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Significantly larger doses of isotretinoin effectively treated acne

Significantly greater doses of isotretinoin after 1 year of completion of therapy effectively treated patients with acne vulgaris and decreased relapse rates without significantly increasing adverse events, according to recent study results.

Researchers conducted a prospective, observational intervention study from August 2008 to August 2009 of 180 patients with severe nodular-cystic acne vulgaris resistant to treatments other than isotretinoin. One hundred sixteen patients (mean age, 19.3 years, 51.9% female; 74.1% white) participated in the 12-month follow-up survey (64% response rate). Patients received isotretinoin at cumulative doses of either at least 220 mg/kg or less than 220 mg/kg.

Required treatment with a prescription topical or oral acne medication after a course of isotretinoin (relapse) or retreatment with isotretinoin (retrial) at follow-up of 12 months was the main outcome, along with adverse events during the trial and after 12 months of treatment.

Acne improvement was reported by 97.4% of patients at follow-up. Relapse occurred in 32.7% of patients at 12 months and 1.72% of patients required a retrial. The group receiving less than 220 mg/kg had a higher relapse rate (47.4%; 95% CI, 32.3%-63%) compared with the other group (26.9%; 95% CI, 18.3%-37.8%).

Cheilitis and xerosis were developed by almost all patients in both groups. The high-dose treatment group more commonly experienced retinoid dermatitis (53.8%) compared with the low-dose cohort (31.6%; P=.02). Other adverse events did not significantly differ between cohorts.

“The dosing study regimen used in this study is considerably higher than that used in previous studies of isotretinoin,” the researchers concluded. “At 1 year after completion of isotretinoin treatment, we found that patients receiving 220 mg/kg or more had a significantly decreased risk of relapse. This study suggests that higher cumulative doses of isotretinoin are effective for treating acne and decreasing relapse rates without increasing adverse events to a significant level.”

Disclosure: The researchers report no relevant financial disclosures.