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

Abstract

Acne vulgaris is one of the most common dermatologic complaints. Recently, isotretinoin has been used as an off‐label indication for the treatment of mild‐to‐moderate grades of acne not responding to conventional treatment. Its conventional recommended dose is 0.5–1.0 mg/kg per day to the cumulative dose of 120–150 mg/kg. To qualify the state of evidence and analyze the efficacy of the low‐daily dose and the pulsed doses of isotretinoin in treating mild‐to‐moderate acne patients with regards to response and relapse rates. Systematic review and meta‐analysis using an electronic literature search were performed. The 320 potentially relevant articles were included and reviewed. The level of evidence is moderate to low as conducted by the GRADE quality of evidence assessment. The pooled statistical estimate for response to treatment in the group comparing low‐daily doses with conventional dose showed an overall benefit for conventional dose. On the other hand, pooled data from the group comparing the low‐daily dose with the pulsed doses yielded an overall beneficial effect from using the low‐daily dose compared with the pulsed doses on achieving the response. Given all of the available studies, the quality of evidence is low. It appears that conventional dose isotretinoin improves the odds of prolonged remission in adults with mild‐to‐moderate acne vulgaris compared to the low doses.

Acne Vulgaris Relapse in Sudanese Patients Treated with Oral Isotretinoin: Rate and Predictive Factors

“…19 In comparison with OI low-daily doses, the conventional doses (0.5-1 mg/kg/day and cumulative doses of 120-150 mg/kg) showed positive clinical outcomes regarding response and relapse rate. 18 Previous findings also suggested that high cumulative doses of OI and continuation of therapy for more than 1 month after complete acne clearance can effectively treat acne with a lower relapse rate and better long-term outcomes if these doses are tolerable. 17,19 Contrastingly, a previous study highlighted the non-advantageous effect of OI cumulative dose higher than 120 mg/kg on acne relapse when compared with a medium cumulative dosage (100-120 mg/kg).…”

“…16,17 In addition, low cumulative doses of isotretinoin and short duration of treatment are strong predictors of acne relapse. [17][18][19] Despite being the golden therapy for severe acne vulgaris, OI has been associated with acne relapse. This study was conducted to evaluate the risk factors associated with acne relapse in Sudanese patients using OI therapy.…”

Isotretinoin‐induced hair disorders in the era of COVID‐19 and related vaccines: A case series

“…ISO should be introduced precociously for mild-to-moderate acne not responding to conventional therapy, if there is no formal contraindication. 1,2 ISO has dose-dependent side effects, which are secondary to retinoic acid receptors expression in the tissues. These side effects are reversible with drug discontinuation.…”

Oral Isotretinoin and Its Uses in Dermatology: A Review

“… 26 Al Muqarrab described a low-daily dose regimen as a short course of 0.1–0.3 mg/kg/day and the pulsed dose regimen as the intermittent use of isotretinoin (every other day low dose or monthly low dose pulses). 27 …”

“…Further RCTs with adequate sample sizes, longer follow-up periods, and analysis outcomes regarding the cumulative dose rather than the daily dose of isotretinoin in mild-to-moderate acne patients are required. 27 While there is still no definitive conclusion on the effectiveness of low-dose isotretinoin therapy for mild-to-moderate acne vulgaris, extensive evidence suggests that a low-dose regimen over a longer period of time has shown more significant outcomes and long-term remission, highlighting the need for higher cumulative doses. 21 , 27 , 30 …”