Isotretinoin: Dose, Duration and Relapse. 30 Years On
Marius Rademaker. Australasian Journal of Dermatology (2012)
Keywords: acne vulgaris, adverse effects, dose, isotretinoin, relapse, retinoid
Abstract: With 30 years of clinical use, it is appropriate
to review the use of isotretinoin. The
indications of isotretinoin have expanded from just acne and rosacea to a wide
range of inflammatory and malignant skin disorders. While
the standard dose of 0.5 to 1 mg/kg per day for 4 months to a cumulative dose
of 120–140 mg/kg per day has served us well in the management of acne vulgaris,
there is emerging evidence that much lower dosages (as low as 5 mg/day) are
just as effective but have significantly
fewer adverse effects. Relapse of acne vulgaris continues to
be a problem but we are beginning to recognise that this is related less to the
cumulative
dose and more to the length of sebaceous gland suppression. Other
factors important for relapse includea macrocomedonal pattern of acne, smoking
and age, both younger (under 14 years) and older (over 25 years).
After 30 years
of use, we now understand why isotretinoin is such an effective drug. Not only
does it clear acne in almost all patients, long-term remission can be achieved
in 70–80% of patients with a single course. Important changes in the use of
isotretinoin include using a lower daily dose for a longer period of time. New
indications continue to emerge, particularly
as a potential treatment for both intrinsic and extrinsic
(photo) aging. Teratogenicity however, remains a very significant concern.
Key words: acne vulgaris, adverse effects, dose,
isotretinoin, relapse, retinoid.
