Efficacy of daily low dose versus intermittent isotretinoin regimens in patients with moderate acne vulgaris: A randomized-controlled trial

Abstract

Background: Oral isotretinoin, a vitamin A acid derivative, is the most effective treatment of severe acne. As its use is associated with many side effects, low-dose and intermittent application protocols for patients with mild or moderate acne have been reported. Aim: Our purpose was to compare the outcome of two different regimens of low dose isotretinoin; daily versus monthly doses in patients with moderate acne vulgaris. Patients and methods: A randomized controlled trial was conducted on 75 patients with moderate acne vulgaris attending outpatient clinic in the dermatology department at El-Jumhuriya hospital in Benghazi city during the period of June 2009 to June 2011. The patients were randomly assigned to two groups. Group 1 consisted of 45 patients, treated with a daily fixed dose of 20 mg of isotretinoin and group 2 consisted of 30 patients, treated with 20 mg of isotretinoin twice daily for seven days every month. Both groups were treated for a total period of four months. No topical treatments were permitted for

Low‐dose oral isotretinoin for the treatment of adult patients with mild‐to‐moderate acne vulgaris: Systematic review and meta‐analysis

“…Severe acne patients may be refractory to response, in particular, on lower doses. Five studies in the analysis included patients known to have mild-to-moderate acne, 21,[25][26][27]29 whereas severe acne patients in the other five studies 17,[22][23][24]28 was not excluded. Additionally, previous evidence has shown that acne patients with hormonal abnormalities or who take medications known to induce acne often respond differently to isotretinoin.…”

“…24,26,28 10% of the study sample was dropped off during the follow-up of three trials, 25,26,29 and it is unknown for two of them whether they treat the study population as ITT or not. 25,29 (Table 1).…”

“…Additionally, previous evidence has shown that acne patients with hormonal abnormalities or who take medications known to induce acne often respond differently to isotretinoin. Eight of the ten trials excluded a study population with known drug-inducing acne, 17,21,22,[25][26][27][28][29] and patients in one additional study excluded patients known to have hormonal abnormalities. 24 Heterogenicity among the included studies is also part of their methodological quality differences.…”

“…17,21,24,[26][27][28][29] Two of the ten trials were doubleblinded, 23,26 two were single-blinded, 24,29 and two were openlabeled 27,28 ; however, the blinding process is not described for the remaining four trials. 17,21,22,25 Only three trials had given the study power needed to signify the differences among their study groups statistically. 24,26,28 10% of the study sample was dropped off during the follow-up of three trials, 25,26,29 and it is unknown for two of them whether they treat the study population as ITT or not.…”

“…Study participants were followed during the treatment period for 6-8 months, [21][22][23][24][25][26][27] but the length of follow-up in three studies was only 4 months. 17,25,28 Study participants were followed after the end of the treatment for 6-12 months, 21,23,24,28,29 the length of the follow-up on the other hand, in three studies was only 2-3 months 17,22,26 and in two studies 25,27 they did not follow the participants up post-treatment. However, because it was clinically meaningful, relapse was investigated as a secondary meta-analytic outcome.…”