Thread: Acuttane~Isotretinoin

Efficacy of low-dose isotretinoin in acne vulgaris.

Sardana K, Garg VK.
Department of Dermatology, Maulana Azad Medical College, Delhi, India.

Low-dose isotretinoin (0.5 mg/kg/day) is a mode of therapy for mild to moderate grades of acne. We analyzed the various trials of this mode of therapy with or without combination with topical agents. We also statistically analyzed the results, efficacy and relapse rates of standard therapy in comparison with the low-dose therapy. Our analysis of the data revealed that the efficacy and relapse rates of low-dose isotretinoin in mild to moderate grades of acne is comparable with the standard regimen (1 mg/kg/day), which is given in the severe grade of acne vulgaris. Thus, the grade of acne vulgaris should dictate the dose of administration of isotretinoin and the standard dose of 1 mg/kg/day is an unnecessary overtreatment for mild to moderate grades of acne.


PMID: 20061724 [PubMed - in process]

Efficacy of fixed low-dose isotretinoin (20 mg, alternate days) with topical clindamycin gel in moderately severe acne vulgaris.

Sardana K, Garg VK, Sehgal VN, Mahajan S, Bhushan P.
Department of Dermatology and STD, Maulana Azad Medical College and Lok Nayak Hospital Delhi. kabirijdvl@gmail.com

BACKGROUND: In view of the potentially serious side-effects of standard isotretinoin (0.5-1.0 mg/kg per day) therapy for acne, we studied the safety and efficacy of low-fixed dose isotretinoin plus topical 1%clindamycin gel in the treatment of moderate grade of acne. METHODS: In this prospective, non-comparative study, 320 adult patients, with moderately severe acne were enrolled and treated with fixed-dose isotretinoin at 20 mg every alternate day (approximately 0.15 mg/kg/day to 0.28 mg/kg/day) for 6 months along with topical clindamycin gel. All female patients were assessed for polycystic ovarian disease. Patients were followed up for 6 months. RESULTS: A total of 305 patients completed the study. Overall, patients received a mean of 38.4 mg/kg cumulative dose of isotretinoin, and very good results were observed in 208 (68.20%), while good response was seen in 59 (19.34%) of patients. Failure of the treatment occurred in 38 (12.46%), while relapses occurred in 50 (16.39%) of patients. Relapses were commoner in females, and 37 of 43 (86.04%) patients had polycystic ovarian disease. Though mild chelitis (91%) and xerosis (43%) were common, laboratory abnormalities in the form of elevated hepatic enzymes (5%) and elevated serum lipids (6%) were rare. CONCLUSION: Six months of treatment with fixed-dose, alternate-day isotretinoin (20 mg) plus topical 1%clindamycin gel was found to be effective in the treatment of moderate acne in adult patients, with a low incidence of side-effects.

PMID: 19143903 [PubMed - indexed for MEDLINE]

Low-dose isotretinoin in the treatment of acne vulgaris.

Amichai B, Shemer A, Grunwald MH.
Huzot Clinic of Clalit Health Services, Ashkelon, Israel.

BACKGROUND: The efficacy of isotretinoin at 0.5 to 1.0 mg/kg per day in the treatment of acne is well established and considered safe, although it is sometimes not easily tolerated because of its cutaneous side effects. OBJECTIVE: The purpose of this study was to determine the efficacy of low-dose isotretinoin in the treatment of acne. METHODS: In this prospective, noncomparative, open-label study, 638 patients, both male and female, with moderate acne were enrolled and treated with isotretinoin at 20 mg/d (approximately 0.3-0.4 mg/kg per day) for 6 months. The patients were divided into two age groups: 12 to 20 and 21 to 35 years old. Patients were evaluated at 2-month intervals by means of clinical and laboratory examinations. A 4-year follow-up was also carried out. RESULTS: At the end of the treatment phase, good results were observed in 94.8% of the patients aged 12 to 20 years, and in 92.6% of the patients aged 21 to 35 years. Failure of the treatment occurred in 5.2% and 7.4% of the two groups, respectively. Twenty-one patients dropped out of the study because of lack of compliance, and another patient discontinued participation because of a laboratory side effect. During the 4-year follow-up period, relapses of the acne occurred in 3.9% of the patients aged 12 to 20 years and in 5.9% of the patients aged 21 to 35 years. Elevated serum lipid levels (up to 20% higher than the upper limit of normal value) were found in 4.2% of the patients and abnormal (<twice the upper limit of normal values) liver tests were observed in 4.8%. LIMITATIONS: This was a noncomparative, open-label study. CONCLUSION: Six months of treatment with low-dose isotretinoin (20 mg/d) was found to be effective in the treatment of moderate acne, with a low incidence of severe side effects and at a lower cost than higher doses.

PMID: 16546586 [PubMed - indexed for MEDLINE]

Comparison of dose-related ocular side effects during systemic isotretinoin administration.

Cumurcu T, Sezer E, Kilic R, Bulut Y.
Department of Ophthalmology, Gaziosmanpasa University School of Medicine, Tokat - Turkey. tcumurcu@gop.edu.tr

PURPOSE: To compare the effects of high- (Group 1) and low-dose (Group 2) isotretinoin treatments for acne vulgaris on lacrimal functions and other ocular complications. METHODS: Twenty-six patients receiving high-dose (>0.5 mg/kg per day) systemic isotretinoin treatment and 25 patients treated with low-dose systemic isotretinoin (<0.5 mg/kg per day) underwent complete ophthalmologic assessment of both eyes before treatment, at days 45 and 90 of treatment, and 1 month after the completion of treatment, together with a microbiologic evaluation of conjunctival flora, tear film break-up time (BUT), and anesthetized Schirmer test of the right eye of each patient. RESULTS: When the results of the anesthetized Schirmer test for Groups 1 and 2 were compared (pretreatment, days 45 and 90 of treatment, and 1 month after treatment), there was no statistically significant difference between the groups (p > 0.05). Although BUT did not differ significantly between the two groups before treatment (p >0.05), there was a statistically significant decrease in BUT in Group 1 when compared with Group 2 at days 45 and 90 of treatment (p <0.05). One month after the completion of treatment, there was no difference in BUT between the two groups (p >0.05). No difference in Staphylococcus aureus colonization was detected between the two groups at days 45 and 90 of treatment (p >0.05). CONCLUSIONS: During systemic isotretinoin treatment, eye dryness was related to the dose used, at least during the period of treatment. Conversely, the rate of conjunctival S aureus colonization was unrelated to the dose of isotretinoin.

PMID: 19253234 [PubMed - indexed for MEDLINE]

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

Ayse Akman,1 Cicek Durusoy,2 Meltem Senturk,3 Cilem Kaya Koc,1 Durali Soyturk,4 and Erkan Alpsoy1
1Department of Dermatology and Venerology, Akdeniz University School of Medicine, 07070 Antalya, Turkey
2Clinics of Dermatology and Venerology, Baskent University Alanya Baskent Hospital, Antalya, Turkey
3Antalya National Hospital, Antalya, Turkey
4Finike National Hospital, Antalya, Turkey
Ayse Akman, Phone: +90-242-2496708, Fax: +90-242-2274490, Email: aakman@akdeniz.edu.tr .
Corresponding author.
Received May 9, 2007; Revised July 3, 2007; Accepted July 30, 2007.

Abstract

Oral isotretinoin is the most effective 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 effects, some of which can result in very disastrous consequences. Data related with intermittent isotretinoin therapy is still limited. Our aim was to asses the efficacy and tolerability of two different 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 first 10 days of each month for 6 months (group 1), or each day in the first month, afterwards the first 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. Efficacy 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 significantly 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 significant differences were obtained among the treatment protocols in patients with moderate acne. However, there was a significant difference 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 effects were found to be lower in groups 1 and 2 compared with group 3. Intermittent isotretinoin may represent an effective alternative treatment, especially in moderate acne with a low incidence and severity of side effects. The intermittent isotretinoin can be recommended in those patients not tolerating the classical dosage.

the company is getting sued because of the side of heart failure and other thing ..i do think

Doctors were prescribing way too high a dose initially. The previous trials I posted prove low doses are effective and have fewer side effects. 20mg daily is very effective but many times 5 times that dose was prescribed resulting in more side effects.