ISOTRETINOIN THERAPY IN ACNE-VULGARIS - A 10-YEAR RETROSPECTIVE STUDYIN SINGAPORE

Background. The use of isotretinoin, a first generation synthetic reti noid, in the treatment of patients with severe acne vulgaris was a maj or therapeutic advance in dermatology. This 10-year retrospective stud y reviews the effectiveness of isotretinoin in patients with acne vulg aris seen in a skin clinic in Singapore. Methods. The case records of 250 cases of severe inflammatory and nodulocystic acne treated with is otretinoin were analyzed with reference to the demographic data, respo nse to isotretinoin, dosage and cost of isotretinoin used, adverse eff ects, clinical follow-up, and relapse. Results. Two hundred and fifty patients, 171 men (68.4%) and 79 women (31.6%), with different types a nd grades of acne vulgaris were studied. The dose of isotretinoin used ranged from 0.33 to 1.0 mg/kg/day (median 0.5 mg/kg/day) for a period ranging from 1 to 12 months (median 4 months). Response was excellent in 127 (50.8%) patients, good in 86 (34.4%), fair in 30 (12.0%) and p oor in 7 (2.8%). Relapse occurred in 14 (5.6%) patients over a 6-month follow-up period. Adverse effects were noted in 140 (56.0%) patients and were mild in most cases. Eighteen (7.2%) patients had to discontin ue the drug due to significant side effects. Conclusion. This study co nfirms that isotretinoin is very effective for severe acne, and comple te remission can be induced in more than 90% of cases even with lower dosage regimens. Significant clinical improvement can be achieved with the use of lower doses (mean 0.5 mg/kg/day) for an average of 4 month s of treatment with lower risk of adverse effects.