Isotretinoin (Roaccutane) Microdosing — A Dermatologist’s Guide

By Dr Christopher Ross, Dermo Direct — Australia’s Premier Online Dermatology Service

What Is Isotretinoin?

Isotretinoin (brand names Roaccutane®, Oratane®, etc.) is one of dermatology’s most effective acne treatments.

Derived from vitamin A, it targets every major cause of acne: excess oil, blocked pores, inflammation, and acne-causing bacteria.

It works by shrinking and resetting the oil glands, helping prevent future breakouts and often leading to long-term remission — even after treatment stops.

At Dermodirect – I get asked a lot by patients – “Can I do microdosing?”

There is a lot of information and also misinformation given to patients by friends, family members and also online. This leads to patients thinking that microdosing is the best way for them to take isotretinoin.

Isotretinoin has been around for about 50-60 years, and historically high doses were used – sometimes patient were started at 1mg/kg of body weight. This meant that a lot of patient suffered quite severe side effects, and either had to put up with them, or stop the medication.

Lower doses tend to give fewer side effects, although every patient handles the medication differently, and it isn’t always about their weight.

I usually start patients on lower doses, particularly if they haven’t had the medication previously, but then try to increase the dose over time if it is being tolerated well – this way we tend to achieve faster results, and also reduce the length of time the patient is on the medication.

If patients don’t tolerate increasing the dose gradually – they can be reduced again to a tolerable level.

What Is “Microdosing”?

Microdosing isotretinoin means using very low daily or alternate-day doses (typically 5–10 mg/day) instead of standard doses of 20–60 mg/day.

This approach is popular for:

• Persistent adult acne (especially in women)
• Sensitive or dry skin prone to irritation
• Mild to moderate acne not responding to creams or antibiotics
• Long-term “maintenance” treatment to prevent relapse

It aims to give the benefits of isotretinoin with fewer side effects and better comfort.

Advantages of Microdosing Isotretinoin

1. Fewer side effects – Dry lips, skin irritation, and nosebleeds are usually milder.
2. Better tolerance for adults – Works well as a gentle, ongoing maintenance option.
3. Minimal blood-test changes – Less effect on liver function and cholesterol in some cases.
4. Improved oil control – Even low doses noticeably reduce shine and pore size.
5. Flexible dosing – Can be adjusted to suit lifestyle and skin sensitivity.

Disadvantages and Limitations

1. Slower results – Improvements develop over months, not weeks.
2. Higher chance of relapse – Total cumulative dose is smaller than full-course therapy, unless prolonged courses are given.
3. Still needs monitoring – Liver and cholesterol checks are still recommended.
4. Pregnancy risk remains – Isotretinoin is strictly contraindicated in pregnancy, even at low doses.

The Dermatologist’s Perspective

At Dermo Direct, trusted by over 10,000 patients in Australia, we tailor acne treatment to each individual.

For those that tolerate higher doses, the faster results and shorter course duration is an advantage.

For others, a low-dose or microdose plan achieves clear, healthy skin with fewer side effects, but will typically need longer courses to achieve the same chance of remission of the higher dose plan.

The key is personalised care — guided by an experienced dermatologist who can monitor safely and adjust as needed.

Disclaimer: The information in this article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you may have about your skin or general health. Individual results may vary.