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Invited Commentary | Practice Gaps

Challenges in Optimizing Isotretinoin Use for Acne Vulgaris

Thomas J. McIntee, MD1; Anna L. Bruckner, MD2,3
[+] Author Affiliations
1Department of Dermatology, Marshfield Clinic, Marshfield, Wisconsin
2Department of Dermatology, Children’s Hospital Colorado, University of Colorado, Aurora
3Department of Pediatrics, Children’s Hospital Colorado, University of Colorado, Aurora
JAMA Dermatol. 2013;149(12):1398. doi:10.1001/jamadermatol.2013.7225.
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Acne vulgaris is one of the most common skin disorders affecting adolescents and young adults. Food and Drug Administration approval of isotretinoin in 1982 dramatically changed the management of nodulocystic and severe, recalcitrant acne. Isotretinoin remains the only acne treatment associated with complete remission and “cure” of nodulocystic acne. Yet despite the dramatic effect of the drug, disease relapse can occur after isotretinoin therapy.

Multiple treatment algorithms and dosing regimens have been proposed for isotretinoin, and a cumulative dose of 120 to 150 mg/kg is widely accepted as the standard treatment protocol. Alternative strategies have been designed to optimize drug dosing to achieve acceptable clinical results while minimizing adverse effects. Such regimens range from 0.2 mg/kg/d to greater than 2 mg/kg/d of isotretinoin with variations in treatment duration. These differing opinions on the dosing of isotretinoin expose a gap in our medical knowledge about optimal isotretinoin dosing for acne vulgaris.

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