Oral Isotretinoin for Acne, Adjusting Treatment According to Patient’s Response

Background: Oral isotretinoin is an established effective therapy for acne. No published data is available on the efficacy and side effects of this drug in Iranian patients. Patients and Methods: A total of 132 acne patients with a mean age of 22.9±6.2 years were treated with oral isotretinoin (Roaccutane) and followed-up from 1999 through 2005. Each patient was started with a dose of 0.75 mg/kg per day until all active lesions healed, followed by a maintenance dose of 20 mg/kg per day for one more month. Laboratory tests were done at monthly intervals. Evaluation of clinical response was based on Leeds technique. Patients were followed-up for a mean period of 4.4 years. Results: Most of the patients had severe nodulocystic acne involving both trunk and face. Treatment was continued for 6.6±2.5 months with a cumulative dose of 111.5 mg/kg±33.9. The mean final improvement rate was 96.7% (95% CI, 84.9% to 108.5%). There was no correlation between improvement rate and age, sex, duration of acne, length of treatment, or cumulative dose. Side effects were generally mild and treated conservatively. In the follow-up, period 18.35% experienced relapse after a mean interval of 1.28 years, 9.17% required a second course of isotretinoin, and only one case needed 3 courses of treatment. Conclusion: Isotretinoin is an effective and safe treatment for acne in Iranian patients. Starting treatment with a high dose and modifying the length of treatment based on the therapeutic response in each patient, might lead to a rapid and good response rate with minimal side effects.