LDL increase while on Accutane 2nd round?

It's great to hear that your first round of Accutane was effective, although I'm sorry to learn about the relapse. Accutane (isotretinoin) can indeed cause changes in lipid levels, including an increase in LDL cholesterol.

In your situation, with an LDL level of 135 mg/dL, which is slightly above the optimal range, it's understandable that there might be differing opinions on how to proceed with your treatment. Here are some considerations to help you decide:

Individual Variability: Different practitioners might have varying thresholds for concern based on their clinical experience and your overall health profile. While a slight increase in LDL might not have concerned Derma A, Derma B might be more cautious, especially if there are other risk factors present.

Balancing Risks and Benefits: The decision to taper the dosage is likely a precaution to minimize any potential cardiovascular risk associated with elevated LDL levels. If your acne is under control, a lower dose might maintain benefits while reducing side effects.

Comprehensive Health Assessment: Consider other factors such as your personal and family history of heart disease, current lifestyle, and any other medications you might be taking. These can influence the decision on whether to adjust your dosage.

Monitoring and Lifestyle: Regular monitoring of your cholesterol levels and incorporating heart-healthy lifestyle changes, such as a balanced diet and regular exercise, can help manage LDL levels during treatment.

Ultimately, the best course of action is a collaborative decision between you and your dermatologist, considering both the effectiveness of the treatment and your overall health. If you have concerns, it might be beneficial to discuss them further with Derma B or seek a second opinion to ensure you are comfortable with your treatment plan.

Best regards,