High-dose isotretinoin in acne vulgaris: Improved treatment outcomes and quality of life

Amanda A. Cyrulnik, Kate V. Viola, Aron J. Gewirtzman, Steven R. Cohen

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background Isotretinoin, for acne treatment, is associated with high rates of permanent remission. However, at recommended doses of 0.5-1.0 mg/kg/day for 5-6 months [average cumulative dose: 120-150 mg/kg], more than 20% of patients experience a relapse within two years that requires further medical management. Objective To examine outcomes of high-dose isotretinoin in a cohort with cystic acne, as well as measuring its impact on quality of life (QOL). Methods A single dermatologist, single institution investigation within an academic tertiary care center in Bronx, NY. Eighty patients with nodulocystic acne, maintained on oral isotretinoin at a dose of 1.3 mg/kg/day or greater, were studied from 2006-2009 while additionally participating in a QOL survey. Main outcome measures included documented events, acne clearance, presence of relapse, and quality of life parameters. Results The mean daily dose of isotretinoin was 1.6 mg/kg/day for an average time course of 178 days [cumulative dose: 290 mg/kg]. No side effects or laboratory abnormalities led to discontinuation of treatment. There were no psychiatric symptoms. One-hundred percent (100%) of patients were disease-free upon completion of treatment. During the three-year study period, 10 patients (12.5%) developed a relapse that required an additional course of isotretinoin. Analysis of QOL domains (self-perception, role-social, symptoms) revealed significant improvement following isotretinoin therapy (p = 0.0124, p = 0.0066, p = 0.0265, respectively). Conclusions Isotretinoin prescribed at 1.5 mg/kg/day or greater for 5-6 months [cumulative total dose of 290 mg/kg] is safe and effective compared to current standard dosing practices. We propose the use of high-dose isotretinoin (>1.3 mg/kg/day) as a treatment option in severe nodulocystic acne and encourage larger, prospective, multicenter studies into this therapeutic approach.

Original languageEnglish (US)
Pages (from-to)1123-1130
Number of pages8
JournalInternational Journal of Dermatology
Volume51
Issue number9
DOIs
StatePublished - Sep 2012

Fingerprint

Isotretinoin
Acne Vulgaris
Quality of Life
Recurrence
Therapeutics
Tertiary Care Centers
Self Concept
Multicenter Studies
Psychiatry
Outcome Assessment (Health Care)
Prospective Studies

ASJC Scopus subject areas

  • Dermatology

Cite this

High-dose isotretinoin in acne vulgaris : Improved treatment outcomes and quality of life. / Cyrulnik, Amanda A.; Viola, Kate V.; Gewirtzman, Aron J.; Cohen, Steven R.

In: International Journal of Dermatology, Vol. 51, No. 9, 09.2012, p. 1123-1130.

Research output: Contribution to journalArticle

Cyrulnik, Amanda A. ; Viola, Kate V. ; Gewirtzman, Aron J. ; Cohen, Steven R. / High-dose isotretinoin in acne vulgaris : Improved treatment outcomes and quality of life. In: International Journal of Dermatology. 2012 ; Vol. 51, No. 9. pp. 1123-1130.
@article{1193407c70f844739e06ee61dacda7e9,
title = "High-dose isotretinoin in acne vulgaris: Improved treatment outcomes and quality of life",
abstract = "Background Isotretinoin, for acne treatment, is associated with high rates of permanent remission. However, at recommended doses of 0.5-1.0 mg/kg/day for 5-6 months [average cumulative dose: 120-150 mg/kg], more than 20{\%} of patients experience a relapse within two years that requires further medical management. Objective To examine outcomes of high-dose isotretinoin in a cohort with cystic acne, as well as measuring its impact on quality of life (QOL). Methods A single dermatologist, single institution investigation within an academic tertiary care center in Bronx, NY. Eighty patients with nodulocystic acne, maintained on oral isotretinoin at a dose of 1.3 mg/kg/day or greater, were studied from 2006-2009 while additionally participating in a QOL survey. Main outcome measures included documented events, acne clearance, presence of relapse, and quality of life parameters. Results The mean daily dose of isotretinoin was 1.6 mg/kg/day for an average time course of 178 days [cumulative dose: 290 mg/kg]. No side effects or laboratory abnormalities led to discontinuation of treatment. There were no psychiatric symptoms. One-hundred percent (100{\%}) of patients were disease-free upon completion of treatment. During the three-year study period, 10 patients (12.5{\%}) developed a relapse that required an additional course of isotretinoin. Analysis of QOL domains (self-perception, role-social, symptoms) revealed significant improvement following isotretinoin therapy (p = 0.0124, p = 0.0066, p = 0.0265, respectively). Conclusions Isotretinoin prescribed at 1.5 mg/kg/day or greater for 5-6 months [cumulative total dose of 290 mg/kg] is safe and effective compared to current standard dosing practices. We propose the use of high-dose isotretinoin (>1.3 mg/kg/day) as a treatment option in severe nodulocystic acne and encourage larger, prospective, multicenter studies into this therapeutic approach.",
author = "Cyrulnik, {Amanda A.} and Viola, {Kate V.} and Gewirtzman, {Aron J.} and Cohen, {Steven R.}",
year = "2012",
month = "9",
doi = "10.1111/j.1365-4632.2011.05409.x",
language = "English (US)",
volume = "51",
pages = "1123--1130",
journal = "International Journal of Dermatology",
issn = "0011-9059",
publisher = "Wiley-Blackwell",
number = "9",

}

TY - JOUR

T1 - High-dose isotretinoin in acne vulgaris

T2 - Improved treatment outcomes and quality of life

AU - Cyrulnik, Amanda A.

AU - Viola, Kate V.

AU - Gewirtzman, Aron J.

AU - Cohen, Steven R.

PY - 2012/9

Y1 - 2012/9

N2 - Background Isotretinoin, for acne treatment, is associated with high rates of permanent remission. However, at recommended doses of 0.5-1.0 mg/kg/day for 5-6 months [average cumulative dose: 120-150 mg/kg], more than 20% of patients experience a relapse within two years that requires further medical management. Objective To examine outcomes of high-dose isotretinoin in a cohort with cystic acne, as well as measuring its impact on quality of life (QOL). Methods A single dermatologist, single institution investigation within an academic tertiary care center in Bronx, NY. Eighty patients with nodulocystic acne, maintained on oral isotretinoin at a dose of 1.3 mg/kg/day or greater, were studied from 2006-2009 while additionally participating in a QOL survey. Main outcome measures included documented events, acne clearance, presence of relapse, and quality of life parameters. Results The mean daily dose of isotretinoin was 1.6 mg/kg/day for an average time course of 178 days [cumulative dose: 290 mg/kg]. No side effects or laboratory abnormalities led to discontinuation of treatment. There were no psychiatric symptoms. One-hundred percent (100%) of patients were disease-free upon completion of treatment. During the three-year study period, 10 patients (12.5%) developed a relapse that required an additional course of isotretinoin. Analysis of QOL domains (self-perception, role-social, symptoms) revealed significant improvement following isotretinoin therapy (p = 0.0124, p = 0.0066, p = 0.0265, respectively). Conclusions Isotretinoin prescribed at 1.5 mg/kg/day or greater for 5-6 months [cumulative total dose of 290 mg/kg] is safe and effective compared to current standard dosing practices. We propose the use of high-dose isotretinoin (>1.3 mg/kg/day) as a treatment option in severe nodulocystic acne and encourage larger, prospective, multicenter studies into this therapeutic approach.

AB - Background Isotretinoin, for acne treatment, is associated with high rates of permanent remission. However, at recommended doses of 0.5-1.0 mg/kg/day for 5-6 months [average cumulative dose: 120-150 mg/kg], more than 20% of patients experience a relapse within two years that requires further medical management. Objective To examine outcomes of high-dose isotretinoin in a cohort with cystic acne, as well as measuring its impact on quality of life (QOL). Methods A single dermatologist, single institution investigation within an academic tertiary care center in Bronx, NY. Eighty patients with nodulocystic acne, maintained on oral isotretinoin at a dose of 1.3 mg/kg/day or greater, were studied from 2006-2009 while additionally participating in a QOL survey. Main outcome measures included documented events, acne clearance, presence of relapse, and quality of life parameters. Results The mean daily dose of isotretinoin was 1.6 mg/kg/day for an average time course of 178 days [cumulative dose: 290 mg/kg]. No side effects or laboratory abnormalities led to discontinuation of treatment. There were no psychiatric symptoms. One-hundred percent (100%) of patients were disease-free upon completion of treatment. During the three-year study period, 10 patients (12.5%) developed a relapse that required an additional course of isotretinoin. Analysis of QOL domains (self-perception, role-social, symptoms) revealed significant improvement following isotretinoin therapy (p = 0.0124, p = 0.0066, p = 0.0265, respectively). Conclusions Isotretinoin prescribed at 1.5 mg/kg/day or greater for 5-6 months [cumulative total dose of 290 mg/kg] is safe and effective compared to current standard dosing practices. We propose the use of high-dose isotretinoin (>1.3 mg/kg/day) as a treatment option in severe nodulocystic acne and encourage larger, prospective, multicenter studies into this therapeutic approach.

UR - http://www.scopus.com/inward/record.url?scp=84865349545&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84865349545&partnerID=8YFLogxK

U2 - 10.1111/j.1365-4632.2011.05409.x

DO - 10.1111/j.1365-4632.2011.05409.x

M3 - Article

C2 - 22909370

AN - SCOPUS:84865349545

VL - 51

SP - 1123

EP - 1130

JO - International Journal of Dermatology

JF - International Journal of Dermatology

SN - 0011-9059

IS - 9

ER -