Profile of acne patients in the Philippines requiring a second course of oral isotretinoin

Background Oral isotretinoin (OI) is currently the gold standard in the treatment of moderately severe to severe acne vulgaris. Approximately 50-85% of patients achieve permanent cure with one course based on 1.0-2.0 mg/kg/body weight. It has been shown that a dosage of less than 1 mg/kg/body weight predisposed to noncure and required a second course for a permanent cure. Objective Purpose of this study was to describe the profile of acne patients in the Philippines requiring a second course of OI. Methods Charts of acne vulgaris patients given OI in a private dermatology clinic (SSJ) over a period of 10 years were reviewed and analyzed. All patients were given a total dose of 1 mg/kg/body weight (cumulative total dose of 120 mg/kg/body weight). Result Of 240 patients taking OI included in the study, 193 completed the entire course. One hundred and 43 (59.6%) were cured after one course and required no further therapy (control group: CG), 42 (17.5%) experienced relapse and were treated with topical therapy, and eight (3.3%) relapsed and required oral antibiotic plus topical therapy. Only 47 patients (19.6%) required a second course of OI therapy (study group: SG). There was no difference between the two groups in age, sex, severity and location of lesions. Two factors were found to be of statistically significant difference: Total dose actually taken with 103.5 mg/kg/body weight for the SG vs. 118.55 mg/kg/body weight for the CG. Median duration of treatment was 6.7 months for the SG vs. 7.41 months for the CG, respectively. Conclusion The profile of acne patients in the Philippines requiring a second course of OI is seen in those taking a mean cumulative dose (actual total dose) less than 120 mg/kg/body weight, with a mean actual duration of 6.7 months.