Treatment of acne with intermittent and conventional isotretinoin: a randomized, controlled multicenter study

Abstract

Oral isotretinoin is the most eVective choice in the treatment of severe acne. Application of isotretionin to acne has been expanded to treat those patients with less severe but scarring acne who are responding unsatisfactorily to conventional therapies. However, its use is associated with many side eVects, some of which can result in very disastrous consequences. Data related with intermittent isotretinoin therapy is still limited. Our aim was to asses the eYcacy and tolerability of two diVerent intermittent isotretinoin courses and compare them with conventional isotretinoin treatment. In this multicenter and controlled study, 66 patients with moderate to severe cases were randomized to receive either isotretionin for the Wrst 10 days of each month for 6 months (group 1), or each day in the Wrst month, afterwards the Wrst 10 days of each month for 5 months (group 2) or daily for 6 months (group 3). The drug dosage was 0.5 mg/kg/day in all groups. Patients were followed-up for 12 months. EYcacy values were evaluable for 22 patients in group 1, 19 patients in group 2, and 19 patients in group 3. Acne scores in each group were signiWcantly lower at the end of treatment and follow-up periods (P < 0.001). When patients were evaluated separately as moderate (n = 31) and severe (n = 29), no statistically signiWcant diVerences were obtained among the treatment protocols in patients with moderate acne. However, there was a signiWcant diVerence between groups 1 and 3 to the response of the treatments in severe acne patients at the end of follow-up period (P = 0.013). The frequency and severity of isotretionin-related side eVects were found to be lower in groups 1 and 2 compared with group 3. Intermittent isotretinoin may represent an eVective alternative treatment, especially in moderate acne with a low incidence and severity of side eVects. The intermittent isotretinoin can be recommended in those patients not tolerating the classical dosage.

Randomized comparative study of combination of low dose oral isotretinoin with pulsed azithromycin and low dose oral isotretinoin alone in the management of moderate to severe acne

“…Traditionally it was used for severe nodulo-cystic acne in dose of 1-2 mg/kg/day. [4][5][6][7] In the recent years however a number of investigators have found it to be useful even in relatively low doses ranging from 0.3 to 0.5 mg/kg/day. [8][9][10][11][12] It has been seen that there is dose dependent decrease in sebum production with oral isotretinoin.…”

Blue light therapy versus low dose isotretinon in mild to moderate acne

“…The standard dose of isotretinoin is 0.5-1 mg/kg/day for 20-24 weeks, with a maximum cumulative dose of 120-150 mg/kg. It has been recommended for the treatment of severe nodulocystic acne in the doses of 1-2 mg/day [11]. While using this treatment protocol the incidence of side-effects is quite high and requires regular monitoring including a watch on the serum lipid profile.…”

A randomized, open-label, comparative study of efficacy of low-dose continuous versus low-dose intermittent oral isotretinoin therapy in moderate-to-severe acne vulgaris

“…However, long-term daily use of this drug results infrequent side effects, some of which may lead to disastrous complications resulting in difficulties in complying with the treatment. [5] Recent reports indicate that acne patients have been benefiting from the low-dose or intermittent treatment protocols. Lowdose isotretinoin, such as 0.15-0.40 mg/kg was reported to be effective with a low incidence of severe side effects.…”

“…Moreover, data regarding intermittent treatment protocol are limited. [5] Hence, considerable doubt exists in deciding which protocol would give the maximum benefits, so this study has been undertaken to determine and compare the efficacy of the oral isotretinoin in low-dose continuous with low-dose intermittent in the treatment of moderate-to-severe acne vulgaris. Sample size calculation: [6] Sample size (n) = Z 2 P (1-P)/d 2 = 1.96 2 × 96.03 (1-96.03)/ (19.18) 2 = ~95 (Z is 1.96 for 95% confidence interval, P = maximum response score, and d = the difference between maximum and minimum score).…”