The latest Alberta Tools for Practice1 (#158) found that small randomized controlled trials (RCTs) and observational studies demonstrate low-dose (~20mg/day) isotretinoin improves acne similar to conventional dosing. Low-dose may reduce common side effects (chapped lips, dry skin, epistaxis) by 16-35% but may be associated with increased relapse rates, particularly with severe acne and/or possibly impacted by lower total accumulated dose. Dr Marius Rademaker alluded to this in his 2013 article where he suggests starting start with doses of 10 mg/day, and continue until all the active acne lesions have resolved and continue treatment for a further 2–4 months, perhaps at the lower dose of 5–10 mg/day (or 10 mg alternate day) to reduce the risk of relapse and help with resolution of acne scarring.2 I have been using the Rademaker approach for over two years and have had excellent results and no cracked lips nor red faces. I have no cases of flares as predicted by him.
As published in NZ Doctor and Research Review
