Efficacy of fixed daily 20 mg of isotretinoin in moderate to severe scar prone acne

Rasi, Abbas; Behrangi, Elham; Rohaninasab, Masoumeh; Nahad, Zahra Mehr

Efficacy of fixed daily 20 mg of isotretinoin in moderate to severe scar prone acne

Authors

¹ Skin and Stem Cell Research Center, Department of Dermatology, Tehran University of Medical Sciences; Department of Dermatology, Rasoul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

² Department of Dermatology, Rasoul-e Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran

³ Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan; Department of Dermatology, Rasoul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background: Despite advances in acne therapy in recent years, treatment failure is common. Isotretinoin is the only drug that affects almost all factors in acne pathogenesis, but side-effects are common at the doses reported in published studies in the literature. The aim of this study was to investigate the efficacy of low daily dose isotretinoin in moderate to severe acne patients. The secondary objective was to measure the rate of relapse 5 years after the completion of therapy.
Materials and Methods: In this retrospective, noncomparative study, 146 patients with moderate to severe scare prone acne. Treatment regimen consisted of isotretinoin, fixed 20 mg daily, and duration of treatment-based on the weight of patient, until total cumulative dose of 120 mg/kg of body weight is achieved. No topical or other systemic therapy was allowed during the trial. Liver function tests (serum glutamic-oxalocetic transaminase, serum glutamate pyruvate transaminase, direct and total bilirubin), and lipid profiles (total cholesterol, low-density lipoprotein, high-density lipoprotein, triglyceride) were evaluated for all patients, before the initiation of treatment and again after the 2 ^nd month of treatment. All data analyzed by Microsoft Office Excel 2007; in descriptive statics frequency and SPSS.18 software.
Results: At the end of treatment course, (96.4%) demonstrated complete clearing of their acne, defined as no acne or occasional isolated lesions. In 5-year follow-up, relapse accrued in 11 (7.9%) of patients. All adverse effects were mild, and discontinuation of treatment was not necessary.
Conclusion: Low dose isotretinoin was found to be a safe and effective choice for patients with moderate to severe scar prone acne vulgaris.

Keywords

References

1.	Cunliffe WJ, Gould DJ. Prevalence of facial acne vulgaris in late adolescence and in adults. Br Med J 1979;1:1109-10.
2.	Dhir R, Gehi NP, Agarwal R, More YE. Oral isotretinoin is as effective as a combination of oral isotretinoin and topical anti-acne agents in nodulocystic acne. Indian J Dermatol Venereol Leprol 2008;74:187.
3.	Cunliffe WJ, van de Kerkhof PC, Caputo R, Cavicchini S, Cooper A, Fyrand OL, et al. Roaccutane treatment guidelines: Results of an international survey. Dermatology 1997;194:351-7.
4.	Peck GL, Olsen TG, Butkus D, Pandya M, Arnaud-Battandier J, Gross EG, et al. Isotretinoin versus placebo in the treatment of cystic acne. A randomized double-blind study. J Am Acad Dermatol 1982;6:735-45.
5.	Layton AM, Dreno B, Gollnick HP, Zouboulis CC. A review of the European Directive for prescribing systemic isotretinoin for acne vulgaris. J Eur Acad Dermatol Venereol 2006;20:773-6.
6.	Strauss JS, Rapini RP, Shalita AR, Konecky E, Pochi PE, Comite H, et al. Isotretinoin therapy for acne: Results of a multicenter dose-response study. J Am Acad Dermatol 1984;10:490-6.
7.	Brelsford M, Beute TC. Preventing and managing the side effects of isotretinoin. Semin Cutan Med Surg 2008;27:197-206.
8.	Sundström A, Alfredsson L, Sjölin-Forsberg G, Gerdén B, Bergman U, Jokinen J. Association of suicide attempts with acne and treatment with isotretinoin: Retrospective Swedish cohort study. BMJ 2010;341:c5812.
9.	Marqueling AL, Zane LT. Depression and suicidal behavior in acne patients treated with isotretinoin: A systematic review. Semin Cutan Med Surg 2007;26:210-20.
10.	Amichai B, Shemer A, Grunwald MH. Low-dose isotretinoin in the treatment of acne vulgaris. J Am Acad Dermatol 2006;54:644-6.
11.	Mandekou-Lefaki I, Delli F, Teknetzis A, Euthimiadou R, Karakatsanis G. Low-dose schema of isotretinoin in acne vulgaris. Int J Clin Pharmacol Res 2003;23:41-6.
12.	Hermes B, Praetel C, Henz BM. Medium dose isotretinoin for the treatment of acne. J Eur Acad Dermatol Venereol 1998;11:117-21.
13.	Straus JS, Thaibautat DM. Disease of the sebaceous glands. In: Freedberg I, Eisen AZ, Wolf K. Dermatology in General Medicine. 5 ^th ed. New York: McGraw-Hill; 1999. p. 769-84.
14.	Stainforth JM, Layton AM, Taylor JP, Cunliffe WJ. Isotretinoin for the treatment of acne vulgaris: Which factors may predict the need for more than one course? Br J Dermatol 1993;129:297-301.
15.	Layton AM, Knaggs H, Taylor J, Cunliffe WJ. Isotretinoin for acne vulgaris - 10 years later: A safe and successful treatment. Br J Dermatol 1993;129:292-6.
16.	Wessels F, Anderson AN, Kropman K. The cost-effectiveness of isotretinoin in the treatment of acne. Part 1. A meta-analysis of effectiveness literature. S Afr Med J 1999;89:780-4.
17.	Pochi PE, Shalita AR, Strauss JS, Webster SB, Cunliffe WJ, Katz HI, et al. Report of the Consensus Conference on Acne Classification. Washington, D.C., March 24 and 25, 1990. J Am Acad Dermatol 1991;24:495-500.
18.	Lidén S, Göransson K, Odsell L. Clinical evaluation in acne. Acta Derm Venereol Suppl (Stockh) 1980;Suppl 89:47-52.
19.	Goulden V, Clark SM, McGeown C, Cunliffe WJ. Treatment of acne with intermittent isotretinoin. Br J Dermatol 1997;137:106-8.
20.	Seukeran DC, Cunliffe WJ. Acne vulgaris in the elderly: The response to low-dose isotretinoin. Br J Dermatol 1998;139:99-101.
21.	Palmer RA, Sidhu S, Goodwin PG. ′Microdose′ isotretinoin. Br J Dermatol 2000;143:205-6.
22.	Chivot M, Midoun H. Isotretinoin and acne: A study of relapses. Dermatologica 1990;180:240-3.
23.	Lehucher-Ceyrac D, Weber-Buisset MJ. Isotretinoin and acne in practice: A prospective analysis of 188 cases over 9 years. Dermatology 1993;186:123-8.
24.	Sardana K, Garg VK, Sehgal VN, Mahajan S, Bhushan P. Efficacy of fixed low-dose isotretinoin (20 mg, alternate days) with topical clindamycin gel in moderately severe acne vulgaris. J Eur Acad Dermatol Venereol 2009;23:556-60.
25.	Katsambas A, Papakonstantinou A. Acne: Systemic treatment. Clin Dermatol 2004;22:412-8.
26.	Layton AM, Cunliffe WJ. Guidelines for optimal use of isotretinoin in acne. J Am Acad Dermatol 1992;27:S2-7.
27.	Akman A, Durusoy C, Senturk M, Koc CK, Soyturk D, Alpsoy E. Treatment of acne with intermittent and conventional isotretinoin: A randomized, controlled multicenter study. Arch Dermatol Res 2007;299:467-73.

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