Oral A Acid Dosage for Effective Acne Treatment

Oral isotretinoin dosage?

Hello, Doctor.
I started taking oral isotretinoin in October of last year.
I weigh about 60 kg, and my doctor said my condition was not very severe, so I could stop after taking 100 capsules.
Initially, I was prescribed 20 mg every three days, but after discussing with my doctor due to an increase in oil production, we changed it to one capsule every two days.
My acne situation stabilized, and in July (after taking a total of 20 mg * 95 capsules), my dermatologist said I could stop the medication.
However, a month after stopping, I began to experience excessive oiliness and developed many small pimples.

Later, I switched to another dermatologist, who said that the way my previous doctor prescribed the medication was incorrect.
He mentioned that taking one capsule every two days or every three days makes it difficult to accumulate the dosage, and that the medication requires time to take effect.
He then changed my regimen to one 10 mg capsule daily.

Is what my current dermatologist said about "taking one capsule every two days or every three days makes it difficult to accumulate the dosage, and the medication requires time to take effect" correct? Or is it simply that I didn't take the medication long enough initially to accumulate an adequate dosage? I feel that the current regimen and the previous accumulated dosage are not significantly different, but the cost of the medication is much higher.
Thank you for your response.

Ms. Zhang, 10~19 year old female. Ask Date: 2020/09/24

Dr. Wu Yuxin reply Dermatology

There is no absolute method of consumption; it should vary from person to person, as each individual's severity and needs/expectations differ.
For example, one might start with one pill a day, but after a month, if the condition improves, it could change to one pill every two days.
However, after some time, if the condition worsens or improves further, adjustments can still be made.

Reply Date: 2020/09/24

More Info

When it comes to oral isotretinoin (commonly referred to as A Acid), understanding the dosage and its relationship to effective acne treatment is crucial. Isotretinoin is a powerful medication used primarily for severe acne that has not responded to other treatments. The effectiveness of isotretinoin is closely tied to the cumulative dose taken over the course of treatment, which is typically expressed in milligrams per kilogram of body weight.

In your case, weighing approximately 60 kg, the recommended cumulative dose for isotretinoin treatment is generally between 120 mg/kg and 150 mg/kg. This means that for optimal results, you would need to accumulate a total dose of around 7,200 mg to 9,000 mg over the course of your treatment. If your initial regimen was 20 mg every three days, this would indeed lead to a slower accumulation of the drug in your system compared to a daily dose.
Your previous dermatologist's approach of taking isotretinoin every two or three days may not have allowed for sufficient drug accumulation to achieve the desired therapeutic effect. Isotretinoin works by reducing sebum production, normalizing skin cell turnover, and decreasing inflammation, but these effects take time to manifest. The medication needs to build up in your system to reach a level where it can effectively combat acne.
The new regimen of taking 10 mg daily is more in line with standard practices, as it allows for a more consistent and effective accumulation of the drug in your body. This daily dosing can help maintain stable blood levels of isotretinoin, which is essential for its efficacy. The concern that you might not have taken the medication long enough or at a sufficient cumulative dose is valid. Acne can be a chronic condition, and even after successful treatment, there is a risk of recurrence, especially if the initial treatment was not adequate.

Regarding your concerns about the cost of the medication, it's important to weigh the potential long-term benefits of a more effective treatment against the immediate financial burden. While it may seem that the new regimen is more expensive, achieving a complete resolution of acne may ultimately save you money on additional treatments or medications in the future.

In terms of managing side effects, isotretinoin can cause dryness of the skin and mucous membranes, which is often managed with moisturizers and lip balms. If you experience significant side effects, it's important to communicate these with your dermatologist, as they may need to adjust your dosage or provide additional supportive care.

In summary, your current dermatologist's advice aligns with established guidelines for isotretinoin treatment. A consistent daily dose is generally more effective for accumulating the necessary levels of the medication in your system. If you have ongoing concerns about your treatment plan or the potential for acne recurrence, it is advisable to maintain open communication with your dermatologist. They can provide personalized guidance based on your specific situation and help you navigate the complexities of acne management.

Similar Q&A

Understanding Oral A Acid: Why Isn't It Working for My Acne?

I have been taking oral isotretinoin at a dosage of 20 mg per day for over 10 months, and I am still experiencing acne without any improvement. Does this mean that the medication is ineffective for me, or could it be a matter of my body responding slowly? My face is also peeling,...

Dr. Wu Yuxin reply Dermatology
You should consult your attending physician about this issue, as they are the most familiar with your condition.

Oral A Acid Dosage Guidance for Acne Treatment: Key Considerations

Hello Dr. Yu-Hsin, I would like to inquire about my boyfriend, who is currently taking oral isotretinoin at a dosage of 20mg. If he has been on this dosage for one month, can he switch to 10mg and take two capsules a day next month? His current weight is 60kg. How long would he...

Dr. Wu Yuxin reply Dermatology
Without actually seeing the lesion, it is impossible to determine the issue. You should consult your attending physician, as they are the most familiar with your condition.

Managing Acne: Safe Reintroduction of Oral A Acid for Oily Skin

I weigh 53 kg and am a moderate acne patient. I need to wash my face once every class due to extremely oily skin. The topical treatments and oral antibiotics have had very limited effects. It may be due to my naturally oily skin. A little over a year ago, I took 20 mg for nearly ...

Dr. Wu Yuxin reply Dermatology
The dosage can be adjusted; some individuals may manage well with taking it 2-3 times a week, but it's important to discuss this with a physician.

Understanding the Frequency of Oral A Acid Usage in Dermatology

Hello, doctor. The dosage prescribed by the clinic is 20 mg per day, taken 5 times a week. Could you please explain whether this dosing schedule is intended to enhance the absorption efficacy of each pill or to reduce the likelihood of side effects? I do not have any issues with ...

Dr. Wu Yuxin reply Dermatology
You should consult your attending physician about this issue, as they are most familiar with your condition and can help you choose the appropriate medication.