Isotretinoin Dosing in Adolescents: Does Weight Change Matter?
Isotretinoin remains the gold standard for treating severe nodulocystic acne, with cumulative dosing of 120-150 mg/kg shown to balance safety and efficacy. Higher doses (up to 220 mg/kg) have also been deemed safe and may improve outcomes. Standard dosing is based on a patient’s weight at the start of treatment, but should that dose be adjusted if a teen gains or loses weight during therapy?
A new study published in JDD, “Impact of Weight Changes on Isotretinoin Dosing in Adolescents: A Retrospective Cohort Study”, explores that very question. Researchers reviewed 57 adolescent patients treated with isotretinoin at Augusta University between 2015 and 2020, stratifying data by age, gender, and treatment duration.
While there were statistically significant weight changes in some groups over the course of treatment, these differences were not clinically meaningful, and did not warrant adjusting isotretinoin dosage mid-treatment.
The takeaway for dermatologists: the current weight-based dosing standard remains appropriate for adolescents, even over longer courses of therapy. Routine weight-based dose recalculations during treatment may not be necessary, streamlining care and avoiding unnecessary complexity.
J Drugs Dermatol. 2025;24(6) doi:10.36849/JDD.8949
