Premium
High‐dose isotretinoin in acne vulgaris: improved treatment outcomes and quality of life
Author(s) -
Cyrulnik Amanda A.,
Viola Kate V.,
Gewirtzman Aron J.,
Cohen Steven R.
Publication year - 2012
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/j.1365-4632.2011.05409.x
Subject(s) - isotretinoin , medicine , acne , discontinuation , quality of life (healthcare) , cohort , cumulative dose , young adult , dermatology , nursing
Background Isotretinoin, for acne treatment, is associated with high rates of permanent remission. However, at recommended doses of 0.5‐1.0 mg/kg/day for 5‐6 months [average cumulative dose: 120‐150 mg/kg], more than 20% of patients experience a relapse within two years that requires further medical management. Objective To examine outcomes of high‐dose isotretinoin in a cohort with cystic acne, as well as measuring its impact on quality of life (QOL). Methods A single dermatologist, single institution investigation within an academic tertiary care center in Bronx, NY. Eighty patients with nodulocystic acne, maintained on oral isotretinoin at a dose of 1.3 mg/kg/day or greater, were studied from 2006‐2009 while additionally participating in a QOL survey. Main outcome measures included documented events, acne clearance, presence of relapse, and quality of life parameters. Results The mean daily dose of isotretinoin was 1.6 mg/kg/day for an average time course of 178 days [cumulative dose: 290 mg/kg]. No side effects or laboratory abnormalities led to discontinuation of treatment. There were no psychiatric symptoms. One‐hundred percent (100%) of patients were disease‐free upon completion of treatment. During the three‐year study period, 10 patients (12.5%) developed a relapse that required an additional course of isotretinoin. Analysis of QOL domains ( self‐perception, role‐social, symptoms ) revealed significant improvement following isotretinoin therapy (p = 0.0124, p = 0.0066, p = 0.0265, respectively). Conclusions Isotretinoin prescribed at 1.5 mg/kg/day or greater for 5‐6 months [cumulative total dose of 290 mg/kg] is safe and effective compared to current standard dosing practices. We propose the use of high‐dose isotretinoin (>1.3 mg/kg/day) as a treatment option in severe nodulocystic acne and encourage larger, prospective, multicenter studies into this therapeutic approach.