• For decades, Accutane has been a drug of last resort for persistent acne.
• A founder who designed a new platform to streamline regulatory red tape is changing access.
• People are microdosing Accutane and reporting fewer side effects. Dermatologists have mixed views.

In the dermatology world, Accutane has a reputation as the nuclear option for bad acne.

It's the only drug that can shrink oil glands, potentially clearing pimples for good. But it comes with serious risks — primarily: a high rate of birth defects if you take it and become pregnant. Other side effects include sun sensitivity, high cholesterol, mood changes, and joint pain.

Parents are scared to put their teens on it. Dermatologists often reserve it for stubborn acne, after other creams, cleansers, antibiotics, and pills have been exhausted. And strict pregnancy-prevention rules mean monthly check-ins, tests, and blood work.

But in recent years, some of the stigma around the retinoid drug, generically called isotretinoin, has started to fade, as people have gravitated to a smaller, more strategic "Hollywood dose" of Accutane. By taking small amounts of the drug, maybe just a few days per week, many patients find they can maintain a dewy, glass-like complexion on camera while avoiding painful side effects like ultra dry skin, and the initial acne breakout purge that comes with heftier prescriptions.

"I love the Accutane glow-up," Honeydew dermatology founder David Futoran, 29, said. For him, it includes hair that's less oily, and baby-soft cheeks.

Futoran is partly responsible for turning Accutane from a maligned prescription of last resort into a buzzy internet sensation. He's found new ways to streamline and digitize paperwork, turning most of the required monthly doctor's office visits and testing for the drug into something people can do at home. Honeydew is now growing 3x year over year, Futoran said, and interest in low-dose prescriptions is increasing.

Dermatologists are divided on the trend of microdosed Accutane. Yes, it is a very effective drug, and it can clear up most breakouts. But there are tradeoffs to taking an intermittent or low-dose approach, and some doctors say why bother dancing around side effects when you could get on and off the potent drug in months, and have clear skin for life?

Founder mode for skin

Futoran founded Honeydew in 2022 after spending years on various antibiotics and multi-step cleansing and cream routines, with his acne constantly coming back.

His vision was to make prescription acne care faster and more accessible. He partnered with his longtime dermatologist, Dr. Joel Spitz, to build a telemedicine platform connecting patients with providers and treatments for acne, rosacea, eczema, and psoriasis.

Yet Futoran was still hesitant to take Accutane himself, partly because of the logistical headaches.

One morning, he said, he woke up with a large, painful cyst in the middle of his forehead. That was it, he said — he decided he was finally going on the low-dose form of Accutane his company had been prescribing.

"I should have done that from the start," he said. "My skin is way less irritated than it ever was on any of the topicals, and I just have peace because I know it works."

Accutane works because it shrinks oil glands by turning down sebum production. It triggers the death of some stem cells, which is great for clearing up overactive oil-producing glands, but very bad for developing fetuses.

In addition to making regulatory compliance digital, Honeydew offers specially formulated lip balms, cleansers, antihistamines and supplements like Omega-3 designed to replace lost oil.

Bringing a celebrity skin trick to the masses

Celebrities including Chris Pine, Pete Davidson, Emma Stone, and Kendall Jenner have all been open about using this powerful oral retinoid to help clear up persistent acne. The shadow business of microdosing Accutane, though, using it as a glow up drug even for minor, isolated breakouts, happens more through a whisper system between doctors and patients.

26-year-old marketing manager and social media influencer Kennedy Faris started microdosing Accutane with Honeydew in the spring. About a decade ago, she watched her little brother suffer some of the rarer mental health side effects of Accutane, and she was worried about the possibility the drug could lead to depression.

"My brother's a very happy person, so it was really scary," Faris told Business Insider. "I was really hesitant about starting."

After struggling to get a prescription from an in-person dermatologist, Faris heard about Honeydew from a follower and partnered with the brand. She started on a low dose of 10 milligrams, working her way up to a standard 40 mg dose over the course of a few months.

After years of trying different skincare products, antibiotics, and medications, she feels like she's finally found a more permanent solution to cystic acne. There are drawbacks to being on the drug, she said, including sensitivity to alcohol, sunlight, and some nightmares. But the real benefit has been her renewed confidence, optimism, and joy, with friends noticing she's "more bubbly and happy," she said. "I was like, 'wow, I was kind of depressed.'"

Because the drug shrinks pores, Faris has also noticed her face and nose appear slimmer.

"Everyone talks about the fake nose job," she said.

Some patients recovering from real nose jobs even use the drug to lower surgery-related inflammation and shrink pores on the nose while their face heals. As testosterone therapy booms, more men are taking Accutane to deal with oilier skin. And increasingly, patients are lining up for low-dose Accutane for minor breakouts, just to be in the clear. People are gravitating to skin treatments that will give them the edge at work and on screen, Spitz said.

"Everyone's on Zoom or Google Meets or they're on TikTok or they're on Insta, and they want to look good," he added.

The potential drawbacks of microdosing

Some doctors worry that microdosing Accutane could lead to more health complications if people stay on the medication for years at a time.

"In my practice, I just basically put people on the standard dose and then they're done at five months, and then they feel much better, Dr. Ariel Ostad, a dermatologist in Manhattan who is not affiliated with Honeydew, said. "Patients, once they go on it, their skin clears up really quickly, and they're happy, and they realize it's not as bad as they thought."

A shorter treatment course means less time worrying about drug interactions, liver or heart health, pregnancy, sun sensitivity, or bone issues.

Futoran said traditional dosing can be "absolutely the right answer for some patients," and roughly 40% of Honeydew prescriptions are at standard dosages. Still, he cites studies showing patient satisfaction is higher with low-dose Accutane, and said Honeydew patients on smaller dosages have "materially better retention."

"The best clinical outcome is when patients complete their course, but faster is not always better," he said.

Lula promises to expand full-day schooling and student aid as Flávio Bolsonaro challenges his education record and attacks his family.

Brazilian President Luiz Inácio Lula da Silva pledged to bring full-day schooling to every school through the secondary level if re-elected, while opposition candidate Flávio Bolsonaro accused his government of cutting education funding and attacked the president’s family over online gambling.

RELATED: Datafolha Poll Shows Lula and Bolsonaro Tied at 50% Ahead of Runoff

The exchange during an education segment of the presidential debate centered on extended school hours, student assistance and childcare before turning into a personal confrontation over jogo do tigrinho, an online gambling game.

Lula, of the Workers’ Party (PT), challenged Bolsonaro to explain his plans for full-day schooling. Bolsonaro, of the Liberal Party (PL), responded that he would deliver what the current government had failed to achieve, accusing Lula’s administration of cutting federal funding for the program and attempting to conceal the reductions.

Text Reads: Full-Day Schooling Pits Lula Against Bolsonaro in Debate
Lula committed to “concluding in the next term 100% of full-day schools in this country up to secondary education.”
He defended his administration and highlighted the creation of ProUni. He also denounced the conditions in which he received the presidency regarding education.

Bolsonaro then shifted the discussion to online gambling, accusing Lula of being responsible for the rise of jogo do tigrinho. He claimed the game was created and authorized in 2022 by those now in government and alleged that its cancellation was being pursued only as the election approached. He also invoked the nicknames Lulinha and Tigrinho in referring to the president’s sons.

Lula responded by pointing to his party’s record on education since it first took office in 2003. He credited former education ministers Fernando Haddad and Camilo Santana with leading what he described as a transformation of Brazil’s education system. If re-elected, he said, he would ensure that all schools offered full-day schooling through the secondary level.

He also pledged to expand Pé de Meia, a financial assistance program designed to keep students in school, making it available to all secondary students and extending it to university students. Lula said the program had helped prevent 66% of participating students from dropping out, arguing that no young person should have to abandon their education.

Text Reads: “There is no country in the world that managed to develop without first investing in Education. We have more universities, IFs, and full-time schools. We took care of education like it had never been taken care of in the history of this country” – Lula in the Globo debate

The president further recalled that his administration had inherited 5,600 stalled projects involving daycare centers, schools and federal institutes from the previous government. He contrasted those unfinished projects with the civic-military school model promoted by his predecessors, which he also described as incomplete.

Bolsonaro rejected claims that he intended to abolish Pé de Meia, calling the allegation a falsehood spread by his opponent’s campaign. He pledged to maintain the program and cited measures taken under the administration of his father, former President Jair Bolsonaro, including the cancellation of nearly 99% of the debt owed by students who had completed higher education and a 33% teacher salary increase, which he described as the largest in history.

The opposition candidate also proposed a childcare subsidy for mothers unable to work because they lacked access to daycare. He said more than one million children had no place in the public childcare system and pledged to allow families to enroll them in private facilities where public places were unavailable.

On full-day schooling, Bolsonaro proposed using the additional hours for vocational training and instruction in technology, artificial intelligence and application development. He argued that keeping children closer to school would put them farther from crime.

The candidates presented contrasting approaches to education, with Lula emphasizing universal full-day schooling and expanded financial support for students, while Bolsonaro focused on childcare subsidies and vocational training alongside accusations over education funding and the president’s family.