Does a low dosage isotretinoin course which falls below the recommended total cumulative dosage increase the chance of a relapse?

Doctor's Answers 2

The right approach really depends on your social needs and whether the side effects have been horrible.

The conventional method is to achieve a cumulated dose (usually 120mg/kg) and this usually does result in a acne-reduced state for a few years. I have taken 2 courses before which helped but in the end, I self-adjusted and now I take the very occasional dose (maybe once a fortnight) and it works for me.

But yes if the dose is TOO LOW, the risk of relapse is definitely higher, but a high dose comes with higher risks of side effects. My personal practice for my patients is to start higher but after that drag the treatment duration for a while (with a low dose). Seems to work quite well, and you could consider that approach.

Hope all goes well!

Winston

There is a cumulative therapeutic dose in the range of 120mg – 140mg/kg that some doctors adhere to in the bid to reduce the relapse of acne.

Sometimes, doctors may prescribe lower doses (with lower side effects) until the acne has cleared and continue the course for a few more months after.

It really depends on the prescribing doctor as each has his/her own protocol.

If you find that you are still having relapses with lower doses then discuss with your doctor the option of a course to achieve the therapeutic accumulative dose.

With invasive procedures, Acnotin can affect the healing process and sometimes cause scarring. As such, your Lasik doctor is correct in deferring the procedure since you are still currently on Acnotin.

Hope that helps.

All the best!

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Should I request for a higher dose of Isotretinoin if I am on a low dose regime?

Pertaining to your isotretinoin dose, your dermatologist has done absolutely the right thing. I wouldn’t consider 30 mg low by any means. 10 – 15 mg is what’s normally considered to be in the “low range”. Even if you “shopped” around for a different doctor, I don’t think their dosage advice would differ too much from your dermatologist. Besides, it’s still relatively early days. 2 months in, and you are responding and improving. If I were you, I’d stick, rather than twist with the dose.

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How should I prevent Post-Accutane relapse, and advise on long term maintenance isotretinoin dose?

Hi S – 6 years is a long time to be on a course of isotretinoin, unless you were specifically prescribed a low dose, long term “maintenance” isotretinoin regime by your doctor. If you’ve been compliant to the dosage regime (at 120 mg/kg), 85% of patients only need one course to achieve complete remission of acne – this would take 4 – 6 months of treatment, depending on the dose administered. Relapse rates in patients after treatment with oral isotretinoin vary between 10% and 60%.

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