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. Conclusion: MDD, TCD, closed comedonal acne and hyperandrogenism that have been adequately treated prior to isotretinoin treatment had no prognostic value for relapse.
A total of 188 acne patients (113 male and 75 female) with a mean age of 25 years (range 15–42 years) were treated with isotretinoin in doses ranging from 0.5 to 1 mg/kg. The study lasted 9 years. The treatment was not terminated until 2 months after total healing. The patients were then re examined at regular intervals. In the event of a recurrence greater than grade 2 (pre-nodular threshold grade), they underwent a new course of treatment. At the end of the study, three groups were distinguished: (1) immediate, long-term, stable remissions following one single course of isotretinoin (111 patients with an average follow-up period of 27 months); (2) stable remissions following 2 or 3 courses of isotretinoin (54 patients with an average follow-up period of 16 months); (3) immediate partial remissions or partial remissions following several courses of treatment in 23 patients who continued to present with at least grade 3 acne. There was no significant statistical difference between the first two groups with respect to the age and sex of the patients and the grade and prior duration of the acne. The third group differed from the other two in having a greater proportion of patients with microcystic acne (p < 0.05) and women with endocrinological problems ((p < 0.001). Analysis of these results confirmed the importance of the total cumulative dose (in one or more courses of treatment) for obtaining stable remission, the existence of a threshold dose of about 150 mg/kg which, in many cases, should not be exceeded, and the need to take into account the type of acne and the hormonal status of female patients before beginning treatment with isotretinoin.
The objective of this randomized, controlled, multicentre study was to assess the efficacy and safety of a topically applied retinaldehyde 0.1% gel in combination with a topical erythromycin 4% lotion for the treatment of acne vulgaris. Treatment consisted of applying either retinaldehyde or its vehicle every morning and erythromycin every evening for 8 weeks. Efficacy parameters were sequential lesion counts for papules and pustules, and a 6-point semiquantitative scale for comedones and microcysts. Safety parameters were local tolerance and adverse events. Of 74 recruited patients, 73 were appraisable for efficacy and safety. In both treatment groups, papules and pustules were reduced significantly at the end of treatment (P < 0.001), and no statistical difference was observed between the groups. Comedones and microcysts were significantly improved with retinaldehyde combined with erythromycin (P = 0.005), but not with erythromycin alone. However, no statistical difference between the groups could be demonstrated (test power, 50%). Local tolerance of the combined treatment group was very satisfactory, as only a few patients experienced local irritation. In conclusion, retinaldehyde combined with erythromycin appears to be a valuable topical therapy in polymorphic acne.
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