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