Continuous high-dose treatment was slightly more effective, but lower and intermittent doses were also effective against moderate acne.

Isotretinoin effectively treats acne vulgaris. The standard dose is 0.5 mg to 1.0 mg/kg/day for 16 to 32 weeks, usually aiming for a total dose of 120 mg/kg. Lower doses work, too. Investigators conducted a prospective, randomized, controlled, single-blinded clinical trial to compare results with the traditional dose and two lower-dose regimens.


Sixty Korean patients with "moderate" acne were randomized to one of three treatment regimens: continuous high-dose isotretinoin (0.5 mg–0.7 mg/kg/day), continuous low-dose isotretinoin (0.25–0.4 mg/kg/day), or intermittent high-dose isotretinoin (0.5–0.7 mg/kg/day for 1 week out of every 4). The study lasted 24 weeks. Evaluations occurred at baseline, 12 weeks, and 24 weeks. Acne was graded for severity using the global acne grading system (GAGS) and by inflammatory and noninflammatory lesion counts. Patient satisfaction was graded on a 4-point scale, and adverse effects were assessed via clinical reporting, examination, and lab studies. Patients were reassessed for relapse 1 year after the end of treatment.

Forty-nine patients completed treatment. GAGS scores and both inflammatory and noninflammatory lesion counts decreased in all treatment groups. There were no significant differences in GAGS score between the high-dose and low-dose continuous groups; both continuous regimens were superior to the intermittent high-dose treatment. The mean patient-satisfaction score was significantly higher in the low-dose group than in the other two groups. Adverse effects were most common in continuous high-dose recipients. Relapse was more likely among recipients of the intermittent high dose.


Citation(s):

Lee JW et al. Effectiveness of conventional, low-dose and intermittent oral isotretinoin in the treatment of acne: A randomized, controlled comparative study. Br J Dermatol 2010 Nov 29; [e-pub ahead of print].