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Low-Dose Isotretinoin Tames Adult Acne

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Long-Term Dosing a Realistic Option

In the United States, 5 mg of isotretinoin is not available, so dermatologists usually prescribe 10 mg per day as a low dose, according to Dr. Hilary E. Baldwin. She noted that she prescribes low-dose isotretinoin for adults, but not for getting patients from 70% to 100% clear.

Dr. Hilary E. Baldwin

"The FDA mandate for isotretinoin is that it be used for nodulocystic acne unresponsive to conventional therapy, and most of the patients in that 70%-100% group would not qualify, in my opinion. However, I certainly agree with the low dose, long-term approach, and it is often in my adult female patients who continue with their acne long into their mature years," she said in an interview.

She added that she often prescribes isotretinoin for women who tend to get one to two large acne lesions per week. "Topical products are ineffective on this type of lesion and it is hard to justify long-term use of antibiotics for 1-2 lesions per week. Antibiotic resistance is of crucial importance in these patients. Alternatives to long term/low dose isotretinoin include oral contraceptives and spironolactone. However, some adult patients exceed the safe-age contraindications for OCPs," she said.

Dr. Baldwin is vice chair of dermatology at the State University of New York, Brooklyn. She has received research funds from and/or serves as a consultant to Allergan, Coria, Galderma, GlaxoSmithKline, Graceway Pharmaceuticals, L’Oreal, Ortho Dermatologics, Medicis, and Sanofi-Aventis.



"iPledge makes everything harder. It inhibits flexibility. In Australia – where my two nieces and nephew live – when they started isotretinoin, the doctor just gave them 6 months of isotretinoin and sent them on their way," said Dr. Goldberg.

Clinical acne is present in 45% of women aged 21-30 years, 26% of women aged 31-40, and 12% of women aged 41-50, according to the results of a recent cross-sectional study of 2,895 U.S. females aged 10-70 years (J. Womens Health [Larchmt] 2012;21:223-30).

Dr. Rademaker’s investigator-initiated study was sponsored by Douglas Pharmaceuticals (an isotretinoin manufacturer in New Zealand). He had no other conflicts of interest. Dr. Feldman reported significant financial relationships with several pharmaceutical companies. Dr. Goldberg had no financial conflicts to report.

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