What kind of acne does she have?
What is your diagnosis?
This 18- year-old woman came in for the treatment of acne. She has Nodulocystic Acne. In addition she also excoriates many of the lesions. She had minimal acne involvement on her chest and back and was otherwise healthy and taking no medications. We decided to employ the low dose isotretinoin program for her. This low dose isotretinoin treatment program is popularly used in Europe.
Instead of 60 mg per day for 4 months, we recommended half that dose (30 mg per day), but doubled the treatment course from 4 to 8 months. The total isotretinoin cumulative dose was the same, but the side effects, most being dose dependent, were much more tolerable. The main side effect is xerosis, and living in Minnesota, in the dry winter, this becomes a major consideration. No matter what dose you use, clearing of acne on isotretinoin tends to occur around the third or fourth month. We have treated thousands of patients with this European-style, low dose isotretinoin program without any complications. It’s also our observation that the relapse rate is equivalent to the higher dose, shorter course of isotretinoin.
As with all isotretinoin patients, she was on the I-Pledge program and we recommended the liberal use of moisturizers and emollients such as CeraVe cream and also a lip balm, either Aquaphor or Vaniply, lip balm and a gentle, non-detergent cleanser such as Vanicream cleansing bar.
We also instructed the patient to immediately stop the medication with any side effects. We instructed the patient in the appropriate sunscreens, told her, as with all female patients of childbearing potential, that pregnancy was absolutely contraindicated.
We also reviewed with her the American Academy of Dermatology position paper published in December of 2010 indicating that any statistical significant link between isotretinoin and depression and isotretinoin and Inflammatory Bowel Disease is tenuous at best and difficult to discern.