“I am often asked, ‘How many times isotretinoin can be used?’ My answer is, ‘As often as it is needed,’” Dr. Leyden says. “Treatment with isotretinoin at a very low dose can get patients to 100% clear without causing significant side effects,” Dr. Leyden says. “Why treat severe relapses any other way?”
RISK OF RELAPSE
Dr. Leyden observed that an “almost religious belief” now exists that the risk of relapse after successful treatment with isotretinoin is tied to the total cumulative dose. He suggested this idea originated from a single sentence included in an isotretinoin treatment guidelines paper published in the 1990s for which Dr. Leyden was a co-author.1
“The sentence states there is a possible connection between remission and the total cumulative dose. I violently opposed the concept, but I was outvoted,” he says.
Instead, according to Dr. Leyden, patient age is the most important factor determining risk of relapse after successful isotretinoin treatment. As shown in an analysis of iPLEDGE data looking at the need for isotretinoin retreatment among more than 3000 patients aged 10 years and above, the incidence of relapse decreased with increasing patient age and plateaued in groups aged >18 years.
“This finding is consistent with what we know about the benefit of x-ray treatment for acne and corresponds with the natural history of the disease,” Dr. Leyden says.
He added that no systematic studies have looked at whether relapse in younger patients is influenced by isotretinoin dose.
1. Cunliffe WJ, van de Kerkhof PC, Caputo R, et al. Roaccutane treatment guidelines: results of an international survey. Dermatology. 1997;194(4):351-357.