Isotretinoin: Dose, Duration and Relapse

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.