Low dose of isotretinoin: A comprehensive review (original) (raw)
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Low-dose isotretinoin in acne vulgaris
International Journal of Medical Science and Public Health, 2016
Oral isotretinoin (13-cis-retinoic acid) is the only drug that counteracts all the pathogenetic mechanisms that contribute to the development of acne through its broad effects on cellular differentiation, apoptosis, inflammation, and sebaceous gland activity. It results in a significant reduction in sebum production, influences comedogenesis, lowers surface and ductal P. acnes, and exhibits anti-inflammatory properties. [2] Proper use of isotretinoin in acne can minimize the scarring and postacne hyperpigmentation and induce long-term remission. [3] In 1982, US FDA-approved isotretinoin for use in severe recalcitrant nodular acne. [4] In recent days, isotretinoin is recommended in a dose of 1 mg/kg/day with a total cumulative dose of 120-150 mg/kg. The use of such a high dose (1-2 mg/kg/day) leads to a number of dose-dependent mucocutaneous, systemic, and biochemical side effects, which require regular monitoring and lead to a poor compliance. [3] One of the ways of reducing the dose-dependent adverse events and Background: Oral isotretinoin is the only drug counteracting all the pathogenetic mechanisms causing acne. Its proper use can minimize scarring and induce long-term remission. Objective: To assess the efficacy and safety of low-dose (0.5 mg/kg/day) isotretinoin in cases of acne vulgaris with the help of this prospective, single-arm, interventional study. Materials and Methods: Cases with grades II (resistant cases), III, and IV acne vulgaris were enrolled. They were given oral isotretinoin for 4 months. After the completion of 4 months, those with complete clearance of lesions were switched to pulse therapy (1 week on, 3 weeks off), while those with new lesions were continued on isotretinoin for another 2 months. The total duration of therapy was for 6 months, and posttherapy cases were followed up for 6 months to check for relapse. Result: A total of 96 patients were enrolled in the study. At 2-, 4-, and 6-months therapy, complete clearance was seen in 26.7%, 46.7%, and 93.3% in acne grade II (n = 15); 7.9%, 26.3%, and 60.5% in grade III (n = 38); 0%, 26.3%, and 52.6% in grade IV (n = 38) patients, respectively, and 7.4% and 14.1% cases on pulse and continuous therapies, respectively, showed recurrence 6 months after stoppage of therapy. The most common adverse drug reaction was cheilitis (89%). All mucocutaneous adverse events subsided with time, none warranting discontinuation of therapy. Conclusion: Low-dose isotretinoin (0.5 mg/kg/day) therapy has a good efficacy and is associated with minimal side effects, improving patients' compliance and acceptability.
Systemic isotretinoin in the management of acne - a patient questionnaire survey : original research
South African Family Practice, 2009
The acne medication history revealed that commercial brands of beauty products were used by 57.9% of respondents, topical benzoyl peroxide by 22.8%, and systemic cotrimoxazole by 19.3%. Only nine females used an oral contraceptive as acne treatment prior to isotretinoin. The average daily dose of isotretinoin was 44.2 (SD=16.9) mg. Half of the respondents received a suboptimal cumulative dosage of isotretinoin. The average prescribed duration of isotretinoin therapy was 6.2 months. Adequate counselling was received by only 57.9% of patients. A third of the patients who were able to fall pregnant received recommendations for contraception. Pregnancy tests were conducted in only two females. Just over 40% of patients reported a complete clearance of acne lesions.
ISOTRETINOIN FOR TREATING ACNE VULGARIS Review Article
International Journal of Applied Pharmaceutics, 2021
Acne vulgaris (AV) occurs in more than 80% of dermatological cases in adolescents and young adults and affects the quality of life. Oral isotretinoin, a metabolite product of vitamin A, is well-known to be the most effective treatment for severe nodulocystic AV and moderate AV that does not respond to other therapeutic modalities. Thus, this literature review was conducted to explain the mechanism of action, effectiveness, contraindications, side effects, and safety of oral isotretinoin in AV, which provided essential information for dermatologists. Furthermore, isotretinoin is the only treatment modality that has implications for the entire pathogenesis of acne. It contributes to decreasing corneocytes' adhesion, supporting cellular proliferation and follicular renewal, induction of cell apoptosis, and immune regulation. The effectiveness of AV therapy with isotretinoin has expanded as it is also indicated for moderate to severe AV that does not respond well to topical combination therapy or systemic antibiotics. However, isotretinoin is included in Category X drugs and may induce many side effects from mucocutaneous effects to teratogenicity. From this extensive literature review, it can be concluded that isotretinoin is one of the treatment modalities for acne with good effectivity due to its mechanism of actions that affect the entire acne pathogenesis. Considering the various side effects of isotretinoin, its use requires adequate clinical assessment and monitoring by a dermatologist.
Pakistan Journal of Medical and Health Sciences, 2022
Objective: The study's objective was to evaluate the effectiveness and safety of low-dose isotretinoin vs the standard-dose regimen for the treatment of acne vulgaris. Study Design: Randomized controlled trial Place and Duration: This study was conducted at Department of Dermatology, Bannu Medical College and Federal Government Polyclinic Hospital Islamabad in the period from March, 2022 to August, 2022. Methods: Randomization was used to split the total of 190 patients with acne vulgaris who participated in the study into two groups of 95 sample size each. Patients of both sexes were affected with acne vulgaris. Isotretinoin was administered orally to patients in group I at a dose of 20 milligrammes per day for 12 weeks, whereas patients in group II received conventional dosing regimen 80 milligrammes per day. After a total of 12 weeks of therapy, both groups had a final assessment of their effectiveness. SPSS 23.0 was used to analyze all data. Results: In all 190 cases, majority of the cases 110 (57.9%) were females and 80 (42.1%) were male patients. Mena age of the patients in group I was 24.16±10.52 years and in group II mean age was 25.8±9.87 years. We found that efficacy of conventional dosing regimen was higher in 73 (76.8%) as compared to low doze isotretinoin in 50 (52.6%) with p value <0.005. Post-treatment frequency of complication were higher in group II 46 (48.4%) as compared to group I 28 (29.5%). Dry eyes and headache were the common complications in all cases. Conclusion: As a result of this research, we came to the conclusion that the typical dosing regimen for the treatment of acne vulgaris is more effective but poses a greater risk of side effects than the low dose of isotretinoin.
Updated Physician's Guide to the Off-label Uses of Oral Isotretinoin
The Journal of clinical and aesthetic dermatology, 2014
While oral isotretinoin is renowned for its ability to treat acne vulgaris, many of its off-label uses continue to go underappreciated. Since the last review on the unapproved indications of isotretinoin, relevant publications have surfaced with new recommendations. This article attempts to provide physicians with the latest information regarding successful and unsuccessful use of isotretinoin as an effective treatment for dermatological conditions, such as rosacea, psoriasis, pityriasis rubra pilaris, condyloma acuminatum, granuloma annulare, Darier's disease, systemic cutaneous lupus erythematosus, nonmelanoma skin cancer, and hidradenitis suppurativa. Variations in dosage regimens and isotretinoin viability as an alternative to other standard treatments are also discussed in relation to these conditions.
THERAPEUTIC EFFICACY OF ISOTRETINOIN IN THE TREATMENT OF ACNE VULGAR: A BIBLIOGRAPHICAL REVIEW (Atena Editora), 2024
Objective: To analyze the therapeutic efficacy of isotretinoin in the treatment of moderate to severe acne, considering its safety and impact on patients' quality of life. Method: Literature review using the PubMed database, with search terms such as "isotretinoin", "moderate to severe acne", "clinical results and quality of life". 31 articles were analyzed. Results: Acne vulgaris is prevalent in puberty and adolescence, with oral isotretinoin being a primary therapeutic option. Recent studies indicate improvements in quality of life, despite adverse effects such as anxiety, depression and suicidal ideation, related to the severity of acne and a history of psychological conditions. There is no therapy with fully proven efficacy. Final considerations: Oral isotretinoin has favorable clinical results and improved self-esteem, but more research is needed to benefit patients with moderate to severe acne.
JAMA Dermatology, 2013
IMPORTANCE Isotretinoin is the most effective treatment for acne. The ideal dosing regimen is unknown. OBJECTIVE To determine the rates of relapse of acne vulgaris and retrial of isotretinoin after high cumulative-dose treatment and the changes to the adverse effect profile. DESIGN, SETTING, AND PARTICIPANTS A prospective, observational, intervention study was conducted from August 1, 2008, to August 31, 2010, in a single academic tertiary care center with multiple providers. A total of 180 patients with acne resistant to other treatments were enrolled. Of these, 116 participated in the 12-month follow-up survey, for a response rate of 64.4%. EXPOSURE Patients received isotretinoin, with dosing based on the providers' judgment. Patients were divided into 2 groups on the basis of cumulative dosing (<220 mg/kg and Ն220 mg/kg). MAIN OUTCOMES AND MEASURES Relapse (treatment with a prescription topical or oral acne medication after a course of isotretinoin) or retrial (retreatment with isotretinoin) at 12-month follow-up and adverse effects experienced during and after 12 months of treatment. RESULTS The mean age of the participants was 19.3 years, 51.9% were female, and 74.1% were white. At 12 months' follow-up, 97.4% of the patients reported that their acne was improved. Overall, acne in 32.7% of patients in the study relapsed at 12 months, and 1.72% of the patients required a retrial. In the lower-dose treatment group (<220 mg/kg), the relapse rate was 47.4% (95% CI, 32.3%-63.0%) compared with 26.9% (95% CI, 18.3%-37.8%) in the high-dose group (P = .03). Almost 100% of the patients in both treatment groups developed cheilitis and xerosis during treatment. Retinoid dermatitis was significantly more common in the high-dose treatment group (53.8% vs 31.6%; P = .02). None of the other adverse effects was significantly different between the 2 groups. CONCLUSIONS AND RELEVANCE The dosing regimen used in the present study is considerably higher than that used in previous studies of isotretinoin. 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. Rash was the only adverse effect that was significantly more common in the high-dose group during treatment. This study suggests that significantly higher doses of isotretinoin are effective for treating acne and decreasing relapse rates without increasing adverse effects.
The effects of isotretinoin on the ovarian reserve of females with acne
2014
There are some side effects of isotretinoin in many organs. However, a study investigating the effects of isotretinoin on the human ovarian reserve has not been reported previously. The study was conducted to investigate possible effects of isotretinoin on ovarian reserve. Serum anti-Mü llerian hormone (AMH) levels were measured at the beginning and at the end of isotretinoin treatment in 22 patients with acne and in 22 women without. The mean AMH level before treatment was 5.77 ng/mL in the study group and 3.79 ng/mL in the control group (p ¼ 0.008). Following treatment, the mean AMH level was 4.69 ng/mL in the study group. This mean AMH level after treatment was statistically lower than the AMH level before treatment (p ¼ 0.012). There was no significant difference between the mean AMH level at the end of treatment and that of the control group (p ¼ 0.20). The high level of pre-treatment AMH levels could be an evidence of hyperandrogenism in women with acne, even if they are not identified as having polycystic ovary syndrome (PCOS) or hyperandrogenism. Decrease in AMH levels following exposure to isotretinoin may suggest that it has a detrimental effect on the ovaries.
Challenges and Solutions in Oral Isotretinoin in Acne: Reflections on 35 Years of Experience
Clinical, Cosmetic and Investigational Dermatology, 2019
Acne vulgaris affects more than 80% of adolescents and young adults and forms a substantial proportion of the dermatologist's and general practitioner's caseload. Severity of symptoms varies but may result in facial scarring and psychological repercussions. Oral isotretinoin is highly effective but can only be prescribed by specialists. Side effects are recognized and mostly predictable, ranging from cosmetic effects to teratogenicity. These can affect patients' quality of life and treatment adherence. This article provides a commentary on 4 key areas: the use of oral isotretinoin vs oral antibiotics, including the importance of early recognition of nonresponse to treatment, the psychological effects of acne and isotretinoin treatment, the side effects of isotretinoin therapy, and cosmetic treatment options that can help alleviate predictable side effects. The authors, who have all participated in various international expert groups, draw on relevant literature and their extensive professional experience with oral isotretinoin in the treatment of acne. The aim of this article is to provide an informative and practical approach to managing oral isotretinoin treatment in patients with acne, to help optimize treatment of this skin disease.