Acne is a frustrating problem that many people face. Isotretinoin (Accutane/Roaccutane/Acnotin are just brands of isotretinoin) is a very effective medication for acne.
Can low dose Accutane be used long term for acne to prevent further breakouts?
Low dose isotretinoin can be used long-term for acne to prevent further breakouts. It can also help with seborrhea (excessively oily skin) and sebaceous hyperplasia (facial bumps caused by enlarged oil glands).
Traditional practice
Isotretinoin used to be dosed by body weight and doctors aimed to complete a certain total dosage that seemed to have lower relapse rates after 1-2 years. Many doctors were reluctant to prescribe isotretinoin, reserving it for severe cases, as there were many possible side effects such as:
- dryness of lips, eyes, nose, etc
- increased risk of sunburn
- increased risk of scarring
- liver damage, high cholesterol
- muscle damage or bone spurs
- mood changes
- high chance of birth defects if taken near or during pregnancy - oral contraceptive or another reliable contraceptive (condoms don't count) MUST be used
**Low Dose Isotretinoin is Safe and Effective
**
Latest research shows that low dose isotretinoin actually works just as well as the regular dose, with much better tolerability and a much lower chance of side effects. The length of therapy seems to have a greater effect on the relapse rate than the total dosage. Strict contraceptive measures must still be taken.
Thus, low dose isotretinoin is used much more often nowadays especially for recalcitrant, resistant, nodular or cystic acne, acne patients with scarring, etc. I tend to have a low threshold for prescribing low dose isotretinoin where deemed necessary as I believe it is far better to aggressively control acne to prevent scarring.
I routinely use long-term low dose isotretinoin in my acne patients. I usually try to reduce the dosage to the lowest possible effective dose that doesn't cause bothersome side effects but continue for a sufficient duration after the acne has completely abated, so as to achieve adequate sebaceous gland suppression.
While it's fine to repeat a course of isotretinoin if the acne relapses, I usually do not recommend taking it continuously for much longer periods especially if the acne is already under control. Patients on isotretinoin often have great skin that is oil-free and acne-free with a smooth pore-less appearance. Sometimes, patients miss the great skin they had while on isotretinoin and request to continue it even though their acne is under control. While there may not necessarily be problems arising from taking isotretinoin for years, I don't recommend doing so without proper indications as there is insufficient safety data and the risks may not outweigh the benefits.
While oral isotretinoin is effective for acne, it would also be prudent to explore or combine it with other treatment options such as fractional energy devices (e.g. fractional microneedling radiofrequency, fractional lasers, fractional radiofrequency) that can address concomitant marks and scars as well as control acne.
Do speak with a doctor who can discuss a holistic approach to treating your skin.
Hope this help!
Warmest regards,
Dr Wan Chee Kwang
References
- Torzecka et al. The use of isotretinoin in low doses and unconventional treatment regimens in different types of acne: a literature review. Postepy Dermatol Alergol. 2017 Feb; 34(1): 1–5.
- Rademaker et al. Isotretinoin: dose, duration and relapse. What does 30 years of usage tell us? Australas J Dermatol. 2013 Aug;54(3):157-62.
- Rademaker et al. Long term remission of persistent adult acne following very low-dose (5 mg/day) isotretinoin. Australas J Dermatol. 2017 Feb;58(1):69.
