Predictive factors for failure of isotretinoin treatment in acne patients: results from a cohort of 237 patients.
BACKGROUND
The efficacy of oral isotretinoin in acne has been established, though the role of the mean daily dose (MDD) is still unclear.


OBJECTIVE
To determine the predictive factors of resistance to oral isotretinoin and the role of the MDD of isotretinoin on relapse of acne while taking into account patient characteristics and the total cumulative dose (TCD).


METHODS
Two hundred and thirty-seven patients treated with oral isotretinoin for the first time were enrolled by a single dermatologist. Patients with closed comedonal acne and with hyperandrogenism received adequate therapy prior to isotretinoin.


RESULTS
Closed comedonal acne was the only predictive factor of resistance to isotretinoin with an adjusted OR = 2.7 (95% CI: 1.0-7.3). The estimated rates of relapse at 1, 3 and 5 years were 14, 40 and 48%, respectively. Age and grade of facial acne were the only predictive factors for relapse with adjusted relative risks of 0.6 (95% CI: 0.4-0.8) for age >/= 20 and 1.5 (95% CI: 1.0-2.2) for grade > 3.


CONCLUSIONS
MDD, TCD, closed comedonal acne and hyperandrogenism that have been adequately treated prior to isotretinoin treatment had no prognostic value for relapse.
Service de Dermatologie, Hôpital Saint-Louis, Paris, France.
D
D
Lehucher-Ceyrac
P
P
de La Salmonière
C
C
Chastang
P
P
Morel
D000152:Acne Vulgaris / Q000188:drug therapy*; D000328:Adult; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004341:Drug Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015474:Isotretinoin / Q000627:therapeutic use*; D007641:Keratolytic Agents / Q000627:therapeutic use*; D008297:Male; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
D007641:Keratolytic Agents; D015474:Isotretinoin