When I had a serious case of hormonal acne, starting as a preteen, I tried everything to clear it up. Everything but Accutane. 

Accutane has long been considered one of the most effective treatments for acne—but it also has a nasty reputation for causing extremely dry, uncomfortable skin and other serious side effects (including depression and other mental health issues). This can make the treatment journey challenging—and puts off many potential users altogether, myself included. After serious discussions with my dermatologist at the time, we decided it wasn’t the right path for me. 

Accutane has re-entered the zeitgeist in several ways recently. If you've spent any time on the beauty side of social media over the last few years, you've probably come across at least one video of an influencer talking about how they are "microdosing Accutane" or taking a “Hollywood dose” of Accutane. (Or maybe even about the very suspect “Accutane nose job.”)

The promise of the premise certainly sounds appealing: Take a much lower dose of the acne medication isotretinoin and potentially get clearer skin with fewer side effects.

As someone who once decided against Accutane, I can certainly understand why a version that has fewer side effects would catch people's attention.

Accutane is the brand name many people still use for isotretinoin, a prescription oral retinoids used to treat acne. While the original Accutane brand is no longer available, isotretinoin remains one of the most effective acne treatments dermatologists have.

"Accutane is the brand name for isotretinoin. There are several other manufacturers and brands that it goes by, but many people still refer to it as Accutane," says Jeremy Fenton.

Unlike topical retinoids, isotretinoin works throughout the body. It helps reduce oil production and prevents the buildup of dead skin cells that can contribute to clogged pores.

"Isotretinoin reduces the production of sebum (oils in the skin) and it normalizes follicular keratinization. This means that you produce less oil and the change in keratinization reduces the amount of skin cells that can lead to 'clogged pores.' Isotretinoin can have a dramatic reduction in acne, even in the most severe cases, and most patients are able to get completely clear skin," says Fenton.

Traditionally, isotretinoin is prescribed at a dose designed to help patients reach a target cumulative amount over roughly six to eight months. ”The target dose is based on their weight, most people taking somewhere between 120 and 200 mg/kg over that time period," explains Fenton.

The reason dermatologists focus on cumulative dosing is because research suggests reaching that target amount can help keep acne away for years after treatment ends, which depending on the patient, may mean it can get the individual through their acne phase giving them clear skin for life. 

The term "microdosing" generally refers to taking much smaller amounts of isotretinoin over a longer period of time.

"The typical dose is in the range of 0.5 to 1 mg/kg daily, thus an average person may be taking 40 to 80 mg of isotretinoin per day. The range for microdosing can be very broad, with some taking as little as 10mg once per week and some taking 10mg daily,” he says. 

Why might someone go down this route?

"Lower doses will have far fewer side effects and also avoid the initial flare that some people experience when starting it," says Fenton. Common side effects of isotretinoin include dry skin, dry lips, dry eyes, and increased sensitivity to the sun. While these side effects can still occur with lower doses, they're often less severe.

And even with this lower dose approach, it works. However, the trade-off is that it will take longer to see results.

Like many “new” social media trends, this is just a repackaged practice that has existed for decades. 

"It has always been available," says Fenton. "Prescribers have always had the option to prescribe lower doses, but it has not been standard practice in the United States due to the official guidelines recommending the 0.5-1mg/kg daily dosing.”

In fact, in other countries where guidelines around Accutane are more open, this has been a more common practice. It hasn’t been until recently that the available research and dermatology guidelines have started pointing to low-dose isotretinoin as a legitimate alternative for select acne patients. 

Combine that with TikTalk influencers and—bam!—a trend is born. 

Whether you're taking a traditional dose or a low dose, isotretinoin is still a serious medication that requires medical supervision.

"The most important thing everybody should be aware of is the risk of birth defects when a pregnant woman takes isotretinoin. This is true of both low dose and regular dosing. Microdosing DOES NOT remove or reduce this risk," says Fenton.

Because of this risk, isotretinoin is tightly regulated through the iPledge program, which includes monthly monitoring requirements.

"Those who are taking low dose for an extended period must commit to vigilant birth control the whole time," he says.

Patients should also understand that lower doses don't eliminate other potential risks associated with isotretinoin.

"There are also risks of affecting the liver and triglycerides and thus require some labs that need to be monitored regardless of dosing amount," says Fenton.

According to Fenton, low-dose isotretinoin may be most appropriate for people with mild to moderate acne who are particularly concerned about side effects.

"It is particularly useful in patients who are concerned about the side effects," he says.

That said, it isn't necessarily the right fit for everyone.

Patients choosing a low-dose regimen need to be prepared for a longer treatment timeline, more follow-up appointments, and the possibility that insurance coverage may become more complicated over time.

"I have also run into issues with insurance stopping coverage after a period of time when it is a significantly extended timeline," says Fenton.

Meanwhile, some patients still prefer the opposite approach.

Another factor driving interest in low-dose Accutane is the rise of telehealth companies—such as Honeydew or Clear Health—offering online access to isotretinoin treatment. 

While telehealth can increase accessibility, Fenton says patients should still approach these services carefully.

"People should be sure that these are legitimate companies with good reputations," he says.

Most importantly, providers should still be following all of the standard safety protocols associated with isotretinoin.

Despite what social media may suggest, microdosing Accutane isn't new even if it is “trendy.” Dermatologists have used lower-dose isotretinoin protocols for years, particularly for patients with milder acne or concerns about side effects. But all-in-all, I’m always appreciative of broader awareness for all the available options to effectively treat acne. 

And for the right person, a lower-dose approach may offer a more tolerable treatment experience—even if it typically requires a longer commitment, ongoing monitoring, and many of the same safety precautions as traditional isotretinoin therapy.