LAUSR

Acne vulgaris is one of the most common dermatologic complaints. Recently, isotretinoin has been used as an off-label indication for the treatment of mild-to-moderate grades of acne not responding to conventional treatment. Its conventional recommended dose is 0.5-1.0 mg/kg per day to the cumulative dose of 120-150 mg/kg. OBJECTIVES To qualify the state of evidence and analyze the efficacy of the low daily dose and the pulsed doses of isotretinoin in treating mild-to-moderate acne patients with regards to response and relapse rates. METHOD Systematic review and meta-analysis using an electronic literature search were performed. 320 potentially relevant articles were included and reviewed. RESULTS The level of evidence is moderate to low as conducted by the GRADE quality of evidence assessment. The pooled statistical estimate for response to treatment in the group comparing low daily doses with conventional dose showed an overall benefit for conventional dose. On the other hand, pooled data from the group comparing the low daily dose with the pulsed doses yielded an overall beneficial effect from using the low daily dose compared with the pulsed doses on achieving the response. CONCLUSIONS Given all of the available studies, the quality of evidence is low. It appears that conventional dose isotretinoin improves the odds of prolonged remission in adults with mild-to-moderate acne vulgaris compared to the low doses.