FDA approved in 1982. Approved for severe, recalcitrant nodular cystic acne unresponsive to other first line therapies.
Physician Initiated (Off-Label) Use
- Other Acne Use:
- Moderate acne
- Unresponsive Mild inflammatory acne scarring
- Acne resulting insignificant emotional sequelae
- Patients unwilling to use long term medication for the control of their acne
- Acne keloidalis nuchae
- Dissecting cellulitis of the scalp
- Hidradenitis suppurativa
- Pyoderma faciale
- Grovers disease
- Follicular mucinosis
Severe non-cystic acne
- Severe unresponsive acne without cysts.
- Scars often present
- Inflammatory acne causing scars or psychological harm.
- In some the degree of acne may be mild.
Occasional or few cysts
- Adult onset acne characterized by occasional large painful cysts that are often unresponsive to other therapy.
- Those with compulsive disorders resulting in picking of their acne lesions producing significant scars.
Failure of, or unwilling to take long term therapy
- Many patients do not want to continue with long term oral antibiotics which may be required for control.. Acne tends to relapse after stopping antibiotics.
Use of Isotretinoin in Rosacea
- Unresponsive to typical rosacea therapy
- Rosacea fulminans
- Granulomatous rosacea
- Localised rosacea lymphoedema
- 0.2 to 1mg /kg/day or 10 to 60 mg a day.
- Duration of therapy ranging from 6 weeks to 6 months
- Higher total doses trend to better long term results
- Start with low dose for first month makes patients tolerate the drug better.
- 120mg/kg total dose is minimum for all patient
- Multiple treatment acceptable
- Long term low dose regimen is favoured by some clinicians
- Good results in some to mini dose of 10mg daily
- Some respond well in 2 weeks when acne like doses used
- Reports of long term responses seen
- Pyoderma Faciale
- Severe sudden onset of pustules and abscesses.
- Isotretinoin 1 mg /kg/day usually required for 4-5 months. Early short course of systemic steroids desirable starting at around 30mg and reducing by 5-10mg per week.This can be combined with oral anti-inflammatory antibiotics.
- Pyoderma Faciale
[Euro J Dermatol 1996;6:94-6.]
- Rosacea may on rare occasion present with a localized fixed plaque of erythematous swelling particularly on the forehead or cheek.
- Low dose 0.1-0.2mg/kg/day for 2-4 months may be adequate. The dose can be increased if a poor response is achieved.