Acne: low dose isotretinoin 10 mg daily is effective with fewer side effects

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Goodfellow Gems

"Acne: low dose isotretinoin 10 mg daily is effective with fewer side effects"

The latest Alberta Tools for Practice1 (#158) found that small randomized controlled trials (RCTs) and observational studies demonstrate low-dose (~20mg/day) isotretinoin improves acne similar to conventional dosing.  Low-dose may reduce common side effects (chapped lips, dry skin, epistaxis) by 16-35% but may be associated with increased relapse rates, particularly with severe acne and/or possibly impacted by lower total accumulated dose. Dr Marius Rademaker alluded to this in his 2013 article where he suggests starting start with doses of 10 mg/day, and continue until all the active acne lesions have resolved and continue treatment for a further 2–4 months, perhaps at the lower dose of 5–10 mg/day (or 10 mg alternate day) to reduce the risk of relapse and help with resolution of acne scarring.2 I have been using the Rademaker approach for over two years and have had excellent results and no cracked lips nor red faces. I have no cases of flares as predicted by him.

References:

  1. https://www.acfp.ca/tools-for-practice/ #158
  2. Marius Rademaker. Isotretinoin: dose, duration and relapse. What does 30 years of usage tell us? Australasian Journal of Dermatology (2013) 54, 157–162

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.


As published in NZ Doctor 27/04/2016