Oral isotretinoin treatment policy. Do we all agree?

A consensus meeting was held in Brussels in 1995 to review current oral isotretinoin (Roaccutane/Accutane) treatment policies among internationally renowned experts and to improve service to needy patients by proposing treatment guidelines based upon a review of 1,000 acne patients who received this therapy. The group agreed that acne conditions warranting oral isotretinoin treatment include severe acne and poorly responsive acne which improves less than 50% after 6 months of therapy with combined oral and topical antibiotics. Furthermore, acne which relapses, scars or induces consequential psychological distress should be treated with oral isotretinoin. Other indications are gram-negative folliculitis, inflammatory rosacea such as rhinophyma, pyoderma faciale, acne fulminans and hidradenitis suppurativa. Treatment was usually initiated at a daily dose of 0.5 mg/kg (but may be higher) and increased to 1.0 mg/kg. Aiming at a total does of 120-150 mg/kg per treatment course treatment lasted 4-7 months depending upon daily doses. The same dosage guidelines were applied to repeated courses of oral isotretinoin therapy with no evidence of increased risk. Mucocutaneous side-effects were predictable; dose-dependent and systemic side-effects were rarely problematic. Acne patients gain immeasurable physical and emotional relief from isotretinoin treatment and society benefits from limiting bacterial resistance evolution and reducing health care costs.