Micro-dose Protocol – A Game Changer in Acne Treatment

Ever since we launched Clear Health with a focus on Accutane, we knew that there would be a subset of acne-sufferers that we wouldn’t be able to serve given some of the realities of the treatment.

Even though we made the iPLEDGE program more seamless thru a fully-managed digital treatment process and having prescriptions shipped directly, there were still very valid reasons why someone who might be considering Accutane given its dramatic skin-clearing results might be hesitant about going through with treatment:

The treatment is not exactly the most affordable acne treatment option out there
Although serious side effects are rare, common side effects do occur – things like dry skin, dry lips, and minor aches (which is why strenuous, heavy lifting and working out are not recommended on a standard course)
There can be an IB (the infamous “initial breakout”) period where some patients experience an initial skin purge where acne may temporarily get worse
Patients with mild/moderate acne symptoms might not be good candidates for a traditional Accutane course

BUT what if these issues could be addressed? What if there was an Accutane protocol that could provide dramatic, skin-clearing results that could reduce the risk of side effects, be appropriate for milder forms of acne, reduce the risk of an IB, while also being affordable?

Turns out there can be.

Introducing Clear Health’s Micro-dose Protocol, a low-dose form of Isotretinoin treatment that we’ve designed to tackle some of the hurdles mentioned above.

 

What is Micro-dosing Protocol?

Clear Health’s Micro-dose protocol is a low-dose form of Accutane treatment that’s taken for a longer period of time than a traditional 6 month course. The target dosage is lower, around 0.1-0.3mg/kg daily vs the standard dosing protocol which targets around 0.5-1.0mg/kg daily. With a similar target cumulative dose around 120mg/kg of bodyweight, this works out to be around 18-24 months of treatment for most people.  

 

Who is it for? What are the benefits?

Micro-dose Protocol is suitable for people with mild to moderate forms of acne that have not responded to other treatments, or for people with more severe forms of acne who might not tolerate the side effects of a standard protocol course well.

Micro-dose Protocol is also suitable for patients who don’t have adequate insurance coverage of a standard –course treatment (Note: because micro-dosing Protocol is considered an off-label form of prescribing, insurances do not cover micro-dose Protocol).

So why Micro-dose? Or in some circles as it’s called, “Hollywood-dose”? There’s 3 major potential benefits from this dosing protocol:

It can potentially minimize the side effects associated with a standard Protocol course. This includes potentially avoiding the dreaded “initial breakout” associated with Accutane. [1]
It’s suitable for mild to moderate acne. For some people, micro-dosing Protocol is also suitable for excessively oily skin.
More affordable monthly cost. Although not covered by insurance, the lower doses means the cost of the treatment is spread out over more months, resulting in a more affordable monthly price.

You might be thinking – why doesn’t everyone just micro-dose then? It can start to sound like the holy grail of acne treatment. In fact, outside of the United States in Europe, Asia, and South America, micro-dosing Protocol is actually the standard versus the high-dose treatment that’s done here in the U.S.

Unfortunately, nothing is ever perfect so there are a few potential cons for micro-dose Protocol:

For female patients who can get pregnant, the longer duration means a longer commitment to iPLEDGE program adherence. On micro-dose, patients will still be required to do monthly pregnancy tests, requisite bloodwork, monthly check-ins, etc.
For patients with moderately severe to severe acne, the standard course may be more suitable as it takes a shorter amount of time to achieve the target cumulative dosage of Accutane, and it can take longer to see visible results. If micro-dose is not taken for the full treatment length, there is a higher chance of acne relapse where a second course might be needed. [2]  

Note: Studies tend to be conflicted on whether or not the daily dosages provide significant differences in clearances and acne remission (acne coming back after a course), but most studies do show that the cumulative dose, or the total dosage taken over the course of the entire treatment tends to matter when determining acne relapse rates. This is why it’s important to STAY the entire course for micro-dose Protocol to reduce the chance of acne relapse.

Micro-dosing Protocol is considered an off-label form of prescribing, which is typically not covered by insurance plans. For patients with good prescription coverage, this means they would still have to opt for cash-pay options (although thru Clear Health, we’ve made this cash-pay option exceptionally affordable☺)    

 

What’s different about Clear Health’s Micro-dose protocol?

All this being said, your dermatologist would be the best resource to determine if micro-dose Protocol may be a suitable option for you. Thru Clear Health, we’ve layered on our digital treatment portal to streamline the entire process of Accutane treatment from end-to-end, from iPLEDGE requirements, to monthly admin tasks, to follow-up check-ins and bloodwork.

By streamlining the process thru our technology for dermatology providers and thru our relationships with specialty pharmacies and manufacturers, we’re able to offer our Micro-dose protocol at an INCREDIBLE $109/month, which includes the provider evaluation, digital treatment management and support, and the medication delivered directly to you!

As for acne marks and post-inflammatory hyperpigmentation (PIH) after the course is over? We’ve got you too, where patients on our Micro-dose protocol will be able to get our prescription-grade Azelaic Acid topical specifically designed to even out skin tone.

I’m super stoked to be able to unveil this new offering, because it’s something I knew I wish I had access to when I first started breaking out horribly in college. Instead of having to get a PCP referral that took weeks to get into a dermatologist office, then dance thru the pen/paper iPLEDGE hoops, then drive all the way to the pharmacy to pickup my meds, and finally go to Ulta and Quest to get my skincare and labs, Clear Health brings it all home in an affordable, digital one-stop shop.

Having acne is already stressful enough – the treatment process shouldn’t add to it. If you’re ready to start your journey to clarity with us, our team is standing by and ready to help.

 

Michael
CEO and Founder

 

Sources

[1] Daly AU, Baptista Gonçalves R, Lau E, Bowers J, Hussaini N, Charalambides M, et al. A systematic review of isotretinoin dosing in acne vulgaris. JEADV Clin Pract. 2023; 2: 432–449. https://onlinelibrary.wiley.com/doi/full/10.1002/jvc2.154

[2] S. J. Akhtar and I. Hussain, “Isotretinoin in acne: how much and for how long?”, J Pak Assoc Dermatol, vol. 25, no. 1, pp. 1–3, Nov. 2016. https://applications.emro.who.int/imemrf/J_Pak_Assoc_Dermatol/J_Pak_Assoc_Dermatol_2015_25_1_1_3.pdf