ORAL ISOTRETINOIN - HOW CAN WE TREAT DIFFICULT ACNE PATIENTS

Isotretinoin (Roaccutane(R)/Accutane(R)) therapy (120 mg/kg) normally results in complete clearing of nodulocystic acne followed by prolonge d remission, and many patients remain free of disease. Four groups of patients respond poorly or have a high rate of relapse. Preteens and y oung teenagers show a high rate of relapse and several courses of trea tment are usually needed; 14 of 20 under the age of 12 years, 21 of 47 aged 12-14 and 23 of 66 aged 14-16 relapsed within 1 year Individuals with linear lesions consisting of undermining tracks of follicular ep ithelium often show only a partial response. These individuals typical ly have a history of other 'sinus track' disease such as pilonidal sin us and hidradenitis, either themselves or other family members. Hemorr hagic or crusted lesions can be exacerbated by full doses of isotretin oin and patients develop pyrogenic-granuloma-type lesions and even acn e-fulminans-like eruptions. Women with adrenal or ovarian syndrome ass ociated with elevated androgens commonly relapse within 6-12 months af ter isotretinoin therapy.