TABLE 8.

Summary of recommendations for systemic isotretinoin

Oral isotretinoin is recommended for the treatment of severe acne that has not responded to conventional therapy. Level 1++, Grade A

Referral to a dermatologist is recommended in cases of severe nodulocystic acne or conglobate acne. Level 4, Grade D, GPP

An acceptable high-dose isotretinoin therapy of nodulocystic acne is 120 to 150mg/kg cumulative dose. Level 1+, Grade A

For non-nodulocystic or moderate acne, a 0.3 to 0.5mg/kg dose for six months might be sufficient. Level 1+, Grade A

Low-dose maintenance for adult persistent acne can be considered, but with caution due to potential adverse events. Level 2+, Grade C

Pregnancy is an absolute contraindication to systemic isotretinoin. Sexually active female patients should be made aware of the risk of teratogenicity and must be screened for pregnancy. Level 4, Grade D, GPP

Contraception should be discussed with the patient. The patient must be routinely reminded to avoid pregnancy. Level 4, Grade D, GPP

Screen for symptoms of depression before and during treatment and inform the patient of possible risk of depression and suicidal behaviors. Level 4, Grade D, GPP

For long-term therapy, monitoring of laboratory parameters (e.g., serum cholesterol, triglycerides, liver function tests) every six months is recommended. Level 4, Grade D, GPP

Maintenance with topical retinoids is recommended for at least several months after treatment cessation with oral isotretinoin. Addition of BPO might be required for moderate to severe acne. Level 1+, Grade A