Microdosing acne has taken over social media. Here's what a NYC dermatologist has to say about the 'trend' and if its' right for you.
Alexandra Engler is the senior beauty and lifestyle director at mindbodygreen and host of the beauty podcast Clean Beauty School. Previously, she's held beauty roles at Harper's Bazaar, Marie Claire, SELF, and Cosmopolitan; her byline has appeared in Esquire, Sports Illustrated, and Allure.comWhen I had a serious case of hormonal acne, starting as a preteen, I tried everything to clear it up.
Everything but Accutane. Accutane has long been considered one of the most effective treatments for acne—but it also has a nasty reputation for causing extremely dry, uncomfortable skin and other serious side effects . This can make the treatment journey challenging—and puts off many potential users altogether, myself included. After serious discussions with my dermatologist at the time, we decided it wasn’t the right path for me.
Accutane has re-entered the zeitgeist in several ways recently. If you've spent any time on the beauty side of social media over the last few years, you've probably come across at least one video of an influencer talking about how they areTake a much lower dose of the acne medication isotretinoin and potentially get clearer skin with fewer side effects.
As someone who once decided against Accutane, I can certainly understand why a version that has fewer side effects would catch people's attention. First off, what is Accutane and why might someone want to microdose it?used to treat acne. While the original Accutane brand is no longer available, isotretinoin remains one of the most effective acne treatments dermatologists have.
"Accutane is the brand name for isotretinoin. There are several other manufacturers and brands that it goes by, but many people still refer to it as Accutane," says Jeremy Fenton.
"Isotretinoin reduces the production of sebum and it normalizes follicular keratinization. This means that you produce less oil and the change in keratinization reduces the amount of skin cells that can lead to 'clogged pores.
' Isotretinoin can have a dramatic reduction in acne, even in the most severe cases, and most patients are able to get completely clear skin," says Fenton. Traditionally, isotretinoin is prescribed at a dose designed to help patients reach a target cumulative amount over roughly six to eight months. ”The target dose is based on their weight, most people taking somewhere between 120 and 200 mg/kg over that time period," explains Fenton.
The reason dermatologists focus on cumulative dosing is because research suggests reaching that target amount can help keep acne away for years after treatment ends, which depending on the patient, may mean it can get the individual through their acne phase giving them clear skin for life. The term"microdosing" generally refers to taking much smaller amounts of isotretinoin over a longer period of time.
"The typical dose is in the range of 0.5 to 1 mg/kg daily, thus an average person may be taking 40 to 80 mg of isotretinoin per day. The range for microdosing can be very broad, with some taking as little as 10mg once per week and some taking 10mg daily,Lower doses will have far fewer side effects and also avoid the initial flare that some people experience when starting it ," says Fenton.
Common side effects of isotretinoin include dry skin, dry lips, dry eyes, and increased sensitivity to the sun. While these side effects can still occur with lower doses, they're often less severe.trade-off is that it will take longer to see results.
"The biggest downside to microdosing is that if you are aiming to hit that cumulative dose, it can take much longer," Fenton explains. "Many of the studies showing comparable efficacy of microdosing, still had the patients reach the target cumulative dose. "Like many “new” social media trends, this is just a repackaged practice that has existed for decades.
"Prescribers have always had the option to prescribe lower doses, but it has not been standard practice in the United States due to the official guidelines recommending the 0.5-1mg/kg daily dosing. ”in other countries where guidelines around Accutane are more open, this has been a more common practice . It hasn’t been until recently that the available research and dermatology guidelines have started pointing to low-dose isotretinoin as a legitimate alternative for select acne patients.
Fenton agrees:"It is likely becoming more popular primarily due to the media exposure—and that has likely been driven by more recent studies showing that low dose isotretinoin can have similar end results with less side effects and higher patient satisfaction. ”Whether you're taking a traditional dose or a low dose,"The most important thing everybody should be aware of is the risk of birth defects when a pregnant woman takes isotretinoin. This is true of both low dose and regular dosing.
Because of this risk, isotretinoin is tightly regulated through the iPledge program, which includes monthly monitoring requirements.
"Those who are taking low dose for an extended period must commit to vigilant birth control the whole time," he says. Patients should also understand that lower doses don't eliminate other potential risks associated with isotretinoin.
"There are also risks of affecting the liver and triglycerides and thus require some labs that need to be monitored regardless of dosing amount," says Fenton. Additionally, people taking isotretinoin should generally avoid waxing, chemical peels, and certain elective skin procedures while undergoing treatment.low-dose isotretinoin may be most appropriate for people with mild to moderate acne who are particularly concerned about side effects. That said, it isn't necessarily the right fit for everyone.
Patients choosing a low-dose regimen need to be prepared for a longer treatment timeline, more follow-up appointments, and the possibility that insurance coverage may become more complicated over time.
"I have also run into issues with insurance stopping coverage after a period of time when it is a significantly extended timeline," says Fenton. "For these reasons, although there are some who like to maintain a lower dose,"People should be sure that these are legitimate companies with good reputations," he says. Most importantly, providers should still be following all of the standard safety protocols associated with isotretinoin.
"These providers should be discussing all risks in detail and review the requirements for lab monitoring, contraception, and pregnancy testing. If these are not discussed, that should be a red flag.
"Despite what social media may suggest, microdosing Accutane isn't new even if it is “trendy. ” Dermatologists have used lower-dose isotretinoin protocols for years, particularly for patients with milder acne or concerns about side effects. But all-in-all, I’m always appreciative of broader awareness for all the available options to effectively treat acne.
And for the right person, a lower-dose approach may offer a more tolerable treatment experience—even if it typically requires a longer commitment, ongoing monitoring, and many of the same safety precautions as traditional isotretinoin therapy. If you're considering low-dose Accutane, the best place to start is with a board-certified dermatologist who can help determine whether it's an appropriate option for your skin, lifestyle, and health history.
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