Should I request for a higher dose of Isotretinoin if I am on a low dose regime?

Doctor's Answers 1

Pertaining to your isotretinoin dose, your dermatologist has done absolutely the right thing.

I wouldn’t consider 30 mg low by any means. 10 – 15 mg is what’s normally considered to be in the “low range”. Even if you “shopped” around for a different doctor, I don’t think their dosage advice would differ too much from your dermatologist.

Besides, it’s still relatively early days. 2 months in, and you are responding and improving. If I were you, I’d stick, rather than twist with the dose.

My rationale is that side effects for isotretinoin are dose-related – the higher the dose, the more likely you’ll get worse side effects like super bad chapped lips.

You’ve probably done a lot of research into sites like acne.org I imagine, but just because doctors use different management styles in the USA, doesn’t mean that we are super cautious or unnecessarily conservative in our approach. Those on high doses could potentially be much larger/heavier too – they are Americans after all.

Additionally, there’ll always be a self-selecting bunch who are more likely to share their experience online – these people are clearly not representative of everyone else on isotretinoin, who may have mixed results with high dose therapy.

As a final word, doctors treat all patients as individuals, and customise treatments as such. Online “reviews” and “expert patients” who frequent forums are no substitute for that.

2. No, antibiotic resistance will not cause using Clindamycin to make your acne worse.

Do highlight this at your next consult though, as she may be inclined to switch your therapy or persist – depending on how you responded to Clindamycin previously.

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Are there any Accutane providers other than NSC in Singapore? Do antibiotics work for acne?

Thanks for the detailed summary. There’s no problem at all with seeing a GP to treat your acne – the treatment algorithm for acne is pretty standard. My pet peeve is only with clinics who overcharge based on having some sort of special super secret ingredient “miracle acne creams”, because the reality is that all effective topical creams contain well-known ingredients, and packaging it under their own brand shouldn’t give them the right to charge more, or “lock-in” patients to only using their creams.

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Human

Does a low dosage isotretinoin course which falls below the recommended total cumulative dosage increase the chance of a relapse?

There is a cumulative therapeutic dose in the range of 120mg – 140mg/kg that some doctors adhere to in the bid to reduce the relapse of acne. Sometimes, doctors may prescribe lower doses (with lower side effects) until the acne has cleared and continue the course for a few more months after. It really depends on the prescribing doctor as each has his/her own protocol. If you find that you are still having relapses with lower doses then discuss with your doctor the option of a course to achieve the therapeutic accumulative dose.

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Dr Rui Ming Ho

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