Low-cumulative dose isotretinoin treatment in mild to moderate acne: efficacy in achieving stable remission

Background: Aimed at the reduction of post-treatment relapse of severe acne, the cumulative dose of oral isotretinoin should be ≥ 120 mg/kg. However, data on the appropriate oral isotretinoin treatment regimen in mild and moderate acne are lacking. Objective: The purpose of this study was to determine the efficacy of an isotretinoin-sparing protocol in inducing permanent remission of mild and moderate acne. Methods: In this open, prospective, noncomparative study 150 patients affected with mild to moderate acne were treated with isotretinoin until complete recovery and for a further month of treatment, independently of the total cumulative dose reached. Patients then underwent a 1-year maintenance therapy with adapalene 0.1% cream. Patients were followed up for a further year, without any treatment. Results: 139 patients completed the study. Overall, patients received a mean of 80.92 mg/kg cumulative dose of isotretinoin. In the 2-year follow-up, relapse only appeared in 13 patients (9.35%). Conclusion: Comparing our findings with published data, this isotretinoin-sparing regimen was shown to be effective in inducing stable remission and preventing acne relapses in patients with mild to moderate acne. Low cumulative dose regimens may potentially lead to a lower incidence of side effects and to lower costs than higher doses.