Background: Oral isotretinoin (OI) is currently the gold standard in the treatment of moderately severe to severe acne vulgaris. Approximately 50-85% of patients achieve permanent cure with one course based on 1.0-2.0 mg/kg/body weight. It has been shown that a dosage of less than 1 mg/kg/body weight predisposed to noncure and required a second course for a permanent cure.
Objective: Purpose of this study was to describe the profile of acne patients in the Philippines requiring a second course of OI.
Methods: Charts of acne vulgaris patients given OI in a private dermatology clinic (SSJ) over a period of 10 years were reviewed and analyzed. All patients were given a total dose of 1 mg/kg/body weight (cumulative total dose of 120 mg/kg/body weight).
Result: Of 240 patients taking OI included in the study, 193 completed the entire course. One hundred and 43 (59.6%) were cured after one course and required no further therapy (control group: CG), 42 (17.5%) experienced relapse and were treated with topical therapy, and eight (3.3%) relapsed and required oral antibiotic plus topical therapy. Only 47 patients (19.6%) required a second course of OI therapy (study group: SG). There was no difference between the two groups in age, sex, severity, and location of lesions. Two factors were found to be of statistically significant difference: Total dose actually taken with 103.5 mg/kg/body weight for the SG vs. 118.55 mg/kg/body weight for the CG. Median duration of treatment was 6.7 months for the SG vs. 7.41 months for the CG, respectively.
Conclusion: The profile of acne patients in the Philippines requiring a second course of OI is seen in those taking a mean cumulative dose (actual total dose) less than 120 mg/kg/body weight, with a mean actual duration of 6.7 months.