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Before we had high-tech lasers and an encyclopedic knowledge of every exfoliating acid known to man thus far, there was one acne treatment many would ask doctors to prescribe in hopes of clear skin: Accutane. The oral version of isotretinoin was a gold standard when it came to acne, but it came along with some harsh potential side effects (ultra-dry skin, peeling, liver damage, and absolutely no pregnancy).
Now, there’s a new way to take the medication. Meet the “Hollywood Dose,” aka microdosing Accutane.
As Aaron Farberg, MD, Dallas-based double board-certified dermatologist and Clear Health medical director, explains it, microdosing Accutane is an “off-label form of treatment prescribing” where a lower dose of the acne medicine is taken for a longer period of time. So rather than the standard 6-month course that’s usually prescribed in the States, microdosing involves a lower dose for 18 to 24 months.
“There was a time when all of the models and actors in New York were microdosing Accutane,” adds Daniel Belkin, MD, board-certified dermatologist at New York Dermatology Group. “It’s a great way to make your skin amazing, glowy, and beautiful.”
While it’s gone down in popularity thanks to advancements in skin technology and other prescribed treatments that require less paperwork, microdosing Accutane is still commonly used amongst celebs and anyone looking to keep their acne in check without those side effects associated with it. For many experts, Accutane—regardless of the dose—remains one of the top options. “Nothing in the world of prescriptions or devices can clear acne like Accutane,” says Evan Rieder, MD, board-certified dermatologist and psychiatrist at 36 North Moore Dermatology. “No prescription can tighten pores and yield a ‘glass skin’ look like the drug.”
How Microdosing Accutane Works
“Microdosing Accutane is generally great for people who have good skin [and] are looking to take their skin to the next level,” says Dr. Rieder. “By slightly inhibiting oil production, Accutane both starves acne of what it needs to survive and shrinks the pores, whose function it is to expel oil.”
Dhaval Bhanusali, MD, board-certified dermatologist and founder of Hudson Dermatology and Laser Surgery, says that the method is a great alternative to more aggressive treatments. But while it does work to clear the skin, he says he wouldn’t rely on it if you’re looking for a long-term solution to your breakout woes. “I’d think of it as more ‘keeping things at bay’ than truly treating the problem,” he says.
The Downsides
When you’re on a standard dose of Accutane, Dr. Farberg says that some typical side effects include dry skin all around or dryness in targeted areas such as your nose and mouth. You might also have minor body aches and increased levels of your liver enzymes. With a microdose amount, he says the chances of those effects are minimal and occur less often.
Two other and more serious side effects that people tend to associate Accutane with are signs of depression and an elevated risk of inflammatory bowel disease. Dr. Farberg says that while studies have shown that some may experience these while on the treatment, he emphasizes that they’re still very rare to begin with. “It’s important to note that incident rates are very low, and research shows that the stigma associated with these potential side effects may have been previously exaggerated," he says.
The biggest downsides to microdosing Accutane involve more of the logistics. He notes that microdosing Accutane may not be covered by insurance because most insurance plans only cover up to 6 months of treatment. If the out-of-pocket costs don’t make sense for you financially, you might want to rethink asking your dermatologist about this method.
Dr. Belkin adds that because prescribers must log patients’ Accutane use every month, there’s more paperwork and testing for everyone involved. This is especially important for those who can get pregnant, as Dr. Rieder explains that Accutane at any dose can be extremely dangerous for the development of an unborn baby. “Because of this, women of reproductive age who are prescribed Accutane are required to see their doctor monthly for pregnancy tests," he says. “It can often be challenging for some people to find the time to see their doctor monthly.”
While extra appointments and check-ins aren’t that big of a deal health-wise, it’s definitely something to consider if it’s too much of a commitment for you. “It can be logistically annoying,” says Dr. Belkin.
Microdosing Accutane vs. Microdosing Spironolactone
If Accutane isn t for you, there are other medications like Spironolactone, the prescription medicine that treats high blood pressure but is used off-label as a treatment for acne in women, that might be worth exploring. In fact, Dr. Belkin sees more and more people opting for microdosing Spironolactone over Accutane when given the choice. But when trying to figure out which medication works best for you, it’s all in the type of acne you’re hoping to treat.
If your acne is more hormonal, Belkin says you might be better with microdosing Spironolactone. If you’re looking for more of a blanket acne treatment that reduces the oil glands, stick to microdosing Accutane.
Who is this for?
Despite its minimal downsides, it might not be the right treatment for everyone. Dr. Farberg says it’s more suitable for those with mild to moderate forms of acne who might not tolerate the potential side effects of a standard dose. Dr. Belkin agrees and adds that those with oily, sebaceous skin would also benefit from a low dose because Accutane can shrink oil glands, something that a lot of lasers can’t even do.
Those with moderate to more severe forms of acne or those who do not respond to other oral or topical acne treatments would be better off with the standard dose, Dr. Farberg adds. Also, if you’re not looking to be on medication for more than a year and can take the potential side effects well, then he says there’s no real need for you to think about microdosing.
As with anything skin-related, ask your dermatologist to see if you’d benefit from the Hollywood Dose. They might determine that there are better options for you and your skin. “[Microdosing Accutane] is something I don t usually recommend, unless [it’s] a specific scenario,” says Dr. Bhanusali. “There are certainly a small percentage of people who are resistant to traditional [acne] therapy, so this is an option. For those in the limelight, we do it from time to time, but the goal is to not make it an indefinite thing. I always try to minimize systemic meds when applicable.”
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