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from Singapore asked a question

How should I prevent Post-Accutane relapse, and advise on long term maintenance isotretinoin dose?

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Acne & Scars

Hi, I am 24 and have been on isotretinoin (and antibiotics) on and off for the past 6 years. My acne tends to come back after some time off isotretinoin. As of now, I have been on isotretinoin (10mg 3 times a week) for the past 6 months, and have been prescribed a cleanser and cream.

My skin is currently relatively clear, except for some tiny bumps (that don’t seem to be pimples) that I tend to get on my forehead and chin, and flat acne scars. Would you advise that I stop the oral medication? I am afraid to go off the meds for fear that the acne will return eventually.

At the same time, do you have any tips on preventing acne from returning after completing courses of isotretinoin?

DOCTOR’S ANSWER (1)

Hi S – 6 years is a long time to be on a course of isotretinoin, unless you were specifically prescribed a low dose, long term “maintenance” isotretinoin regime by your doctor.

If you’ve been compliant to the dosage regime (at 120 mg/kg), 85% of patients only need one course to achieve complete remission of acne – this would take 4 – 6 months of treatment, depending on the dose administered.

Relapse rates in patients after treatment with oral isotretinoin vary between 10% and 60%.

There are newer studies that show that the rate of remission after completing a course of isotretinoin is higher than what was once thought – amongst other factors, this is likely attributable to the fact that in the past, isotretinoin was only reserved for “severe acne”. This group of acne patients on isotretinoin would gladly call “my skin is currently relatively clear, except for some tiny bumps” a complete remission.

However, with widespread acceptance of it’s safety profile over the last decade, the threshold for using isotretinoin in people with moderate or mild acne is much lower, such as in acne sufferers like yourself. Consequently, patients who developed a few pimples post-treatment were also more likely to call it a relapse.

I am afraid to go off the meds for fear that the acne will return eventually.

If I were you, I’d stop taking isotretinoin, if only to see what happens. After all, your acne situation when off isotretinoin sounds very mild (different story if you get a full blown flare-up each time you went off it). If your condition can be managed on a regime of topical creams (benzoyl cream, salicylic acid wash, retinoic acid and the like), all the better.

Much as isotretinoin is safe (as long it’s monitored closely), I could do without the drying effects, the liver blood test checks, as well as the associated risks of teratogenicity in pregnant females. It’s for this last reason that long term, low-dose isotretinoin maintenance is not recommended if you’re female, or plan to become pregnant.

I’m assuming of course that your doctor doesn’t think your acne could be related to other organic or hormonal causes, such as PCOS (polycystic ovary syndrome) in females. If so, that will need to be addressed to stop acne from recurring.

At the same time, do you have any tips on preventing acne from returning after completing courses of isotretinoin?

This study on relapse rates after completing isotretinoin concludes that:

“Topical retinoid maintenance treatment, applied regularly for the first 2 years after completing treatment with oral isotretinoin, was the most important protective factor in our study. A recent study that took into account maintenance therapy with topical retinoids reported a very low relapse rate (9%) during the first year after discontinuation of oral isotretinoin, even though low doses of that drug had been used”.

So yep – there’s a reason why I still use retinoic acid myself. It’s super effective at preventing acne from recurring (plus prevents wrinkles and skin aging too!!).

Low dose, long-term maintenance isotretinoin

As an aside, the most common dosage for long term, low-dose isotretinoin for prevention of oily skin/new acne outbreaks is 10 or 20 mg, once or twice a week. So your regime would fall within this.

If you are concerned about the long term safety profile of such a regime – I know of many male dermatologist collegues who are on a similar regime themselves.

Do note as stated above that this is not recommended for females and females who want to become pregnant.

TLDR: So in a nutshell, yes, you can continue to take this regime if it’s the only thing that works for you, but if I were you, I’d try a topical therapy (that definitely includes a retinoid!!) first as your condition doesn’t sound too severe (and after ruling out other causes of acne first). Do chat to your doctor too about your situation and considerations.

Cheers

Consult Doctor
0 1750 views 1 Doctors agree 24 Jan 2018
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