# Isotretinoin 5 mg daily for low-grade adult acne vulgaris



## trodizzle (May 21, 2015)

This was an interesting read. I just picked up some Accutane and I wanted to start with a  low dose (you know me) and found this to be an informative (although scientific) read.

Abstract

BACKGROUND:

Despite acne persisting into adulthood in up to 50% of the population, very few therapeutic studies have been performed in this age group.

OBJECTIVES:

To assess the efficacy of 5 mg/day isotretinoin in adult acne.

METHODS:

An investigator initiated, industry-sponsored, randomized, double-blind, placebo-controlled, parallel-group clinical study of isotretinoin 5 mg/day in the treatment of low-grade adult acne for 16 weeks followed by an open-label phase of 16 weeks. Group 1 received 32 weeks of 5 mg isotretinoin/day; Group 2 first received 16 weeks of placebo, followed by 16 weeks open-label 5 mg isotretinoin/day. Patients were followed for a further 10 weeks off treatment. The primary end-point was the difference in acne lesion count and disability score after 16 weeks isotretinoin compared to placebo. Secondary end-points included differences in these counts/scores after 32 weeks of isotretinoin compared to baseline, and after 10 weeks off treatment, compared to end of treatment (week 32).

RESULTS:

There were highly significant differences (P < 0.0001) in acne lesion count, Dermatology Life Quality Index and self-assessment after 16 weeks of isotretinoin, compared to placebo (both per protocol and intention to treat). Acne lesions fell significantly, within 4 weeks of 5 mg isotretinoin/day (Group 1) and continued to fall during 32 weeks of treatment [acne lesion count (mean ± SD): 11.3 ± 8.1 (baseline), 3.6 ± 5.5 (week 16), 1.3 ± 3.1 (week 32), P < 0.0001)]. There was a similar significant reduction in acne lesion count in Group 2, but only from week 20, 4 weeks after starting open-label 5 mg isotretinoin. Adverse effects were minimal.

CONCLUSIONS:

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

Entire Study:
http://www.ncbi.nlm.nih.gov/pubmed/23617693


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## DF (May 21, 2015)

Good find dizzy!


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## trodizzle (Jul 1, 2015)

I wonder if 5mg per day is really a deal breaker or if 10mg EOD would be the same thing? I think that accutane comes in gel caps of 10mg each so you can't really cut those in half to take 5mg per day.


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## NbleSavage (Jul 1, 2015)

In for this - I get occasional breakouts on my shoulders & upper arms.


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## MrRippedZilla (Jul 1, 2015)

So 5mg of Accutane is better than nothing (placebo) - that's all the study is showing and I'm not sure if that's exactly news.

A better study design would have been to compare a low dose of Accutane to some of the more readily accessible acne treatments such as benzoyl peroxide, azelaic acid, retinoids, etc. 

In any event, Accutane is the best available treatment for acne but you need to assess the side effects (potential long term ones too) before deciding on whether the risk/reward ratio is worth it. 
Taking low doses like 10-20mg EOD is pretty common place and is certainly effective - I'm just not sure its necessary for a few spots here and there.


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## PillarofBalance (Jul 2, 2015)

MrRippedZilla said:


> So 5mg of Accutane is better than nothing (placebo) - that's all the study is showing and I'm not sure if that's exactly news.
> 
> A better study design would have been to compare a low dose of Accutane to some of the more readily accessible acne treatments such as benzoyl peroxide, azelaic acid, retinoids, etc.
> 
> ...


I would echo that second part. My youngest brother ran this and had severe acne. 

His lips were constantly cracked peeling and bleeding. He was irritable as hell. And he developed irritable bowel syndrome. Dude can blow up a terlet like no otha 

For some occasional spotting or mild breakouts? Hell no. Not worth the sides.


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## NbleSavage (Jul 2, 2015)

Found a solid analyses of Isotretinoin, what it does and common side effects.


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## HDH (Jul 2, 2015)

It seems like a fairly decent study to show what a low dose of Accutane can do. I've never heard of such a small dose while being effective.  In the results it says "there were highly significant differences in acne lesion count. It also stated they fell greatly in 4 weeks.

When I took it, I ran it at 20ed. I had minimal sides and the acne was getting pretty bad. I had it as a teen as well so I was prone to it already. I know guys that used it at 10 and it worked well for them without all the harsh sides. I don't know the extent of their problem though.

If there is a minimal problem, Accutane might not be the best choice but definitely the easiest. The bad sides I know of in the past come from a dose of 80 to 100. 5 a day would be 1/16 to 1/20th of the dose. Although doses of 60 and 40 can carry some stiff sides. It's like anything else, sides are dose dependent but these can be extreme at higher doses.

The study shows it being pretty safe but of course everyone is different and tolerates things differently. In the end, it would be up to the user and risk they are willing to take.

I tried to look up a half life and saw something around 20 hrs. I know half lives can vary from poster to poster at times so I good search would be in order for EOD usage.

H


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## trodizzle (Jul 2, 2015)

PillarofBalance said:


> I would echo that second part. My youngest brother ran this and had severe acne.
> 
> His lips were constantly cracked peeling and bleeding. He was irritable as hell. And he developed irritable bowel syndrome. Dude can blow up a terlet like no otha
> 
> For some occasional spotting or mild breakouts? Hell no. Not worth the sides.



How much was your brother taking and for how long PoB?


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## PillarofBalance (Jul 2, 2015)

trodizzle said:


> How much was your brother taking and for how long PoB?


Whatever his doc told him to take. Not sure duration. It wasn't too long if I recall because it was interrupted by a brief vacation at county.


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