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  • Intermittent Accutane treatment for acne

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

    Ayse Akman,1 Cicek Durusoy,2 Meltem Senturk,3 Cilem Kaya Koc,1 Durali Soyturk,4 and Erkan Alpsoy1
    1Department of Dermatology and Venerology, Akdeniz University School of Medicine, 07070 Antalya, Turkey
    2Clinics of Dermatology and Venerology, Baskent University Alanya Baskent Hospital, Antalya, Turkey
    3Antalya National Hospital, Antalya, Turkey
    4Finike National Hospital, Antalya, Turkey
    Ayse Akman, Phone: +90-242-2496708, Fax: +90-242-2274490, Email: [email protected] .
    Corresponding author.
    Received May 9, 2007; Revised July 3, 2007; Accepted July 30, 2007.

    Abstract

    Oral isotretinoin is the most effective choice in the treatment of severe acne. Application of isotretionin to acne has been expanded to treat those patients with less severe but scarring acne who are responding unsatisfactorily to conventional therapies. However, its use is associated with many side effects, some of which can result in very disastrous consequences. Data related with intermittent isotretinoin therapy is still limited. Our aim was to asses the efficacy and tolerability of two different intermittent isotretinoin courses and compare them with conventional isotretinoin treatment. In this multicenter and controlled study, 66 patients with moderate to severe cases were randomized to receive either isotretionin for the first 10 days of each month for 6 months (group 1), or each day in the first month, afterwards the first 10 days of each month for 5 months (group 2) or daily for 6 months (group 3). The drug dosage was 0.5 mg/kg/day in all groups. Patients were followed-up for 12 months. Efficacy values were evaluable for 22 patients in group 1, 19 patients in group 2, and 19 patients in group 3. Acne scores in each group were significantly lower at the end of treatment and follow-up periods (P < 0.001). When patients were evaluated separately as moderate (n = 31) and severe (n = 29), no statistically significant differences were obtained among the treatment protocols in patients with moderate acne. However, there was a significant difference between groups 1 and 3 to the response of the treatments in severe acne patients at the end of follow-up period (P = 0.013). The frequency and severity of isotretionin-related side effects were found to be lower in groups 1 and 2 compared with group 3. Intermittent isotretinoin may represent an effective alternative treatment, especially in moderate acne with a low incidence and severity of side effects. The intermittent isotretinoin can be recommended in those patients not tolerating the classical dosage.
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  • #2
    Efficacy of low-dose isotretinoin in acne vulgaris.

    Sardana K, Garg VK.

    Department of Dermatology, Maulana Azad Medical College, Delhi, India.

    Low-dose isotretinoin (0.5 mg/kg/day) is a mode of therapy for mild to moderate grades of acne. We analyzed the various trials of this mode of therapy with or without combination with topical agents. We also statistically analyzed the results, efficacy and relapse rates of standard therapy in comparison with the low-dose therapy. Our analysis of the data revealed that the efficacy and relapse rates of low-dose isotretinoin in mild to moderate grades of acne is comparable with the standard regimen (1 mg/kg/day), which is given in the severe grade of acne vulgaris. Thus, the grade of acne vulgaris should dictate the dose of administration of isotretinoin and the standard dose of 1 mg/kg/day is an unnecessary overtreatment for mild to moderate grades of acne.

    PMID: 20061724 [PubMed - in process]
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    • #3
      Chronic low-dose isotretinoin treatment limits renal damage in subtotally nephrectomized rats.

      Morath C, Ratzlaff K, Dechow C, Schwenger V, Schaier M, Zeier B, Peters J, Tsukada M, Zouboulis CC, Waldherr R, Gross ML, Ritz E, Zeier M, Wagner J.

      Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, 69120, Heidelberg, Germany. [email protected]

      Retinoids are anti-proliferative and anti-inflammatory compounds. We had previously shown that retinoids alleviate kidney damage in acute models of renal disease. We now examined whether retinoids are also effective in a chronic renal ablation model. Subtotally nephrectomized rats (SNx; two-third ablation) were compared to sham-operated controls (sham). SNx rats were administered either 10 mg/kg b.w. (low dose, LD) or 40 mg/kg b.w. (high dose, HD) isotretinoin or vehicle (n = 10 per group). The experiment was terminated after 16 weeks. Systolic blood pressure was significantly higher after SNx compared to sham but lower in SNx with LD isotretinoin (vs. SNx + vehicle). Compared to SNx + vehicle, SNx + LD isotretinoin had lower glomerular cell numbers, less glomerular hypertrophy and sclerosis, and less interstitial expansion. Morphological improvement in SNx + LD isotretinoin was accompanied by improvement in creatinine clearance and reduced urinary albumin excretion. In contrast, HD isotretinoin caused aggravation of renal damage with fibrinoid necroses of vessels and elevated urinary albumin excretion despite lower blood pressure. The dichotomous effects of isotretinoin are at least in part due to time- and dose-dependent alterations of transforming growth factor beta1 and collagen IV gene expression as also suggested by cell-culture studies in vascular smooth muscle cells. In addition, isotretinoin affected the systemic and the renal renin-angiotensin system (which was further analyzed in a model of angiotensin II infusion of the rat). Isotretinoin failed to cumulate at LD but cumulated at HD in SNx. We conclude that LD isotretinoin attenuates progressive renal damage, whereas HD isotretinoin cumulates and aggravates renal damage independent of blood pressure reduction.

      PMID: 18795249 [PubMed - indexed for MEDLINE]
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