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Low-dose isotretinoin in acne vulgaris

Richa Gupta, Priyanka Singhal, Yogesh Marfatia.

Abstract
Background: Oral isotretinoin is the only drug counteracting all the pathogenetic mechanisms causing acne. Its proper use can minimize scarring and induce long-term remission.

Objective: To assess the efficacy and safety of low-dose (0.5 mg/kg/day) isotretinoin in cases of acne vulgaris with the help of this prospective, single-arm, interventional study.

Materials and Methods: Cases with grades II (resistant cases), III, and IV acne vulgaris were enrolled. They were given oral isotretinoin for 4 months. After the completion of 4 months, those with complete clearance of lesions were switched to pulse therapy (1 week on, 3 weeks off), while those with new lesions were continued on isotretinoin for another 2 months. The total duration of therapy was for 6 months, and posttherapy cases were followed up for 6 months to check for relapse.

Result: A total of 96 patients were enrolled in the study. At 2-, 4-, and 6-months therapy, complete clearance was seen in 26.7%, 46.7%, and 93.3% in acne grade II (n = 15); 7.9%, 26.3%, and 60.5% in grade III (n = 38); 0%, 26.3%, and 52.6% in grade IV (n = 38) patients, respectively, and 7.4% and 14.1% cases on pulse and continuous therapies, respectively, showed recurrence 6 months after stoppage of therapy. The most common adverse drug reaction was cheilitis (89%). All mucocutaneous adverse events subsided with time, none warranting discontinuation of therapy.

Conclusion: Low-dose isotretinoin (0.5 mg/kg/day) therapy has a good efficacy and is associated with minimal side effects, improving patients’ compliance and acceptability.

Key words: Acne vulgaris, isotretinoin, low-dose therapy



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