Accutane Question

[legend05]

Is 20mg per day enough to clear up some greasy skin, black heads around shoulders, Im posting this on behalf of a mate of mine, he does alot of modeling work and has lost out on a few jobs as they said his back wasnt clear enough. He went to see the doc and they said he skin was no where near bad enough for accutane or even retin a. Just told him to use some OTC stuff, obviously this isnt really much use to him as he needs results and quite fast, would 20mg accutane do the job?

[Moe-mentum]

If no one can awnser you here you might be able to find what your looking for here....
http://www.acne.org/messageboard/

I am curious to know if and how I may be able to effectively cycle in a moderate application of accutane into my PCT.

Good luck.

[anaBROLIC]

it will def work and 20mgs is okay, but i wouldnt just tell him to just get it and take him. have him research the drug and possible side effects. i personally dont think he should go this route. its not something to play around with and take just because you have greasy skin. its not a quick fix either, just like a cycle of juice, it takes time. it actually gets worse before it gets better.

[Cornholio]

Accutane is powerful meds. I would look into the side affects before starting.

[legend05]

Thats why i posted the question to be honest, Im pretty sure he will do it regardless of what I say so was just going to try and advise him about dosages and possible sides.

[anaBROLIC]

Thats why i posted the question to be honest, Im pretty sure he will do it regardless of what I say so was just going to try and advise him about dosages and possible sides.

yes tell him for the first couple months he can expect, more acne, very dry skin, very dry chapped lips. basically he wont be able to go anywhere without face lotion and chap stick.. it does vary as far as severety goes. its all in dosage but you will still see this on low 20mgs/day. make sure hes not taking any other orals, like anabolics...

[Moe-mentum]

Found this this to be a fairly informative post.
I like the lower dose results that have been documented.

http://www.acne.org/messageboard/ind...howtopic=75454

Here is a study for you on low dose Accutane.




Low Dose, High Rates of Success

Ultra-low dose isotretinoin is all many acne patients need
Jul 1, 2003
By: Alison Palkhivala
Dermatology Times

Dr. Plewig
San Francisco - Low and ultra-low doses of isotretinoin are an effective therapy for many acne patients. This safer and cheaper solution can even be used continuously.

Gerd Plewig, M.D., believes that the doses of isotretinoin typically used in the United States and Europe are far too high. For many patients, as little as 2.5 mg twice a week, which he describes as "a drop of rain on a dusty road" is adequate.

Dermatologists all over the world already are treating some patients continuously with low doses of isotretinoin, according to Dr. Plewig, director, dermatology and allergy clinic, Ludwig-Maximilian University in Munich.

"When you talk to doctors in this country and other countries of the world, they use 10 mg twice a week or three times a week, which is a low or ultra-low dose. But nobody ever bothered to show and demonstrate that it works," he said. Thus, he and his team performed two clinical trials to assess its efficacy.

Study Spotlights Low Dosing In the first trial, 28 patients with acne conglobata and inflammatory acne took a low dose of isotretinoin: 20 mg/kg, 10 mg/kg, or 0.5 mg/kg body weight daily for six months. In the second study, 11 acne patients took an ultra low dose of isotretinoin: 2.5 mg to 5 mg daily or 2.5 mg twice a week for six months. Both trials involved multiple endpoints, including clinical grading, lesion counts, counts of follicular filaments (believed to be precursors to lesions), bacterial colonization, patients' opinion of seborrhea levels, two objective measurements of sebum levels (Sebutape and Bentonite clay), qualitative assessment of sebum using high power, thin layer chromatography, and biopsies to assess size and configuration of sebaceous glands.

Trials Yield Significant Improvement Results of the first trial in which low doses of isotretinoin were used revealed significant improvements in all parameters tested. Numbers of follicular filaments, and lesions dropped, as did levels of bacteria and sebum. Sebaceous glands shrank, as well.

At the end of the second study, which investigated ultra-low doses of isotretinoin, efficacy was maintained on many of the parameters. There were significant reductions in numbers of active lesions and follicular filaments as well as objective measures of sebum levels. Patients' ratings of seborrhea improved, and levels of P. acnes on the skin diminished.

"The endpoint or the lowest point of a retinoid being effective for the treatment of seborrhea, persistent low grade acne, or maintenance therapy for patients with bad acne probably is around 2.5 mg or 2 mg, or maybe even 1.5 mg," Dr. Plewig said.

The best candidates for low and ultra-low doses isotretinoin therapy, Dr. Plewig said, include patients with severe acne who were controlled with higher doses and require a lower-dose maintenance therapy, individuals whose facial acne has persisted from adolescence into adulthood, and people with sebaceous gland hyperplasia. "Some patients come only because of their oiliness. ... For these patients, I think the low or ultra-low dose is very good, and it's cheap, too," he said.

Severe Patients Still Receive Low Doses Dr. Plewig keeps doses of isotretinoin relatively low in patients with severe acne. "I pretreat patients with severe inflammatory acne with systemic corticosteroids to begin with...about 1 mg/kg body weight for about seven to 14 days, taper it off, and then give an antibiotic, usually an erythromycin, a macrolide," he said. "And then I start with the isotretinoin [0.2 mg/kg to 0.4 mg/kg body weight]. It is so much better. We used to start immediately with isotretinoin or tried antibiotics, but often it takes too long, the patients are miserable, and it is so much better for them because you can have a faster final result, a better final result with cooling down the skin first, then adding your active treatment."

Continuous Use Offers Versatility A great benefit of using lower doses of isotretinoin is that it can be used continuously. There are other important advantages, as well. "In terms of pharmacoeconomics, it is cheaper to use lower doses, it is better tolerated by patients, has fewer side effects, fewer laboratory abnormalities, and of course the patients like it when they have continuous elegant treatment," Dr. Plewig said.

Despite the safer side-effect profile with low-dose isotretinoin, Dr. Plewig emphasized that, at any dose, the drug should still be considered teratogenic and be used with great caution in women of childbearing age.


And...

Int J Clin Pharmacol Res. 2003;23(2-3):41-6.
> >
> >
> > Low-dose schema of isotretinoin in acne vulgaris.
> >
> >
> > Mandekou-Lefaki I, Delli F, Teknetzis A, Euthimiadou R,
Karakatsanis
> > G.
> >
> > In severe papulopustular and in nodulocystic/conglobate acne,
oral
> > isotretinoin is the treatment of choice. It is also required for
> > patients with moderate to severe acne, especially when acne
scars
> > start to occur A new therapeutic approach consists of a low-dose
> > regimen of isotretinoin. We performed a comparative study of
high-
> > and low-dose schemas of isotretinoin per os for the treatment of
> > acne. The purpose of this study was to assess the therapeutic
effect
> > and tolerability of low doses of isotretinoin in the treatment
of
> > acne vulgaris and compare low-dose with high-dose regimens.
Sixty-
> > four patients (35 women and 29 men) with different types and
grades
> > of acne vulgaris were divided into two treatment groups of 32
> > patients, in a trial that compared a low dose of 0.15-0.40 mg/kg
per
> > day with a high dose of 0.5-1.0 mg/kg per day. These regimens
were
> > analyzed with reference to clinical history of acne, baseline
> > investigations, dose and response to isotretinoin, clinical and
> > laboratory adverse effects, relapses and cost of therapy. The
mean
> > success rate of the low-dose schema was 69%. The total dose up
to
> > 120 mg/kg should be followed for optimal results (success rate
of
> > 91%) and avoidance of relapses. The low-dose schema produced
fewer
> > adverse effects and offered a very beneficial effect on pre-
existing
> > scarring. Our results confirm the beneficial effect of the low-
dose

[legend05]

Good post, thanks.

I will advise him to use 10 or 20mg per day, would a 6 week course be enough? I read a few threads on acne.org saying it seems to clear blackheads in around 4 weeks

[mrscottsdale]

yes tell him for the first couple months he can expect, more acne, very dry skin, very dry chapped lips. basically he wont be able to go anywhere without face lotion and chap stick.. it does vary as far as severety goes. its all in dosage but you will still see this on low 20mgs/day. make sure hes not taking any other orals, like anabolics...

I used accutane for about 2 months without any of those side effects, It seemed like a pretty safe drug to me, but i quess everyone is different.

[legend05]

I used accutane for about 2 months without any of those side effects, It seemed like a pretty safe drug to me, but i quess everyone is different.

How were the results?