Standard Accutane Treatment vs. Staggered or Intermittent Treatment

Ayse Akman, Cicek Durusoy, Meltem Senturk, Cilem Kaya Koc, Durali Soyturk, Erkan Alpsoy.

Treatment of acne with intermittent and conventional isotretinoin: a randomized, controlled multicenter study.

Arch Dermatol Res. 2007 December; 299(10): 467–473

The purpose of this study was to asses the efficacy and tolerability of two different intermittent isotretinoin courses of treatment and compare them with conventional isotretinoin therapy. Oral isotretinoin is the most effective choice in the treatment of severe acne and is increasingly being used to treat patients with moderate but potentially scarring acne when they fail to respond to other therapies. However, the drug is known to have many adverse effects. There have been reports recently that some acne patients have been benefiting from the low dose or intermittent treatment protocols, but there is very little data available.

The study participants included sixty six patients with moderate tor severe acne, who had not responded to conventional antibiotic therapy or who had rapidly relapsed after the treatment. The participants were randomized into three groups. Group One received isotretinoin for the first ten days of each month for six months. Group Two were treated with the drug daily for the first month, then for the first ten days of each month for the next five months. Group Three received isotretinoin daily for six months. The drug dosage was 0.5 mg/kg/day in all groups.

Participants were examined clinically and the severity of their acne was graded at the baseline, every month during therapy, after therapy, and every 3 months for a 12-month follow-up period. Liver function and fasting lipids were tested at the baseline, monthly during the treatment, and at completion of treatment. The female participants also had a pregnancy test prior to commencing treatment and were given contraceptive counseling during the treatment and for the next 3 months. During the treatment period, physicians also evaluated and recorded side effects at weeks 2, 4, 8, 12, 16, 20 and 24.

Sixty participants completed the course of treatment and the twelve month follow up. The severity of their acne was significantly decreased at the end of treatment and at the end of the follow up period for all three groups compared with the baseline values. The most statistically significant differences in response to treatment were found between groups 1 and 3 in those patients that had severe acne at the onset of treatment. There was an increased likelihood of the acne recurring in those with severe acne in Group 1. The frequency of side effects was highest in group 3. Participants from all groups experienced dry skin and chapped lips. Some participants in Group 3 also experienced nosebleeds and/or fatigue.

The study found that intermittent isotretinoin treatment regimens were effective, especially in mild to moderate acne patients, with a reduced risk of side effects and increased patient compliance. The researchers recommend both of the intermittent protocols for those patients with moderate acne who are unresponsive to antibiotic treatment, or who have a tendency to develop scars. In cases of severe acne, only isotretionin protocol 2 is recommended for those patients who do not tolerate the usual dosage.

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