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Low-dose schema of isotretinoin in acne vulgaris.

Mandekou-Lefaki I, Delli F, Teknetzis A, Euthimiadou R, Karakatsanis G.

In severe papulopustular and in nodulocystic/conglobate acne, oral isotretinoin is the treatment of choice. It is also required for patients with moderate to severe acne, especially when acne scars start to occur A new therapeutic approach consists of a low-dose regimen of isotretinoin. We performed a comparative study of high- and low-dose schemas of isotretinoin per os for the treatment of acne. The purpose of this study was to assess the therapeutic effect and tolerability of low doses of isotretinoin in the treatment of acne vulgaris and compare low-dose with high-dose regimens. Sixty-four patients (35 women and 29 men) with different types and grades of acne vulgaris were divided into two treatment groups of 32 patients, in a trial that compared a low dose of 0.15-0.40 mg/kg per day with a high dose of 0.5-1.0 mg/kg per day. These regimens were analyzed with reference to clinical history of acne, baseline investigations, dose and response to isotretinoin, clinical and laboratory adverse effects, relapses and cost of therapy. The mean success rate of the low-dose schema was 69%. The total dose up to 120 mg/kg should be followed for optimal results (success rate of 91%) and avoidance of relapses. The low-dose schema produced fewer adverse effects and offered a very beneficial effect on pre-existing scarring. Our results confirm the beneficial effect of the low-dose schema. We recommend a total dose > or = 120 mg/kg, as this therapeutic regimen of isotretinoin has proven to be the most successful in preventing relapses and scarring.

Publication Types:

Clinical Trial

PMID: 15018017 [PubMed - indexed for MEDLINE]

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Good article , Emmanuel.

Also good that you are also on a low dose program, so it should help you a lot.

I wish my derm would read such articles, he has put me on 1 mg/kg routine and clearly does not keep in touch with new experiments in the field.

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Thank you for finding that Emmanuel. Hopefully this puts an end to some of the nasty back and forths we've had around here regarding high dose/low dose.

And, unlucky, I agree that it is scary when you walk into a doctor's office and know more about the drugs he is prescribing than he does.

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That is interesting. Does this translate to the fact that low doses are effective, but a higher dose will better prevent relapses and scarring but give far more adverse side effects?

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I think it translates into relapses are more likely at a lower dose but scarring is more likely at a higher dose. After suffering the initial Accutane breakout, I would rather go through a relapse than have the scarring that the initial breakout left behind. This breakout didn't occur until my doctor increased my dose. Now, I am in a position where I have to finish my Accutane, wait six months and then decide what type of surgery I am going to have in order to get rid of the scars. The fact that my prescription is so expensive as will be the surgery doesn't make a high dose seem worth it to me.

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it doesn't matter as long as the total course of accutane is 120mg/kg, the article just states there is lower sides at a low dose but if you read some other articles you will find that the toxicity of accutane is the same whether you take 20mg or 120mg, thats why the course lengths are 15-20weeks with dosage dependent upon what the patient can handle

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Exact quote from my ill-informed smartass derm smile.gif was "It does increase collagen production but there is no evidence that it improves scarring"

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