Making sense of the effects of the cumulative dose of isotretinoin in acne vulgaris
- 15 October 2015
- journal article
- Published by Wiley in International Journal of Dermatology
- Vol. 55 (5), 518-523
- https://doi.org/10.1111/ijd.12942
Abstract
The importance of the cumulative dose of isotretinoin with respect to relapse of acne vulgaris remains controversial. Although guidelines recommend 0.5–1.0 mg/kg/d to a minimum cumulative dose of 120 mg/kg, there has been a trend toward the use of lower daily dosages with no reference to cumulative dose. This study aimed to determine the influence of daily and cumulative dosage on relapse in acne. Charts of patients with acne treated with isotretinoin were reviewed. Demographic details and daily cumulative doses and duration were compared between patients who received one course and two or more courses, respectively. Of 1453 patients, 326 (22.4%) received a second course of treatment (study population). The remainder served as controls (n = 1127). Dosage varied from 10 mg/week to 1.1 mg/kg/d, cumulative dosage from 1 to >300 mg/kg, and duration of treatment from 8 weeks to 5 years. Compared with controls, patients who received a second course were more likely to be women (61 vs. 47%; P < 0.001) and received higher daily (0.71 vs. 0.58 mg/kg/d; P < 0.001) and cumulative (126 vs. 101 mg/kg; P < 0.001) doses. Patients treated with very low doses (e.g. 10 mg three times per week) and/or low cumulative doses (e.g. 25–50 mg/kg) did not relapse more often than controls. Neither daily nor cumulative dosages influenced relapse of acne vulgaris in patients treated with varying doses of isotretinoin as long as treatment was continued for ≥2 months after the acne had completely resolved.Keywords
This publication has 21 references indexed in Scilit:
- Adverse effects of isotretinoin: A retrospective review of 1743 patients started on isotretinoinAustralasian Journal of Dermatology, 2010
- Can We Define Acne as a Chronic Disease?American Journal of Clinical Dermatology, 2008
- Low-dose isotretinoin in the treatment of acne vulgarisJournal of the American Academy of Dermatology, 2006
- Heredity: A Prognostic Factor for AcneDermatology, 2006
- Guidelines for optimal use of isotretinoin in acneJournal of the American Academy of Dermatology, 1992
- Remission rates in acne patients treated with various doses of 13-cis-retinoic acid (isotretinoin)British Journal of Dermatology, 1984
- Changes in long-term sebum production from isotretinoin therapyJournal of the American Academy of Dermatology, 1982
- Isotretinoin versus placebo in the treatment of cystic acne: A randomized double-blind studyJournal of the American Academy of Dermatology, 1982
- The treatment of severe cystic acne with 13-cis-retinoic acid: Evaluation of sebum production and the clinical response in a multiple-dose trialJournal of the American Academy of Dermatology, 1980
- 13-CIS RETINOIC ACID AND ACNEThe Lancet, 1980