Low Dose Accutane Question

Hi. I haven't been on low dose Accutane, but have read the following other
posts which I saved for reference. Hope they help:

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THIS
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I've had three full courses of accutane.....
Fantastic while I was on it, great for a period after, then slowly getting
into trouble..back onto oral and topicals again....then more accutane etc.

Now, because I'm classed as a 'mature adult with persistent recalcitrant
acne' I'm on long-term ,low-dose accutane (40 mg twice a week) and couldn't
be more pleased.

It is rare, though to need a third course, especially if your earlier
courses were intense enough to reach the total effective dose level

Try a third course, but enquire about the 'trickle-dose' regime above
(pioneered by Prof WJ Cunliffe of Leeds University UK, et al )

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AND
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I must say that I am astonished (yes, astonished) with the impact
low-dose accutane has had on reducing my rosacea symptoms.

I have had rosacea now for nearly 2.5 years. Symptoms are daily
flushing and burning, always around mid-day, moderate background
redness, some telangiectasia (throught to be mostly from sun damage),
and relatively mild ocular rosacea characterized by bloodshot eyes.
Over this time, I have tried the usual oral + topical antibiotics,
antihistamines, beta blockers, TCAs, and, most recently, a
5-treatment photoderm series (using Bitter Sr protocol). None of
these, including photoderm, has had anything resembling the impact
that low-dose accutane has had. (See previous post for details on my
photoderm experience.)

At any rate, I was quite intriqued by the discussion concerning
accutane in Geoffrey's book, in particular the fact that investigators
have noted that accutane has
(1) resulted in a reduction of facial skin temperature by up to 1
degree C within 3 days of treatment,
(2) led to a 40 percent reduction in blood flow through the cheeks (as
measured by laser doppler)
(3) eliminated facial burning in 18 patients within several weeks of
taking accutane.

This last observation is contained in the paper

http://archderm.ama-assn.org/issues/v134n7/ffull/dlt0798-10.html

After reading this paper, I was convinced that it was worth trying
another round of accutane. My derm had put me on 40-60 mg/day 6
months after I was diagnosed, and this high dosage really dried out my
face, and increased the flushing and burning. I briefly tried
low-dose accutane last summer, but did not pursue since I wanted to
start the photoderm ASAP.

My first experiment was to initially take 40 mg/day and see what
impact this would have, now that my rosacea symptoms have advanced
since my initial experience nearly two years ago. I did this for 6
days, until I started to feel my face drying out, and then did not
take any accutane for the following 7 days. Here is what I observed:
at about day 3, the facial burning subsided quite noticeably, and I am
certain this was due to the accutane. However, in the following
days, as the plasma concentration of accutane increased, the burning
returned, and indeed, for several days right after stopping accutane
(when plasma concentration was presumably at its highest), my flushing
and burning were essentially as bad as ever. Then, as the plasma
concentration gradually decreased, I noticed a reduction in burning
just as I had at day 3. Obvious conclusion is that there is a rather
narrow range of plasma concentration that significantly reduces
burning and flushing. Corollary is that typical weight-derived dosage
produces concentrations that are way too high, and indeed leads to
increased flushing.

So, after the 6 days at 40 mg/day, and the 7 days off, I began taking
20 mg of accutane every two days. This 10 mg/day is precisely the
dosage given to the 22 participants in the study in the above
reference. (These people were selected because they had rosacea for
mean time of 6 years, and nothing else had worked.). I am now 20
days into this dosage, and I am seeing reduced redness each day. The
daily facial burning is completely gone, and my face feels remarkably
cooler even during my normal daily flush cycles. For first time in
longer than I can remember, my face actually feels normal throughout
the day, with maybe some slight tingling if I am concentrating really
hard (my flushing appears to be sns-mediated, and flushing during
mental calculation is typical of this). This dwarfs any minor
improvement I had seen as result of the photoderm. The bottom line is
that I am seeing exactly what had been reported in literature: a
substantial cooling of the facial skin, and complete elimination of
the incessant daily burning.

Two other observations: my ocular rosacea has also improved in that my
eyes are much less bloodshot, presumably due to reduced flushing.
And, again due to decreased flushing, my telangiectasia are much less
prominent. This improvement is much more pronounced than that
achieved via 5 photoderm treatments.

I strongly believe that the key is to find one's personal "sweetspot"
in terms of accutane dosage and hence corresponding plasma
concentration to achieve optimal reduction of rosacea symptoms. One
way is to increase dosage to point that your lips are just a little
dry (nothing that can't be contained with a good chapstick ...), but
face does not feel unusually dry. The weight-derived dosage that
derms prescribe for cystic acne is WAY off this optimal point. Even
Singer's 1998 review paper on drug therapy for rosacea says that
accutane should be administered at 0.5 mg/day per kg of body weight,
which is still 35 mg/day for 150 lb individual. (Personal note: I am
6 ft 5 inches tall and weigh 200 lbs - this would be 45 mg/day for
me.)

BTW, one reason I started accutane now is that my rosacea was
progressing to point of getting a few bumps. Accutane stopped these
immediately, as documented in above reference as well as essentially
all other accutane studies. If you have any bumps when you start
accutane, they will heal slower than usual since accutane, in course
of shutting down sebaceous glands, does delay healing, which is why
you need to be off it prior to photoderm or laser treatments.

As for accutane side effects, my take is that these are only an issue
at standard dosages, except that it is very clear that women must
never get pregnant on ANY dose of accutane. A leading rosacea
researcher even mentioned to me in a private communication that he
does not do usual blood work at low dosages, and indeed feels
long-term, low-dose accutane treatment is safer than long-term use of
systemic antibiotics. I plan to continue current regimen for at least
6 months, and possibly a year depending how it goes. There is
evidence that symptoms remain in remission after accutane is stopped.

Accutane is indeed an astonishingly effective drug for treating nearly
all rosacea symptoms. (Its effectiveness on acne is why the Am Derm
Society has fought the FDA's attempts to much more tightly regulate
accutane prescriptions.) In the final analysis, it is the only thing
that has produced significant improvement for me. As Heidi has
observed, it may be difficult to convince your derm to prescribe
accutane if you are woman of child-bearing age, particulary if your
symptoms are relatively mild. In this case, you may have to agree to
do standard oral antibiotics + Noritate for a couple of months before
derm agrees to accutane. But you might have some success in this
argument if you show your derm the above paper, and argue that side
effects (with obvious exception of impact on pregnancy) at this low
dosage are MUCH reduced relative to those reported at the much higher
dosages (up to 100 mg/day) for acne treatment.


"Chris Calder" <chris RemoveThis @cashflownetworks.com> wrote in message
news:nLncb.109467$DZ.61139@news04.bloor.is.net.cable.rogers.com...
> Right now I am on my first month of Accutane taking 40mg twice a day for a
> total of 80mg a day, I will be on it for four months. I never had bad acne
> just very irritating white bumps that came to heads every now and again.
> They were mostly on my chin area and around my mouth. My face around my
chin
> and mouth always looked dimpled and red because of all the bumps, and I
> noticed that this area was the oiliest part of may face, and would get
very
> dry just in that area when I washed my face. Anyways my derm put me on
> Accutane to dry up the oil and push the plugs out of the pores. It seems
to
> be working as a lot are coming to heads and drying up and I can see some
> plugs sticking out of the pores, and being pushed out. So my question is
at
> the end of the 4 months would it be a good idea to go on the low dose
> Accutane regimen to keep my pores unclogged and the oil down? I saw
someone
> post that they take 40mg twice a week on Mondays and Fridays, I would like
> to try this. Another question is do you get the side efeects like dry lips
> and excessive dryness of the face when on such a low dose? Or will my skin
> return to almost normal in terms of hydration, just without the oiliness
> because of the Accutane. Any help would be greatly appreciated.
>
> Thank you,
> Chris
>
>
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