Isotretinoin: Is More Better?

Very high cumulative doses significantly reduced relapse, but caution is advisable until safety is more firmly established.

Isotretinoin often stops severe nodulocystic acne, but recurrences are common. Prior research suggests that relapse rate correlates inversely with total dosage. Many physicians recommend a cumulative dose of 120–150 mg/kg. Could even higher doses cause longer-lasting remission without undue harm?

In a prospective, unblinded, observational study, 180 patients with severe, unresponsive, nodulocystic acne (mean age, 19.3 years; 51.9% female) received isotretinoin until 1 month after new lesions stopped developing. After treatment ended, patients were divided into a high cumulative dose group (≥220 mg/kg) and a low cumulative dose group (<220 mg/kg). During treatment, laboratory abnormalities were uncommon and did not differ statistically betwee…

Reviewing Author

Mark V. Dahl, MD

Disclosures

Consultant / Advisory board Ulthera, Inc.; AuBio LifeSciences, LLC; Paris Therapeutics

Equity Elorac, Inc.; Makucell, Inc.; Paris Therapeutics

Editorial boards UpToDate

Leadership positions in professional societiesNational Rosacea Society (Chairman, Medical Board)