Study examines how often acne recurs after isotretinoin treatment

Isotretinoin, commonly referred to as Accutane, is the only approved medical treatment capable of inducing long-term remission of severe acne. Although highly effective, some individuals experience recurrence of acne after a course of treatment. A new study from researchers at Mass General Brigham examined how often acne recurs after isotretinoin and what factors might put patients at risk of acne coming back. They found that acne recurrence necessitating treatment with an oral medication such as oral antibiotics, spironolactone, or another course of isotretinoin occurred in approximately 1-in-5 patients, more frequently among females and those who had taken lower cumulative dosages. However, daily dose was not predictive of acne recurrence and benefits of higher cumulative dose were not seen beyond 220mg/kg. Results are published in JAMA Dermatology.

These findings support that dosing regimens could be individualized to patient goals and preferences. So long as a sufficient cumulative dose is reached, it appears that a both lower and higher daily dose regimens can be effective. Since side effects are very dependent on dose, these results can help clinicians work with patients to pick the best dose for them to balance risks and benefits."

John Barbieri, MD, MBA, of the Department of Dermatology and Director of the Advanced Acne Therapeutics Clinic at Brigham and Women's Hospital

Using data from MarketScan, this retrospective analysis examined patients who had at least one previous acne diagnosis and were treated with a course of isotretinoin lasting at least four months, and who had at least one year of available follow-up data. Of the 19,907 patients, 35% received a subsequent prescription acne treatment, with 22.5% receiving an oral medication; 8.2% were treated with a second course of isotretinoin. The researchers also found that female patients were at greater risk of having acne recurrence, though they were less likely to be treated with a second course of isotretinoin. The researchers found that greater cumulative isotretinoin dose was associated with reduced acne recurrence, but not beyond 220mg/kg.