Efficacy of low-dose isotretinoin in acne vulgaris

Abstract

Low-dose isotretinoin (0.5 mg/kg/day) is a mode of therapy for mild to moderate grades of acne. We analyzed the various trials of this mode of therapy with or without combination with topical agents. We also statistically analyzed the results, efficacy and relapse rates of standard therapy in comparison with the low-dose therapy. Our analysis of the data revealed that the efficacy and relapse rates of low-dose isotretinoin in mild to moderate grades of acne is comparable with the standard regimen (1 mg/kg/day), which is given in the severe grade of acne vulgaris. Thus, the grade of acne vulgaris should dictate the dose of administration of isotretinoin and the standard dose of 1 mg/kg/day is an unnecessary overtreatment for mild to moderate grades of acne.

Isotretinoin is safe and efficacious in Asians with acne vulgaris

“…These regimens vary from daily therapy to intermittent or alternate day therapy, with an overall dose of 0.14-0.75 mg/kg/day (11). Using an isotretinoin-sparing protocol which sought to reduce total cumulative dose, Borghi et al recently reported a remission rate of more than 90% at a low mean cumulative dose of 80.9 mg/kg (12).…”

“…Recently, there has been a shift to the use of lower and more intermittent dosage regimens to decrease dose-related side-effects (10,11). These regimens vary from daily therapy to intermittent or alternate day therapy, with an overall dose of 0.14-0.75 mg/kg/day (11).…”

What′s new in the management of acne?

“…[43,44] Isotretinoin 20 mg in an alternate day regimen seems to be an effective and safe treatment option in mild to moderate cases, according to an Indian study. [45] However, intermittent regimens with 0.5-0.7 mg/kg/day of isotretinoin for a week, every 4 weeks, did not achieve good patient satisfaction and remission.…”

Nocebo effect in Dermatology

“…Finasteride doses as low as 0.2 mg/day adequately suppress both scalp skin and serum dihydrotestosterone levels, with clinical efficacy comparable to higher daily doses of 1 and 5 mg. [54] Similarly, low dose isotretinoin has been reported to be equi-efficacious to higher doses in multiple acne trials. [55] To vitiate the possibility of nocebo effect, isotretinoin may be initially administered at a lower daily dose (0.3 mg/kg) or on alternate days, followed by the full therapeutic dose (0.5-1 mg/kg/day), once the patient is comfortable. The value of similar regimens has been proven in a preliminary study.…”