Roaccutane treatment guidelines: Results of an international survey

W. J. Cunliffe, P. C M Van De Kerkhof, R. Caputo, S. Cavicchini, A. Cooper, O. L. Fyrand, H. Gollnick, A. M. Layton, J. J. Leyden, J. M. Mascaró, J. P. Ortonne, A. Shalita

Research output: Contribution to journalArticlepeer-review


Background: Oral isotretinoin (Roaccutane®) revolutionized the treatment of several countries with a special interest in acne treatment met to formally review the survey of their last 100 acne patients treated with oral isotretinoin. The primary purpose of the survey was to identify the types of acne patients who were prescribed oral isotretinoin and how the patients were managed. Results: Of the 1,000 patients reviewed, 55% of those who received oral isotretinoin had those indiations treated historically, i.e. severe nodular cystic acne or severe inflammatory acne, not responding to conventional treatment. Forty-five percent of patients who were prescribed oral isotretinoin however had either moderate or mild acne. Most patients in this group had moderate acne (85%) However, 7.3% had acne on physical examination. The criteria for prescribing oral isotretinoin in this less severe group of patients included acne that improves <50% after 6 months of conventional oral antibiotic and topical combination therapy, acne that scars, acne that induces psychological distress and acne that significantly relapses during or quickly after conventional therapy. Treatment is usually inititated at daily doses of 0.5 mg/kg (but may be higher) and is increased to 1.0 mg/kg. Most of the physicians aimed to achieve a cumulative dose of > 100-120 mg/kg. Mucocutaneous side-effects occur frequently bur are manageable while severe systemic side-effects are rarely problematic (2%). The teratogenicity of oral isotretinoin demands responsible consideration by both female patients and their physicians. Significant cost saving when treating acne patients with oral isotretinoin as compared to other treatment modalities were further proven in this study. Conclusions: Our recommendation is that oral isotretinoin should be prescribed not only to patients with severe disease but also to patients with less severe acne, especially if there is scarring and significant psychological stress associated with their disease. Acne patients should, where appropriate, be prescribed isotretinoin sooner rather than later.

Original languageEnglish
Pages (from-to)351-357
Number of pages7
Issue number4
Publication statusPublished - 1997


  • Acne treatment
  • Isotretinoin, oral

ASJC Scopus subject areas

  • Dermatology


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