Q: My teen has bad acne and wants to try Accutane. I’ve heard that some people are “microdosing” the drug to reduce the side effects. Does that work?
When teens (and adults) have severe, painful acne that causes scarring, makes them feel self-conscious and is resistant to other treatments, dermatologists often prescribe isotretinoin, an oral medication commonly known by the brand name Accutane.
Isotretinoin works by shrinking the skin’s oil glands and keeping skin cells from clumping, both of which can clog pores, said Dr. John Barbieri, an assistant professor of dermatology at Harvard Medical School. It may also lower inflammation that causes redness, swelling and pain.
Most people who take isotretinoin enjoy clear skin for the long term, Dr. Barbieri said. But the drug’s side effects can be distressing and sometimes severe. These can include dry skin, lips and eyes; nosebleeds; headaches; muscle aches; joint pain; depression; irritability; and high cholesterol. In some cases, Dr. Barbieri said, acne may return.
For those who have had side effects (or worry about them), or if their acne has returned after treatment, dermatologists may prescribe lower doses of isotretinoin, often referred to as “microdosing,” said Dr. Sara Perkins, an associate professor of dermatology at the Yale School of Medicine.
What is a microdose?
There’s no standard definition of an isotretinoin “microdose,” Dr. Perkins said. How much you take depends on your weight, how severe your acne is and how well you tolerate the medication when you take it, she explained.
If you’re 130 pounds, for instance, a standard dose may range from about 30 milligrams to 60 milligrams per day; a lower-dose regimen may be more in the ballpark of around 10 milligrams to 30 milligrams per day.
Or, a doctor may recommend taking a low-dose pill only three times a week, Dr. Barbieri said.
Whether you take a full dose or a “microdose,” the goal is to receive the same total amount of isotretinoin by the end of treatment, said Dr. Heather W. Goff, a professor of dermatology at the University of Texas Southwestern Medical Center in Dallas. It just might take longer on a lower dose.
A standard treatment typically takes four to six months, whereas a “microdose” might require eight months to a year or more, Dr. Goff said.
Reaching the cumulative dose reduces the risk that your acne will return after treatment, Dr. Goff said.
Is microdosing right for you?
The main reason dermatologists suggest low doses of isotretinoin is to help reduce side effects, Dr. Perkins said. But microdosing can also help manage acne that has returned after a standard isotretinoin course, Dr. Barbieri said. It also may be right for those with mild-to-moderate acne that hasn’t cleared with other treatments, Dr. Perkins added.
You should never take any dose of isotretinoin if you are or might soon become pregnant. The drug can cause severe birth defects, miscarriage and stillbirth. Everyone who wants to take isotretinoin must register with the Food and Drug Administration’s iPLEDGE Program. This system monitors isotretinoin prescriptions and ensures that patients who can become pregnant use contraception and submit negative pregnancy tests before starting the drug, Dr. Goff said. It also requires women to submit regular pregnancy tests while taking the medication.
Isotretinoin may raise blood cholesterol and triglyceride levels and may potentially elevate liver enzymes, so dermatologists routinely perform blood tests to monitor those levels.
This testing could become burdensome if you’re on a lower dose, Dr. Perkins said. Because you’ll be on the drug for longer than a standard course, you may need regular monitoring for a year or more.
Still, Dr. Barbieri noted, both standard and low-dose regimens can deliver excellent results.
Dr. Goff explained the trade-offs of the two treatment styles using the analogy of a road trip: If you have to drive 100 miles, you’ll get there quickly if you drive 100 miles per hour, but it may be risky.
“Or, you can drive five m.p.h.,” she said. “You’ll still get there, it’ll just take a heck of a lot longer with fewer risks.”
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