Treatment of acne with intermittent and conventional isotretinoin: a randomized, controlled multicenter study

Abstract

Oral isotretinoin is the most effective choice in the treatment of severe acne. Application of isotretionin to acne has been expanded to treat those patients with less severe but scarring acne who are responding unsatisfactorily to conventional therapies. However, its use is associated with many side effects, some of which can result in very disastrous consequences. Data related with intermittent isotretinoin therapy is still limited. Our aim was to asses the efficacy and tolerability of two different intermittent isotretinoin courses and compare them with conventional isotretinoin treatment. In this multicenter and controlled study, 66 patients with moderate to severe cases were randomized to receive either isotretionin for the first 10 days of each month for 6 months (group 1), or each day in the first month, afterwards the first 10 days of each month for 5 months (group 2) or daily for 6 months (group 3). The drug dosage was 0.5 mg/kg/day in all groups. Patients were followed-up for 12 months. Efficacy values were evaluable for 22 patients in group 1, 19 patients in group 2, and 19 patients in group 3. Acne scores in each group were significantly lower at the end of treatment and follow-up periods (P < 0.001). When patients were evaluated separately as moderate (n = 31) and severe (n = 29), no statistically significant differences were obtained among the treatment protocols in patients with moderate acne. However, there was a significant difference between groups 1 and 3 to the response of the treatments in severe acne patients at the end of follow-up period (P = 0.013). The frequency and severity of isotretionin-related side effects were found to be lower in groups 1 and 2 compared with group 3. Intermittent isotretinoin may represent an effective alternative treatment, especially in moderate acne with a low incidence and severity of side effects. The intermittent isotretinoin can be recommended in those patients not tolerating the classical dosage.

Fig. 1

Flow-chart of patients participating in the study. m/s moderate/severe

Fig. 2

The repeated measures of FDA global grades of two different intermittent isotretinoin and classical dosage. The graph reflects all included patients. Differences in acne scores were not statistically significant between the groups (0–18 months) according to the repeated measure of ANOVA (P = 0.554)

Fig. 3

Differences in FDA global grade for patients with moderate acne (n = 31) a and severe acne (n = 29) b at the end of follow-up period. Differences between groups 1 and 3 in severe acne patients was significant (P = 0.013)

Fig. 4

Repeated measures of average severity scores for dry, chapped lips (P < 0.001)

Fig. 5

Repeated measures of VAS for rash or facial redness. Differences in VAS were statistically significant between group 3 and intermittents groups (P = 0.001)