Predictive Factors for Failure of Isotretinoin Treatment in Acne Patients: Results from a Cohort of 237 Patients

Abstract

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.

Prospective Study of Risk Factors of Relapse after Treatment of Acne with Oral Isotretinoin

“…This count of lesions allowed to define the kinetics of the evolution of lesions under treatment for patients who experienced a relapse after treatment termination compared to those who did not. In other studies published in the literature, the assessment of acne was thus far less precise, using the classification of Burke and Cunliffe [10, 11], the technique of Leeds [1, 8, 14] or subjective improvement scales [9, 15]. …”

“…This response rate is lower compared to those commonly observed in the literature. Indeed, Falk and Stenvold [9] obtained 70% of complete remission, Lehucher-Ceyrac and Weber-Buisset [10] obtained 95% in 1993 and Lehucher-Ceyrac et al [11] 92% in 1999. Data are less precise for Layton et al [1] and Ng and Goh [12], with an improvement for 85 and 97% of patients, respectively, without distinguishing between partial and complete response.…”

“…However, despite its high efficacy, isotretinoin may lead to relapse within a variable time after treatment termination. The frequency of relapse remains much discussed, especially due to the absence of well-defined criteria for relapse and because most studies are retrospective [1,5,6,7,8,9,10,11,12]. …”

Heredity: A Prognostic Factor for Acne

“…There seem to be several significant factors in the low response to isotretinoin treatment [16], such as severe comedonal acne, hyperandrogenism and above all the early onset of acne. Our results suggest that family history of acne may explain the lower efficacy of isotretinoin treatment.…”

Maintenance Treatment With Topical Adapelene in Patients With Nodulo Cystic Acne After Systemic Isotretinoin Therapy NodulokistikAkne İçin Sistemik İsotretinoin Kullanan Hastalarda Topikal Adapelene

“…In the past it has been shown that lower daily doses like 0.5 mg/kg or a total dose less than 120 mg/kg of isotretinoin could be related with higher relapse rates (4). It was also shown that beginning isotretinoin treatment with lower daily doses like 0.5 mg/kg might minimize some adverse effects like dry mucosa, myalgia and initial flares of acne (5). In a more recent study lower daily doses were not shown to be a risk factor for recurrence of acne (6,7).…”