International Journal of Medical Science and Public Health | 2016 | Vol 5 | Issue 02 181 Access this article online Website: http://www.ijmsph.com Quick Response Code: DOI: 10.5455/ijmsph.2016.0807201537 Research Article Low-dose isotretinoin in acne vulgaris Richa Gupta 1 , Priyanka Singhal 2 , Yogesh Marfatia 3 1 Consultant Dermatologist, Ahmedabad, Gujarat, India. 2 Consultant Dermatologist, Bansal Hospital, Bhopal, Madhya Pradesh, India. 3 Department of Dermatology, SSG Hospital and Medical College Baroda, Vadodara, Gujarat, India. Correspondence to: Richa Gupta, E-mail: drricha08.gupta@gmail.com Received July 8, 2015. Accepted July 20, 2015 proliferation of Propionibacterium acnes, and infammation. [1] Oral isotretinoin (13-cis-retinoic acid) is the only drug that counteracts all the pathogenetic mechanisms that contribute to the development of acne through its broad effects on cellular differentiation, apoptosis, infammation, and sebaceous gland activity. It results in a signifcant reduction in sebum produc- tion, infuences comedogenesis, lowers surface and ductal P. acnes, and exhibits anti-infammatory properties. [2] Proper use of isotretinoin in acne can minimize the scarring and postacne hyperpigmentation and induce long-term remission. [3] In 1982, US FDA-approved isotretinoin for use in severe recalcitrant nodular acne. [4] In recent days, isotretinoin is recommended in a dose of 1 mg/kg/day with a total cumu- lative dose of 120–150 mg/kg. The use of such a high dose (1–2 mg/kg/day) leads to a number of dose-dependent mucocu- taneous, systemic, and biochemical side effects, which require regular monitoring and lead to a poor compliance. [3] One of the ways of reducing the dose-dependent adverse events and Background: Oral isotretinoin is the only drug counteracting all the pathogenetic mechanisms causing acne. Its proper use can minimize scarring and induce long-term remission. Objective: To assess the effcacy and safety of low-dose (0.5 mg/kg/day) isotretinoin in cases of acne vulgaris with the help of this prospective, single-arm, interventional study. Materials and Methods: Cases with grades II (resistant cases), III, and IV acne vulgaris were enrolled. They were given oral isotretinoin for 4 months. After the completion of 4 months, those with complete clearance of lesions were switched to pulse therapy (1 week on, 3 weeks off), while those with new lesions were continued on isotretinoin for another 2 months. The total duration of therapy was for 6 months, and posttherapy cases were followed up for 6 months to check for relapse. Result: A total of 96 patients were enrolled in the study. At 2-, 4-, and 6-months therapy, complete clearance was seen in 26.7%, 46.7%, and 93.3% in acne grade II (n = 15); 7.9%, 26.3%, and 60.5% in grade III (n = 38); 0%, 26.3%, and 52.6% in grade IV (n = 38) patients, respectively, and 7.4% and 14.1% cases on pulse and continuous therapies, respectively, showed recurrence 6 months after stoppage of therapy. The most common adverse drug reaction was cheilitis (89%). All mucocutaneous adverse events subsided with time, none warranting discontinuation of therapy. Conclusion: Low-dose isotretinoin (0.5 mg/kg/day) therapy has a good effcacy and is associated with minimal side effects, improving patients’ compliance and acceptability. KEY WORDS: Acne vulgaris, isotretinoin, low-dose therapy Abstract International Journal of Medical Science and Public Health Online 2016. © 2016 Richa Gupta. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license. Introduction Acne vulgaris and its consequent hyperpigmentation and scarring are a cause of great distress for almost all the adolescents. It is an infammatory disease of pilosebaceous unit, and the four major pathophysiological mechanisms are increased sebum production, follicular hyperkeratinization,