Everyone is Suddenly Microdosing Accutane

7 min readIf you’ve spent any time on the BeautyTok lately, you may have seen one of your favorite influencers raving about their experience microdosing Accutane. Creators are claiming the low-dose approach delivers many of the medication’s skin-clearing perks—think fewer severe acne breakouts, less oil, and even a glowier complexion—without the notoriously intense side effects that have long been associated with the drug.Though it may be the hot skincare topic on social media right now, dermatologists say there’s nothing new about it. “Microdosing Accutane is an old dermatology trick we’ve been practicing for years,” says Kiran Mian, DO, a board-certified dermatologist at Hudson Dermatology & Laser Surgery in New York City. “Like anything talked about on social media, it’s become a ‘trend’ as more and more people learn about its existence and benefits.”Meet the experts: Jessica Weiser, MD is a board-certified dermatologist and founder and medical director of Weiser Skin MD in New York City and Weiser Skin West MD in Aspen. Kiran Mian, DO is a board-certified dermatologist at Hudson Dermatology & Laser Surgery in New York City.And its rise in popularity makes a lot of sense: “Microdosing, or taking a medication in small doses, feels safer and takes on less risk in terms of side effects while still delivering benefits,” Dr. Mian adds.Still, as beauty treatments, procedures, and surgeries become more mainstream, some experts caution against thinking of low-dose Accutane as an informal beauty hack. “Because it carries real potential side effects, it has never been and should not be considered a casual medication,” says Jessica Weiser, MD, a board-certified dermatologist and founder and medical director of Weiser Skin MD in New York City and Weiser Skin West MD in Aspen. While a lower dose can be an effective treatment strategy for the right patient (and something derms often opt for), it’s still a prescription medication that requires close medical supervision.Ahead, everything you need to know about the trending skincare treatment and if derms really think you should microdose Accutane.What Is Accutane?Accutane is the brand name for oral isotretinoin, which is still widely prescribed today, although Accutane itself was officially discontinued in the United States in 2009. Isotretinoin itself is “a prescription-strength orally-dosed vitamin A medication that is FDA-approved for the treatment of severe recalcitrant nodular acne unresponsive to conventional therapy,” says Dr. Weiser. If you have moderate-to-severe, treatment-resistant acne, it’s likely you’ll be having a conversation with your dermatologist about this medicine.Unlike topical acne treatments like benzoyl peroxide, salicylic acid, and topical etinoids, which work primarily on the surface of the skin, oral isotretinoin addresses acne at deeper levels. “It works at the level of your skin’s DNA, rewiring it to alter gene expression,” explains Dr. Mian. “It targets the primary skin behaviors that lead to acne, namely oil production, skin cell turnover, bacterial count, and inflammation.”Because it’s so effective, isotretinoin is often considered the gold standard for stubborn acne that hasn’t responded to topical medications or oral antibiotics. But its power also comes with significant side effects. “Common ones include dry skin, chapped lips, dry eyes, and muscle or joint soreness with heavy exercise,” says Dr. Mian. Also, because of how isotretinoin works, it thins the top layer of the skin, “so patients cannot have waxing for hair removal, nor can they undergo any resurfacing-type laser or energy-based device treatments,” explains Dr. Weiser.However, some of the medication’s best-known—and most widely-reported—side effects are even riskier. Teratogenicity, “meaning it has been shown to cause birth defects if taken during pregnancy,” says Dr. Weiser, is one that’s received a lot of attention. That’s just the beginning, though, which is why the medication has been swirling in controversy for years. “Additionally, serious mental health concerns such as depression and suicidal thoughts have been reported and, as such, the medication carries a mental health side effect warning,” adds Dr. Weiser. “There are a wide variety of other less serious potential side effects as well, including elevated triglycerides, liver toxicity, dry eyes and vision changes (specifically night vision), nose bleeding, sun sensitivity, and more.”Dr. Mian explains that the temporary increase in blood fats or liver strain is monitored with monthly bloodwork. Additionally, “some side effects are nonspecific and may or may not be causally related to Accutane, like hair loss,” she says. “Hair shedding can be caused by Accutane, but more commonly is caused by other things like stress, anemia, vitamin deficiency, or thyroid abnormalities.” While the more serious side effects are rarer, they remain important considerations when deciding whether isotretinoin is appropriate for you.How does Accutane benefit skin?Acne clearing may be isotretinoin’s primary claim to fame, but its effects on the skin extend well beyond just reducing pimples. Dr. Mian explains that isotretinoin decreases clogged pores and the size and activity of oil glands. To get really into the science of it all, it “converts to two different forms of retinoic acid that work on receptors inside the cell’s nucleus to alter gene expression,” she says. “The downstream effects of this molecular chain of events results in decrease in size and activity of oil glands. It stabilizes skin cell division, balancing epidermal turnover resulting in less pore clogging.”And what does that mean for you, exactly? Isotretinoin can “decrease oil production by 90 percent,” she explains. “It also changes the skin environment, making it less favorable for bacteria, and decreases inflammation by decreasing the migration of immune cells to acne lesions.” Essentially, it helps normalize skin cell turnover, reducing clogged pores while calming inflammation throughout the skin for a clearer, less oily complexion. Its multi-pronged approach is one reason isotretinoin remains such an effective acne treatment. Rather than targeting just one cause of acne, it addresses several at once, making long-term clear skin possible for many patients.As an added perk, isotretinoin also has “the ability to reduce certain skin cancers, specifically keratoacanthoma type squamous cell carcinomas,” says Dr. Weiser.What are the benefits of microdosing Accutane?In this case, there’s no universally accepted definition of “microdosing.” That’s because it’s traditionally prescribed based on body weight “with a daily dose prescribed and a target cumulative dose in mind for long-term remission,” says Dr. Mian. “Microdosing Accutane is considered off-label and involves taking a dose much smaller than the usual weight-based dose, or taking the medication less frequently.”This may be attractive to some patients because it delivers the benefit of clear skin while minimizing side effects. “Microdosing can be done in various ways,” says Dr. Weiser. “The most traditional way is to divide dosing in half or thirds and take the medication for two to three times the duration for the purpose of acne clearing.” For example, if a patient weighing 130 pounds were taking a regular dose of Accutane, they “would take 30 mg twice daily for six months to reach the approximate total dose required for acne clearing,” says Dr. Weiser. If microdosing, “this same patient could take 30 mg once daily for 12 months or 20 mg once daily for 18 months,” she explains.Why extend the timeline? Simply put, fewer side effects. “Reducing the dose in turn reduces the side effects,” says Dr. Weiser. “At doses of 10 to 30 mg daily, patients can experience no major side effects (they would still have skin sensitivity, sun sensitivity and teratogenicity regardless of dosing).”Dr. Mian agrees, adding that lower doses often improve tolerability and adherence while also helping reduce the severity of the initial “purge” or worsening of acne that can occur when starting treatment. “The liver risks, sun sensitivity, and lip and eye dryness are dose-dependent and minor doses are usually very well tolerated with minimal to no side effects,” says Dr. Weiser. For patients who are particularly sensitive or worried about side effects, easing into isotretinoin with a lower dose may make the treatment much easier to stick with. If you’re looking for mild acne and oil control, it’s worth asking your dermatologist about this approach.Is it right for you?Microdosing isotretinoin may be a good option for those who want the benefits of the medication with fewer side effects. Because patients with sensitive skin or those at higher risk of experiencing a significant acne purge may benefit from starting with a lower dose, it may be right for you. “If you have mild acne, it may help keep skin clear,” says Dr. Mian. “Those with very sensitive skin or risk of severe purging are good candidates.” Dr. Weiser echoes that sentiment, noting that “For mild acne and oil control, microdosing is usually completely sufficient.”That being said, low-dose isotretinoin isn’t a shortcut, side effect-free, or safer version of the medication. “The risk of birth defects and mental health issues are significant regardless of dosing,” says Dr. Weiser. Additionally, Dr. Mian emphasizes that “all the potential side effects are still possible even at lower doses.” This means that, even when microdosing Accutane, you must still avoid pregnancy, protect your skin from the sun, and remember to let other doctors and healthcare providers know you’re taking the medication before any procedures.Of course, lower doses aren’t always right for everyone. “If you have severe acne, microdosing may not be enough for you,” says Dr. Mian. Also, “You do have a higher chance of relapse if you take Accutane at lower doses,” she notes.As tempting as it may be to think of microdosing Accutane as the latest skincare hack, dermatologists say it’s better to think of it still as a serious medical treatment. For the right patient, a lower dose can offer impressive results with improved tolerability and significantly fewer side effects, as long as it’s prescribed and monitored by a dermatologist.And sure, the viral trend may be on everyone’s FYP right now, but the strategy itself has been part of dermatologists’ playbook for years.Catharine Malzahn is a contributing beauty writer at Cosmopolitan and was previously the beauty assistant at Good Housekeeping, Woman's Day, and Prevention.Brian Underwood is beauty director at Women’s Health, where he oversees content strategy for the brand across all platforms, including digital, print, and social. Underwood previously served as beauty and wellness director at Oprah Daily and O, The Oprah Magazine. During his tenure leading beauty content for the Oprah brand at Hearst, stories Underwood commissioned were awarded the Skin Cancer Foundation Media Award and a Fragrance Award for Editorial Excellence (his second). He was the launch Beauty Director of Dr. Oz THE GOOD LIFE, and has held additional editorial positions at Fitness, Organic Style, Good Housekeeping, Life & Style Weekly, and Woman’s Day and has written for Self, Shape, Seventeen, Redbook, Cosmopolitan, and many more. Underwood previously served on the Skin Cancer Foundation’s gala committee and as partnerships director of the Trans Beauty Clinic, a New York-based charitable organization that provided beauty services and workshops to the city’s trans community.