High-dose isotretinoin in acne vulgaris: improved treatment outcomes and quality of life.
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.
Department of Dermatology, Albert Einstein College of Medicine, New York, NY 10467, USA.
Amanda A
AA
Cyrulnik
Kate V
KV
Viola
Aron J
AJ
Gewirtzman
Steven R
SR
Cohen
D000152:Acne Vulgaris / Q000188:drug therapy* / Q000523:psychology; D000293:Adolescent; D000328:Adult; D002648:Child; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006261:Headache / Q000139:chemically induced; D006306:Health Surveys; D006801:Humans; D015474:Isotretinoin / Q000008:administration & dosage* / Q000009:adverse effects; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000139:chemically induced; D011788:Quality of Life / Q000523:psychology*; D012008:Recurrence; D012189:Retrospective Studies; D012649:Self Concept; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
D003879:Dermatologic Agents; D015474:Isotretinoin