When discussing the treatment for severe acne, it’s remiss not to examine the enormous part Accutane has played. As the very first isotretinoin introduced, Accutane has had a long history of treating patients—with more than 19.8 million prescriptions written in the U.S. alone. While the common and more serious side effects are well-publicized, Accutane remains an effective treatment for severe nodular acne that does not respond to other treatments.
And now there is a new contender in the game: Clear Health’s Micro-Dose Accutane Protocol, a low-dose form of Accutane treatment. Designed to tackle “some of the hurdles” associated with traditional Accutane, the protocol is taken for a longer period than the traditional six-month course.
According to the brand, the Clear Health version is “suitable for people with mild to moderate forms of acne that have not responded to other treatments, or for people with more severe forms of acne who might not tolerate the side effects of a standard Accutane course well.”
What Is a Low-Dose of Accutane?
“Microdose Accutane, or alternative dosing Accutane, is a well-known secret of dermatologists,” Dallas dermatologist Aaron Farberg, MD shared with Dermatology Times. (He’s also the medical director of Clear Health and the publication’s spring editor-in-chief.) “We’ve utilized this off-label regimen for Hollywood celebrities, models and even ourselves, in some cases.
We always have to remember that how a patient’s acne impacts them is extremely important and must be considered when deciding on the right treatment course,” Dr. Farberg continued. “A microdose treatment essentially spaces out that six-month treatment over a much longer period of time, whereby you maintain the improved effects on the skin while minimizing the side effects.”
New York dermatologist Jody A. Levine, MD says she’s been prescribing a low-dose Accutane for a while—mostly for adult acne—but in a way that’s slightly different than the Clear Health protocol. “The more common method is to use 10 mg a day for a longer period of time than traditional dosing. It works very nicely.”
Also a fan of the Accutane microdose, Phoenix, AZ dermatologist Dr. Karan Lal says the U.S. is a bit behind in its use. “Low-dose isotretinoin is very popular in countries in Asia and in Europe. There are many different protocols for low-dose Accutane with the most common being 40 mg three times a week.”
Dr. Lal also calls out his desert-climate office as having to do with his preference: “I have been prescribing low-dose Accutane for the past two years living in Arizona because of the dry heat and the higher risk of adverse events, specifically nosebleeds, dry lips and photosensitivity. I prefer to do 10 mg a day for a longer period of time. Patients enjoy that it is much more tolerable. These lower doses also make parents feel more comfortable. I use low-dose isotretinoin in middle-aged and older adults for oily skin, hard to treat dandruff, dull and wrinkled skin, and photodamaged skin.”
As far as downsides go, Dr. Lal says there are a few: “Patients have to come in every month for a visit, which means it is a co-pay. Depending on the patient’s comorbidities, lab work may be required with more frequent monitoring. Personally, at lower doses in children I do not check labs.”
Who Is a Low-Dose of Accutane Good for?
While she considers any low-dose of Accutane to be “highly effective,” Dallas dermatologist Elizabeth Bahar Houshmand, MD does point out it’s an off-label form of Accutane and candidates should be prepared to take it for a longer period of time. “Low-dose or microdosed Accutane is an off-label use of isotretinoin,” she explains. “Patients take a smaller amount of the medication over a longer period of time. The best candidates for low-dose isotretinoin are patients who have mild-to-moderate acne that has not been controlled by standard treatments, like topical prescriptions, oral antibiotics or other oral medications.”
