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Agaddy-

You are right that higher the dose of Accutane, the greater likelihood that acne will not return, perhaps ever (although there are a few cases where it does it return regardless of dose). In that case, the cause could be more hormonal and other approaches (for women, BC pills and for men, saw palmetto or even B5 since that synthesizes hormones) should be really helpful.

I do have fears that since I am at a low dose for my weight (150lbs) that it may return when I'm done in a month. But I could not tolerate a higher dose than 40mg/day. I had headaches, dizziness, I couldn't do anything. My body rejected it, I think. The low dose (20mg/day) has cleared me and I am more optimistic that despite what the literature, I will remain so.

By the way, Roche is testing and perhaps soon will make available a new "version" of Accutane...it's a micro-nized version (think Retin-a micro). Clinical studies have shown that at the lowest dose, this new version is just as effective as higher doses with less side affects. Here's a summary of the article:

Fewer, Lower Doses Of Micronized Isotretinoin Effective For Nodular Acne

A DGReview of :"A randomized trial of the efficacy of a new micronized formulation versus a standard formulation of isotretinoin in patients with severe recalcitrant nodular acne"

Journal of the American Academy of Dermatology

08/17/2001
By James Adams

Isotretinoin in its micronized formulation can be administered less often and in lower doses for treatment of severe recalcitrant nodular acne.

It can still achieve clinically equivalent results to the administration of standard formulation isotretinoin.

Investigators from 18 different institutions, including University of Iowa Healthcare in Iowa City, Iowa, and Roche Laboratories, Inc. in Nutley, New Jersey, United States, conducted a double-blind, double-dummy study with 600 patients with severe recalcitrant nodular acne.

Half of the patients received 0.4 milligrams/kilogram of micronized isotretinoin in a single dose without food. The other half received two divided doses of standard isotretinoin with food for a total daily dose of 1.0 milligrams/kilogram.

The investigators monitored acne lesion counts for a 20-week period.

Results showed that the two patient groups had equal reductions in the total number of nodules. A similar number of patients from each group exhibited 90 percent clearance of nodules.

"Once-daily use of the micronized and more bioavailable formulation of isotretinoin under fasted conditions is clinically equivalent to the standard twice-daily formulation under fed conditions in the treatment of severe recalcitrant nodular acne," the investigators conclude.

J Am Acad Dermatol 2001; 45: 187-195 "A randomized trial of the efficacy of a new micronized formulation versus a standard formulation of isotretinoin in patients with severe recalcitrant nodular acne"





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