practicaldermatology.com
Results from a new cohort study show higher cumulative isotretinoin dosages are associated with lower rates of acne relapse and retreatment, and that daily dosing does not influence these outcomes for patients on conventional or high cumulative doses.
Authors on the study analyzed data from 19,907 patients aged 12 years or older in the MarketScan database from 2017 to 2020. Patients completed a minimum of four months of isotretinoin therapy and were monitored for at least one year post-treatment. Among the participants, 22.5% experienced acne relapse and 8.2% required isotretinoin retreatment.
According to the study results, female sex (HR = 1.43) was associated with increased acne relapse, while cumulative isotretinoin dosage was inversely related to relapse risk (HR = 0.996 per mg/kg). Female patients also had reduced rates of isotretinoin retreatment (HR = 0.68), and higher cumulative doses were associated with lower retreatment rates, particularly in those receiving low or conventional cumulative dosages. Maximum daily dose was not found to significantly affect relapse or retreatment rates in patients achieving cumulative dosages of 120 mg/kg or higher.
"The findings of this cohort study suggest that higher cumulative dosage may potentially reduce risk of acne relapse and isotretinoin retrial," the authors concluded. "Furthermore, daily dose was not associated with decreased risk of the outcomes for conventional and high cumulative dosage; therefore, daily dosing could be individualized to patient goals and preferences."
Source: Lai J, et al. JAMA Dermatology. 2025. Doi:0.1001/jamadermatol.2024.5416