Low-dose Isotretinoin Research Articles

A prospective, randomized, split-face study of concomitant administration of low-dose oral isotretinoin with 30% salicylic acid chemical peeling for the treatment of acne vulgaris in Asian population.

Acne vulgaris (AV) is a common dermatosis. For moderate to severe AV, isotretinoin is the first-line treatment. Chemical peeling with supramolecular salicylic acid (SSA) was developed with water solubility and advanced skin penetration properties. In the present study, we investigated the efficacy and safety of oral low-dose isotretinoin combined with 30% SSA chemical peeling. Thirty-three moderate-to-severe acne patients were enrolled and received oral low-dose (0.2-0.4 mg/kg/d) isotretinoin and were then randomly assigned to receive 30% SSA or not on each side of the face with 2-week intervals for four sessions. Photos, the number of lesions, GAGS score, skin indices (melanin, erythema, pore, and texture), hydration, and transepidermal water loss (TEWL) were assessed at 0, 2, 4, 6, and 10 weeks. Side effects, efficacy, and satisfactory rates were recorded. A total of 29 patients completed the study. Oral isotretinoin combined with SSA decreased response time compared to isotretinoin monotherapy, with significantly improved GAGS score, count of lesions, and efficacy (%) at 4-6 weeks. Skin indices of melanin, erythema, pore, and texture evaluated at week 10 were improved as well. Oral isotretinoin with or without SSA was effective by the lesion clearance; only SSA significantly improved the TEWL. All the side effects were temporary and tolerable, and no adverse effects were observed. Oral low-dose isotretinoin combined with 30% SSA is safe and effective, which advanced the onset of action and improves lesion clearance.

Efficacy and Safety of Adding Low-Dose Isotretinoin to Itraconazole in the Treatment of Chronic Recurrent Dermatophytosis among Sample of Iraqi Patients: An Open-Labelled Therapeutic Clinical Comparative Study.

An increasing number of dermatophytosis is seen now in daily clinical practice, with unusual presentations, running a chronic recurrent course and seems to be more resistant to systemic and topical conventional treatments, which necessitate the use of other treatment options that help to cure these challenging clinical conditions such as isotretinoin along with itraconazole. This is a prospective randomised open-label therapeutic comparative clinical trial to assess the efficacy and safety of low-dose isotretinoin along with itraconazole to treat and reduce the recurrence of this distressing chronic recurrent dermatophytosis. Eighty-one patients with chronic recurrent dermatophytosis with positive mycological examination were recruited, all of them received itraconazole for 7 days per month for 2 consecutive months duration; half of them were randomly chosen to receive low-dose isotretinoin every other day for 2 months in addition to itraconazole. All patients were followed up at monthly intervals for 6 months. The patients who received isotretinoin along with itraconazole showed earlier and complete clearance in 97.5% with a significantly low recurrence rate (12.8%) in comparison with those who received itraconazole alone where the cure rate was relatively slower reported in 53.7% of the patients with a relapse rate of 68.1% with no significant side effects. Low-dose isotretinoin with itraconazole seems to be safe, effective and promising choice in the treatment of chronic recurrent dermatophytosis as it induced earlier complete cure with a significant reduction of recurrence rate.

Erytromelanosis faciei successfully treated with low-dose oral isotretinoin

Erytromelanosis faciei successfully treated with low-dose oral isotretinoin

How safe and effective is prescribing oral isotretinoin to treat acne in patients on renal dialysis? A systematic review.

Patients on renal dialysis often develop severe acne. In spite of this, the literature remains scarce about the use of isotretinoin for the treatment of acne in this group of patients, and many clinicians remain apprehensive and hesitant to use it. To systematically review the literature surrounding the safety and efficacy of isotretinoin for the treatment of acne in patients on renal dialysis. Four electronic databases (MEDLINE, Embase, CINAHL, Emcare) were systematically searched in March 2021. The search strategy incorporated the terms 'isotretinoin', 'renal', 'kidney', 'dialysis' and 'acne', along with terms closely related to these. Studies were considered eligible if they reported the use of isotretinoin for treatment of acne in patients with renal impairment or on renal dialysis, and if they had relevant implications to this topic. The search resulted in a total of 63 results. Using the PRISMA approach, 11 articles were deemed relevant to this review: 1 randomized single-blinded placebo-controlled trial, 2 case series, 2 retrospective studies and 6 case reports. Hence the level of evidence was mostly low (Grading of Recommendations, Assessment, Development and Evaluations level 3). This review of the literature suggests that low-dose isotretinoin (10-20 mg) can safely and successfully be used to treat severe acne in patients on renal dialysis, leading to a significant improvement in their quality of life. As the current literature on this topic is scarce, more studies would be beneficial to further establish the safe use of isotretinoin in patients on renal dialysis.

Should Isotretinoin be Stopped Prior to Surgery?

Should Isotretinoin be Stopped Prior to Surgery?

Does isotretinoin affect spermatogenesis? a rat study

Aim Inthe literature, studies investigating the effects of isotretinoin on spermatogenesis are controversial and there is no consensus. In this study, the aim was to investigate whether isotretinoin has any effects on spermatogenesis and, if present, whether these effects are dose linked or not. Materials and methods Twenty-two rats were divided into four groups. The first group (n=5) was administered 7.5 mg/kg/day and the second group (n=5) was administered 30 mg/kg/day isotretinoin dissolved in sunflower oil orally for 4 weeks. Group 3, the sham group (n=6), was administered only sunflower oil. Group 4 was the control group and was administered standard feed and water. At the end of the fourth week, all rats were killed and histologic investigation was performed. Sperm motility, sperm count, sperm vitality, seminiferous tubule diameters, germinal epithelium thickness, and apoptotic indices were assessed. Follicle-stimulating hormone, luteinizing hormone (LH), and testosterone levels were measured in serum. Results There was a significant degree of reduction in sperm motility, sperm viability, seminiferous tubule diameters, and germinal epithelium thickness in the first and second groups compared with the control group. Sperm count was found to be significantly reduced in the second group compared with the other groups. Follicle-stimulating hormone and luteinizing hormone values were not observed to change in all groups. Conclusion This study concluded that both high-dose and low-dose isotretinoin disrupted spermatogenesis; however, it did not affect the hypothalamic–pituitary–gonadal axis.

Low-dose isotretinoin versus minocycline in the treatment of rosacea.

Rosacea is a common inflammatory facial skin condition affecting the adult population. Its papulopustular subtype is mainly treated pharmacologically by topical and oral antibiotics. For severe or antibiotics-recalcitrant disease, daily low-dose isotretinoin has also been reported to be effective. However, no previous study has assessed the efficacy of once-weekly administered isotretinoin for papulopustular rosacea. For this purpose, a retrospective comparative study was conducted. For severe rosacea, 40 mg/week isotretinoin (24 patients) was administered. For mild to moderate rosacea, once-weekly 20 mg/week isotretinoin (28 patients) was compared with 100 mg/day minocycline (24 patients). Treatment courses lasted 4 to 7months. Forty milligrams per week isotretinoin was highly effective for severe rosacea, achieving complete response (over 90% improvement) in 62.5% of patients and partial response (50%-90% improvement) in additional 29.2% of patients. Twenty milligrams per week isotretinoin and hundred milligrams per day minocycline showed comparable efficacy for mild to moderate rosacea (complete response of 10.7% vs 8.3% and partial response of 28.6% vs 33.3%, respectively). This study demonstrates that that the use of a weekly low-dose isotretinoin is an effective treatment for papulopustular rosacea, including among patients with severe disease.

Cryotherapy plus low-dose oral isotretinoin vs cryotherapy only for the treatment of anogenital warts: a randomized clinical trial.

Anogenital warts are a common human papillomavirus infection. They cause emotional distress, especially when they are in the anogenital region. Cryotherapy is a first-line treatment. Previous clinical trials and case series have reported variable results with retinoids (isotretinoin) as adjuvant therapy. To determine the safety and efficacy of low-dose oral isotretinoin as adjuvant treatment of anogenital warts. Forty-six patients with anogenital warts were randomly assigned to isotretinoin + cryotherapy (n = 23) or only cryotherapy (n = 23). Patients were allocated via an interactive web-based randomization system. Evaluators were blinded to treatments. Isotretinoin 20mg/daily + cryotherapy or cryotherapy were prescribed for 6weeks. Patients were followed for 4months. Genotyping of lesions was performed before treatment started. Dermatology Life Quality Index (DLQI) and Columbia-Suicide Severity Rating Scale (C-SSRS) were measured at the beginning and end of therapy. All patients completed the study. Both Groups had 50% clearance at the end of treatment. Recurrence in the combined group was not significantly lower than in the cryotherapy group (P = 0.59). Improvement was observed in the DLQI of all patients in both groups (P = 0.001). No suicidal intention was detected with the C-SSRS. Two patients (one in each group) had liver function test abnormalities after treatment. Combined therapy showed a slight not significant efficacy for anogenital warts in Hispanic patients. Low-dose isotretinoin seems to be safe even when it is used with cryotherapy on anogenital warts. On April 25, 2019 with registration number DE19-00004, CONBIOÉTICA-19-CEI-001-20160404. Prospectively registered.

Lupus miliaris disseminatus faciei with complete response to isotretinoin

Lupus miliaris disseminatus faciei is an uncommon type of granulomatous rosacea characterized by a papular eruption in the central regions of the face. A 43-year-old woman presented with an asymptomatic papular eruption on the face that had developed over a period of five months. Physical examination revealed multiple, small, reddish-brown papules, distributed symmetrically on the central area of the face. A biopsy was taken, showing dermal epithelioid cell granulomas with central necrosis and surrounding lymphocytic infiltrate with multinucleate giant cells. No foreign bodies were found in granulomas and no mycobacterial or fungal components were detected. On the basis of these findings, the diagnosis of lupus miliaris disseminatus faciei was made. The patient was given oral isotretinoin 20mg/day with initial slow response. After 6 months' treatment the lesions completely disappeared. Many authors consider this entity to be a variant of granulomatous rosacea. It is a chronic condition that primarily affects young adults. Treatment is usually unsatisfactory. Therapies with corticosterois, tetracyclines, retinoids, clofazimine or topical tacrolimus have been described but there is a lack of controlled studies and convincing results. Our success with a 6-month course of low dose isotretinoin suggests consideration of a longer trial prior to abandoning this as treatment.

Evaluation of low doses effect of systemic isotretinoin in monotherapy and combination on qualitative and quantitative composition of microbiota in patients with acne

Objective.To evaluate the effect of low doses of systemic isotretinoin in monotherapy and combination on the qualitative and quantitative composition of the microbiota in patients with acne with moderate papulo-pustular acne.Materials and methods. 78 patients were monitored on an outpatient basis. Group 1 consisted of 38 patients. This group was divided into two age subgroups: A (12–24 years; n = 18) and B (25–45 years; n = 20). All patients in group 1 received monotherapy in the form of systemic administration of isotretinoin at a dose of 0.5–0.7 mg per 1 kg of body weight per day daily for 6 months. Group 2 consisted of 40 patients who were also divided into two age groups: A (12–24 years; n = 21) and B (25–45 years; n = 19). This group received combination therapy with isotretinoin at a dose of 0.1–0.3 mg per kg of body weight per day daily for 6 months in combination with phototherapy with broadband incoherent light (wavelength 440–950 nm) once every two weeks, a course of 4–6 procedures. To study the features of the qualitative and quantitative composition of the skin microbiota of acne patients, all patients were scraped and smeared with a sterile cotton swab before and after therapy, followed by analysis of microbial markers by chromatography-mass spectrometry.Results. Against the background of monotherapy in patients of different age groups, there was a positive dynamic in relation to the majority of microbiota indicators, its severity in subgroup A (12–24 years) was statistically more significant (p < 0.05). However, the complete normalization of the composition of the facial skin microbiota in both subgroups did not occur. After combination therapy, there was a pronounced positive dynamics and normalization of most indicators of the microbiota of the skin, regardless of age. However, the number of some targeted microorganisms turned out to be slightly higher than normal and after therapy.Conclusions. The use of low-dose isotretinoin monotherapy, as well as its combination with broadband incoherent light, does not allow to completely normalize the composition of the microbiota in patients suffering from acne papulo-pustular form of moderate severity, which requires further study and analysis.

Efficacy of combined use of low-dose isotretinoin and phototherapy in patients with different subtypes of rosacea

Material and methods. 73 patients with different subtypes of rosacea were under observation on an outpatient basis. To study the effectiveness of the combined method of treatment, all patients, depending on the therapy used by the method of simple randomization, were divided into 2 groups, within the groups into 3 subgroups, depending on the subtype of rosacea. Patients of the 1st group received monotherapy with isotretinoin at a dose of 8 mg per day in a daily regimen for three months, then in a regimen every other day for another 3 months. Patients in group 2 received combined therapy with isotretinoin in combination with phototherapy with broadband incoherent light (wavelength 440–950 nm) once every two weeks, a course of 4–6 procedures. Patients of all groups used specialized dermatological cosmetics throughout the study period.Research results. The developed combined method, regardless of the subtype of rosacea, is more effective than monotherapy with isotretinoin: with ETPR, the total DISHS index decreased by 91.2%; with PPPR by 89.6%; with a combination of subtypes by 93.8% versus 41.6%, 53.4% and 54.0% in group 1, respectively.Conclusion. The developed combined method contributes to a more pronounced improvement in the quality of life compared to monotherapy: the DIKI index in group 2 with ETPR decreased by 70.5%, with PPPD by 88.5%, with a combination of subtypes by 95.0%, while in 1 group by 36.3%, 72.4% and 73.8%, respectively.

Systematic review of low-dose isotretinoin for treatment of acne vulgaris: Focus on indication, dosage, regimen, efficacy, safety, satisfaction, and follow up, based on clinical studies.

Oral isotretinoin is the most effective treatment for moderate to severe acne and its side effects are mostly dose-dependent. Low dose isotretinoin (0.5 mg/kg/day for 1 week every 4 weeks for 6-months) could be effective and even in its end result, comparable with high or optimal doses. In this systematic review, we aimed to sum up the results of clinical trials regarding indications, dosage, prescription protocol, effectiveness, side effects, patient satisfaction, recurrence rate, and follow-up period of low dose isotretinoin in treatment of acne. Cochrane, Google Scholar, Science Direct, PubMed, and Medline were searched. A total of 460 articles were searched electronically and 382 articles were excluded. About 4 were non-English and 2, before 1980. The full text of 72 articles was reviewed. Finally 15 documents met the inclusion criteria for entering this systematic review. The standard dose of isotretinoin is 0.5-1 mg/kg/day for 4 months with a total dose of 120-140 mg/kg/day. Daily doses between 0.1 and 0.3 mg/kg can be recommended for more than 6 months due to the occurrence of fewer side effects and more economical concerns. For greater effectiveness, it could be combined with other medications.

17980 Severe nodulocystic acne in a renal dialysis patient managed successfully with low-dose isotretinoin

A 31-year-old woman with a background of a previous simultaneous pancreas-kidney (SPK) transplant with failed kidney, on long-term dialysis, was referred to our dermatology service for management of severe nodulocystic acne. She had type 1 diabetes, with secondary retinopathy, nephropathy and gastroparesis. Examination revealed severe nodulocystic acne affecting her face and neck, with evidence of scarring. Previous treatments included conventional topical treatments, as well as oral oxytetracycline. Her regular medications were mycophenolate mofetil, prednisolone, isoniazid, and paroxetine. Six months of low dose isotretinoin treatment (20 mg daily) resulted in complete resolution of her acne and there have been no adverse side effects reported thus far. Nodulocystic acne is not uncommon in renal dialysis patients. The mechanism of this whilst still largely unknown, has previously been postulated to be related to the toxic effect of uraemia. Nodulocystic acne often has a significantly negative impact on a patient’s quality of life and often fails to respond to conventional acne therapy. The use of low dose isotretinoin to treat acne in haemodialysis patients has been scarcely reported with only Lin et al’s prospective study in 1999 showing significant efficacy and minimal side effects. Renal elimination of isotretinoin and its metabolites is known to be negligible, and isotretinoin is protected from haemodialysis removal through its protein binding. Our case adds to the evidence that low-dose isotretinoin can safely and successfully be used to treat severe nodulocystic acne in renal dialysis patients, leading to a significant improvement in patients’ quality of life.

Combined Low-Dose Isotretinoin and Pulsed Dye Laser Versus standard-Dose Isotretinoin in the Treatment of Inflammatory Acne.

Acne is a widespread disorder of the pilosebaceous unit. Isotretinoin is the background treatment of cases of severe acne. Side effects associated with the standard 0.5-1 mg/kg/day dose decrease patient compliance. Pulsed dye laser (PDL) was proved effective in the management of inflammatory acne. The focus was to evaluate the efficacy of combining low-dose isotretinoin (0.25 mg/kg/day) with PDL in comparison with the standard higher-dose isotretinoin (0.5 mg/kg/day) as monotherapy for the management of acne vulgaris. The current prospective randomized comparative study included 46 acne patients, who were randomly divided into two groups. The first (ISO/PDL group) was treated with oral isotretinoin (0.25 mg/kg/day) and five sessions of PDL. The second (ISO group) was treated with oral isotretinoin (0.5 mg/kg/day). The physician's clinical assessment was done by three blinded dermatologists using quartile scale score and erythema score at baseline, 3 months, and 6 months and global acne grading system (GAGS) at baseline and 6 months. Patient satisfaction was assessed using the Cardiff Acne Disability Index (CADI). Both groups showed a significant improvement in all assessed parameters compared with baseline at 3 and 6 months. Comparing both groups together, the ISO/PDL group showed a statistically significantly greater improvement regarding all parameters at both assessment times. Regarding adverse events, six patients (26%) suffered from flare in the ISO group versus none in the combined group. Dryness was encountered in 20 patients (86%) in the ISO group versus five patients (21%) in the other group. The ISO/PDL group received significantly less cumulative isotretinoin dosage (48.7 ± 5.7 mg/kg) in comparison to the ISO group (100.4 ± 3.1 mg/kg) (P < 0.05). The current study offers a new collaboration between two well-studied and established treatment modalities leading to a harmony of therapeutic synergism while minimizing the risk of side effects. Longer periods of follow-up are recommended to diagnose any relapses and modify the proposed protocol. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Treatment of Moderate to Severe Acne and Scars With a 650-Microsecond 1064-nm Laser and Isotretinoin

Background: Laser procedures for acne and acne scars have traditionally been postponed for at least 6 to 8 months after the end of systemic isotretinoin therapy. Lower dosages with more modern laser devices having unique energy parameters of high power in microsecond pulse durations have made it possible to administer laser therapy during or shortly after completion of isotretinoin therapy, thus reducing the risk of side effects of isotretinoin.Methods: Patients with moderate to severe facial acne (n=46) and atrophic scars enrolled in a 6-month study. Genetic analysis of patients revealed the presence of polymorphisms of genes Col1A2, MMP3, ESR1, MMP1, and MMP7, which can lead to scar formation. Patients underwent low-dosage isotretinoin therapy (0.2-0.3 mg/kg/day) in combination with facial laser treatment using a 650-microsecond, 1064-nm Nd: YAG laser. Acne severity was graded using the Investigators Global Assessment (IGA) scale and quality of life was evaluated by the Dermatology Life Quality Index (DLQI). Results: IGA parameters decreased from 1.8 ± 0.2 (mean ± SD) initially to 0.5 ± 0.4 at the end of the study, a 72.3% reduction which was significant (P<0.01). The DLQI index decreased from 10.1 ± 1.3 initially to 2.8 ± 1.2, a 72.3%, a significant reduction (P<0.01). Inflammatory elements resolved without scarring. Laser treatment was well tolerated and improvement in pre-existing scars was noticeable. Conclusions: The 650-microsecond, 1064-nm laser in combination with low-dose isotretinoin is safe and effective in patients with acne complicated by atrophic scars and genetically prone to post-acne scarring. J Drugs Dermatol. 2020;19(6): doi:10.36849/JDD.2020.5108

Safety of Combined Fractional Microneedle Radiofrequency and CO2 as an Early Intervention for Inflammatory Acne and Scarring Treated With Concomitant Isotretinoin.

Fractional microneedle radiofrequency (FMRF) systems are popular options for treating acne scars. However, treatment efficacy when used in combination with traditional ablative fractional laser (AFL) and the safety profile with concomitant use of isotretinoin remain unknown. The aim of this study was to assess the safety and efficacy of an early intervention combination treatment protocol for inflammatory acne and acne scars. The electronic records of 71 patients with inflammatory acne and acne scars were included in this retrospective observational study. Data were collected for all patients who received combination FMRF and AFL. Within the study group, 43 patients were receiving low-dose isotretinoin or had completed isotretinoin within the past 3 weeks. The mean Scar Global Assessment score significantly decreased after 3 sessions of combination treatment (n = 71). Patients with inflammatory acne showed a significant decrease in the number of inflammatory lesions (n = 30). Patients with concomitant low-dose isotretinoin use reported a further decrease in Scar Global Assessment score (n = 43). There were no reported persistent side effects, including prolonged inflammatory reaction or scarring. Combination treatment with FMRF and AFL is an effective and well-tolerated treatment modality for acne scars and inflammatory acne.

Assessment of Plasma Homocysteine in Acne Patients isotretinoim Therapy

Abstract Background Acne is a chronic inflammatory disorder of the pilosebaceous unit. Oral isotretinoin is a highly effective treatment for patients with moderate and severe, but causes significant side effects. Objective To estimate homocysteine level in acne patients after treatment with isotretinoin. Patients and Methods The prospective study was conducted at Ain Shams University Faculty of Medicine, Egypt, from June 2017 to November 2017, including male or non-pregnant female patients more than 18 years of age, categorized by the Global Evaluation Acne (GEA) into 22 patients with moderate acne vulgaris and 22 patients with severe acne. Isotretinoin was started in a dosage of 0.5 mg/kg/day, and 1.0mg/kg/day in moderate and severe acne patients respectively. Baseline homocysteine level, liver function tests, serum cholesterol and lipid profile were tested before and after 3 months. Results There was significant difference (p = 0.001) in homocysteine level among all cases Moreover, homocysteine serum level in patient's group who received high dose isotretinoin (1 mg/kg/d) showed highly significant results (p = 0.001) in contrast to patient's group who received low dose isotretinoin (0.5 mg/kg/d) = 0.003). A significant increase in lipid profile and liver function test was seen in all cases. Conclusion low dose isotretinoin seems to have less side effects on basic laboratory data such as CBC, liver function tests, lipid profile and homocysteine serum levels than high dose.

Optimizing Isotretinoin Treatment of Acne: Update on Current Recommendations for Monitoring, Dosing, Safety, Adverse Effects, Compliance, and Outcomes.

Acne vulgaris is the most common skin disease treated by dermatologists. It can be severe and result in permanent scars. Isotretinoin is the most effective treatment for acne and has the potential for long-term clearance. Prescribing and monitoring protocols can vary widely among prescribers. Recent studies, reports, and consensus statements help shed light on optimizing the use of isotretinoin for acne. A recent literature review is summarized in this article to help the practitioner optimize isotretinoin use for acne. The article outlines the advantages and disadvantages of standard, high-dose, and low-dose isotretinoin regimens; discusses the current status of controversies surrounding isotretinoin (including depression/suicide, pregnancy, and inflammatory bowel disease); reviews monitoring recommendations and treatment for hypertriglyceridemia and elevated transaminase levels; and discusses common adverse effects seen with isotretinoin, along with their treatment and prevention.

Low dose of isotretinoin: A comprehensive review.

Isotretinoin is a first-generation retinoid initially approved for the treatment of severe cases of acne vulgaris (nodulocystic acne). Because of its broad anti-inflammatory and immunomodulatory properties, it has been used beyond its initial approval in a myriad of other indications. Adverse effects of isotretinoin vary from xerosis to teratogenicity. Herein, we reviewed the literature, through date-unlimited PubMed search, from inception till December 2019, using the following search terms: "low-dose isotretinoin" and "dermatology," "isotretinoin and safety," "isotretinoin, off-label uses," "isotretinoin and male fertility," "isotretinoin, iPLEDGE system," aiming to deliver a therapeutic update relevant to clinical practice. All English-language articles were considered with no limitation based on the articles' type. Low-dose isotretinoin is not limited to old and novel dermatological conditions, but also showed promising results in the field of infertility and safety in the field of gastroenterology. We also highlight on the safety profile of the drug and experts' recommendations to enhance safety measures to decrease fetal risk while on isotretinoin.

Acne fulminans induced by a low dose isotretinoin: case report and review of the literature

Acne fulminans is a rare complication of classic acne. Less than 200 cases have been reported. It usually affects adolescent males with pre-existing acne vulgaris. It is characterized by an acute eruption of numerous and large inflammatory nodules, plaques, erosions, and ulcers covered by hemorrhagic crusts. The disorder may occur spontaneously or may be triggered by isotretinoin. We report a young boy who developed acne fulminans after isotretinoin therapy at a dose of 0.1mg/kg/day. A systematic literature review gathering previously reported cases on PubMed revealed that one similar case has been reported. Regarding therapeutic strategies, there are no randomized clinical trials to identify the best treatment for acne fulminans. Recommendations are based on case series and case reports. We share this case to raise awareness of the induction of acne fulminans by a very low dose of isotretinoin.