. I'd say if you aren't seeing slight results by month three, clearing of pores, some skin softening, then I'd discuss with your Dr. Remember the lower the dose, the more subtle the side effects but also results. I was at 10mg a day month one/two then I went to 20mg a day. My results were noticeable more early on. My skin could handle it fine.

    I hope this helps.

    Yvette

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    Senior Member TheMediumDog's Avatar
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    Thanks again Yvette. Your info helps a lot.

    *

    So, my derm was pretty relaxed about it all. I begin at a super low dose, and slowly crank up. For him, this mostly takes away the dangers of negative effects on the rosacea (through drying etc) because one can just stop if they appear, and one won't have taken too many backward steps.

    So my regimen is:

    Week 1: 2 x 5mg (told you it was super low)
    Week 2: 2 x 10mg
    Weeks 3+4: 2 x 20mg.

    ...with very much a 'play it by ear' attitude after that. I expect nothing to happen in the first two weeks; but I'll be watching out big time after the first 20mg and will have all my toes crossed.

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