It is a mixed bag. I think it is still worth considering. Maybe I can get a prescription and try it for few months and decide on the effect. I am not sure about doing it long term. Maybe like a 12 week course once a year? Isotretinoin is known to induce autophagy so maybe it might be beneficial in this regard as well. Seems that indirectly via upregulation of the expression of of the transcription factor p53 down regulates mTORC1. It is not looking that bad after all. I always thought that isotretinoin is a dangerous drug, but micro dosing, cycling and intermittent dosing might be possible and positive for skin aging.
(10-20 mg three times a week for 2 months, group A)
All patients treated with oral isotretinoin noted improvement in wrinkles, thickness and color of the skin, size of pores, skin elasticity, tone, and reduction in pigmented lesions and mottled hyperpigmentation. A statistically significant difference was found in the improvement of group A. Using minimal amounts of this drug, the side effects were practically negligible.
There was an improvement in the overall appearance of the skin, regarding texture, wrinkles depth and skintone. Skin thickness, suppleness, and pore size improved. Both the number of collagen fibers and the density of elastic fibers increased in the statistically significant manner. Elastosis decreased, the thickness of the epidermis increased, and the stratum corneum diminished. Reduction of pigmented lesions and uneven hyperpigmentation was detected. With low-dose isotretinoin, side effects were absent or negligible, limited to minimal lip dryness.
https://apcz.umk.pl/JEHS/article/view/41331
Clinically, patients, as well as the researching and the assessor physicians, noticed improvement in skin quality. One patient presented severe solar elastosis, 11 manifested the moderate form, while 8 presented the discreet type. According to histological analysis, 65% of the patients revealed alteration in the distribution and thickness of the elastic fibers, which can be interpreted as a histological improvement, while 60% showed an increase in collagen density. We observed an increase in collagen density, from 51.2% to 57.4%, (p=0.004). At the end of the 12-week follow-up period, this density decreased to 54.7% (p=0.050). There was an increase in the density of elastic fibers, from 26.5% to 31.3%, (p=0.02), which had dropped to 27.5% at the end of the 12-week follow-up period.
Clinical evaluation showed slight improvement; profilometry, corneometer and skin elasticity tests presented significant difference in pre/post values (P = 0.001 to 0.028), but no differences between A/B. Histological findings and p53 expression were comparable between groups before treatment (P > 0.1); microscopic analysis showed no differences between groups for most variables, after treatment. Slight but significant difference between A/B for p53 with major reduction post isotretinoin [0.66+/-0.31 vs. 0.94+/-0.34 respectively (P = 0.04) was observed. There were minor side effects and no significant laboratory test alterations. We concluded that no significant clinical, microscopic changes but p53 epidermal expression reduction were observed. The role of ultra-violet induced p53 mutation in skin carcinogenesis reinforces retinoids chemoprevention. Oral isotretinoin seemed safe but not effective to treat photoaging. Caution should be considered for women prone to pregnancy. Further controlled studies are necessary.
This is a good view on pros and cons of a dermatologist. It might not be better than topical tretinoin with less worrying about systemic effects. The benefits might be greater in people with really oily skin as systemic isotretinoin stops oil production.
