Oral isotretinoin: patient selection and management

Abstract

Oral isotretinoin therapy should now be considered in many patients with moderate acne. The retinoid brings about a significant reduction in the physical and psychological effects of the condition. Oral isotretinoin is recommended in patients with severe acne and moderate acne unresponsive to conventional therapy. Patients with scarring, high sebum excretion rates, severe depression or dysmorphophobia and with some unusual variants, such as acne fulminans, Gram-negative folliculitis and pyoderma faciale, can also benefit. For moderate acne isotretinoin is recommended if there is a less than 50% improvement, or relapse, after 2–3 courses of oral antibiotics. Recent research has shown an increased incidence of resistant strains of propionibacteria. This is often associated with increasing difficulty in management with oral antibiotics. Such patients often require isotretinoin. The cumulative dose of the retinoid seems to be of great importance in the success of the therapy and a dose of some 120 mg/kg appea...