Department of Dermatology, Albert Einstein College of Medicine, New York, NY 10467, USA.
Int J Dermatol. 2012 Sep;51(9):1123-30. doi: 10.1111/j.1365-4632.2011.05409.x.
Isotretinoin, for acne treatment, is associated with high rates of permanent remission. However, at recommended doses of 0.5-1.0 mg/kg/day for 5-6 months [average cumulative dose: 120-150 mg/kg], more than 20% of patients experience a relapse within two years that requires further medical management.
To examine outcomes of high-dose isotretinoin in a cohort with cystic acne, as well as measuring its impact on quality of life (QOL).
A single dermatologist, single institution investigation within an academic tertiary care center in Bronx, NY. Eighty patients with nodulocystic acne, maintained on oral isotretinoin at a dose of 1.3 mg/kg/day or greater, were studied from 2006-2009 while additionally participating in a QOL survey. Main outcome measures included documented events, acne clearance, presence of relapse, and quality of life parameters.
The mean daily dose of isotretinoin was 1.6 mg/kg/day for an average time course of 178 days [cumulative dose: 290 mg/kg]. No side effects or laboratory abnormalities led to discontinuation of treatment. There were no psychiatric symptoms. One-hundred percent (100%) of patients were disease-free upon completion of treatment. During the three-year study period, 10 patients (12.5%) developed a relapse that required an additional course of isotretinoin. Analysis of QOL domains (self-perception, role-social, symptoms) revealed significant improvement following isotretinoin therapy (p = 0.0124, p = 0.0066, p = 0.0265, respectively).
Isotretinoin prescribed at 1.5 mg/kg/day or greater for 5-6 months [cumulative total dose of 290 mg/kg] is safe and effective compared to current standard dosing practices. We propose the use of high-dose isotretinoin (>1.3 mg/kg/day) as a treatment option in severe nodulocystic acne and encourage larger, prospective, multicenter studies into this therapeutic approach.
异维 A 酸用于治疗痤疮，其缓解率很高。但是，推荐剂量为 0.5-1.0mg/kg/天，持续 5-6 个月[平均累积剂量：120-150mg/kg]，超过 20%的患者在两年内复发，需要进一步的医学治疗。
研究高剂量异维 A 酸治疗囊肿性痤疮的疗效，并评估其对生活质量（QOL）的影响。
这是一项在纽约布朗克斯的学术三级护理中心进行的单皮肤科医生、单机构调查。2006-2009 年，80 例结节囊肿性痤疮患者接受了口服异维 A 酸治疗，剂量为 1.3mg/kg/天或更高，同时参与了一项 QOL 调查。主要观察指标包括记录事件、痤疮消退、复发情况和生活质量参数。
异维 A 酸的平均日剂量为 1.6mg/kg/天，疗程平均为 178 天[累积剂量：290mg/kg]。没有不良反应或实验室异常导致治疗中断。没有出现精神症状。100%（100%）的患者在完成治疗后无疾病。在三年的研究期间，10 名患者（12.5%）复发，需要再次接受异维 A 酸治疗。QOL 领域（自我认知、角色社会、症状）分析显示，异维 A 酸治疗后显著改善（p=0.0124，p=0.0066，p=0.0265）。
与目前的标准剂量相比，每天 1.5mg/kg 或更高剂量的异维 A 酸[累积剂量 290mg/kg]治疗 5-6 个月是安全有效的。我们建议将高剂量异维 A 酸（>1.3mg/kg/天）用于严重结节囊肿性痤疮的治疗选择，并鼓励对此治疗方法进行更大规模、前瞻性、多中心研究。
