Department of Dermatology, SMS Medical College and Hospital, Jaipur, Rajasthan, India.
Indian J Dermatol Venereol Leprol. 2011 Nov-Dec;77(6):688-94. doi: 10.4103/0378-6323.86482.
Oral isotretinoin is recommended for severe nodulocystic acne in the doses of 1-2 mg/kg/day which is usually associated with higher incidence of adverse effects. To reduce the incidence of side-effects and to make it more cost-effective, the lower dose regimen of isotretinoin has been used.
To compare the efficacy and tolerability of oral isotretinoin in daily, alternate, pulse and low-dose regimens in acne of all types and also to assess whether it can be used for mild and moderate acne also.
One hundred and twenty patients with acne were randomized into four different treatment regimens each consisting of 30 patients. Group A was prescribed isotretinoin 1 mg/kg/day, Group B 1 mg/kg alternate day, Group C 1 mg/kg/day for one week/four weeks and Group D 20 mg every alternate day for 16 weeks. Patients were further followed for eight weeks to see any relapse. Side-effects were also recorded.
Though the daily high dose treatment Group A performed better initially at eight weeks, at the end of therapy at 16 weeks results were comparable in Group A , B and D. Patients with severe acne did better in Group A than in Group B, C and D. Patients with mild acne had almost similar results in all the groups while patients with moderate acne did better in Group A, B and D. Frequency and severity of treatment-related side-effects were significantly higher in treatment Group A as compared to Group B, C and D.
We conclude that for severe acne either conventional high doses of isotretinoin may be used or we can give conventional high dose for initial eight weeks and later maintain on low doses. Use of isotretinoin should be considered in mild to moderate acne also, in low doses; 20 mg, alternate day seems to be an effective and safe treatment option in such cases.
口服异维 A 酸推荐用于重度结节囊肿性痤疮，剂量为 1-2mg/kg/天，通常与更高的不良反应发生率相关。为了降低不良反应的发生率并使其更具成本效益，已经使用了较低剂量的异维 A 酸方案。
比较每日、隔日、脉冲和低剂量异维 A 酸方案治疗各种类型痤疮的疗效和耐受性，并评估其是否也可用于轻度和中度痤疮。
将 120 例痤疮患者随机分为四组，每组 30 例。A 组给予异维 A 酸 1mg/kg/天，B 组给予异维 A 酸 1mg/kg 隔日，C 组给予异维 A 酸 1mg/kg/天，每周一次，共四周，D 组给予异维 A 酸 20mg 隔日，共 16 周。患者进一步随访 8 周，观察是否有复发。记录不良反应。
虽然每日高剂量治疗组 A 在 8 周时表现更好，但在 16 周的治疗结束时，A 组、B 组和 D 组的结果相当。重度痤疮患者在 A 组的疗效优于 B、C 和 D 组。轻度痤疮患者在所有组中的结果几乎相同，而中度痤疮患者在 A、B 和 D 组中的疗效更好。治疗相关不良反应的频率和严重程度在治疗组 A 中明显高于 B、C 和 D 组。
我们得出结论，对于重度痤疮，可以使用常规高剂量异维 A 酸，也可以在最初的 8 周内使用常规高剂量，然后维持低剂量。对于轻度至中度痤疮，也可以考虑使用异维 A 酸，低剂量，20mg，隔日似乎是一种有效的、安全的治疗选择。
