Acute acne flare following isotretinoin administration: potential protective role of low starting dose.

E-Mail [email protected] www.karger.com flammatory flares may occur during the first 3–5 weeks of treatment [5] . The flares manifest by paradoxical aggravation of acne, notably of the inflammatory component. As a rule, mild forms of flare resolve spontaneously and do not require change or discontinuation of treatment. Sometimes, inflammatory flare-up can be particularly severe and may distress the patient. These severe flares must be distinguished from acne fulminans, which is accompanied by systemic signs, articular symptoms and biochemical signs of inflammation [6] . Severe inflammatory acne deterioration may lead to scar development. In severe cases, systemic steroid therapy and either reduction or discontinuation of isotretinoin are necessary. The actual responsibility of oral isotretinoin in the extent of these flares is not proven. However, improvements usually occur upon discontinuation of isotretinoin, while increases in dosage can aggravate the inflammation. In order to avoid acne flares, many authors suggest to start oral isotretinoin treatment with a dose of no more than 0.5 mg/kg/ day for the first month, and then to increase the daily dosage to 1 mg/kg [7] . With the present observational study, we wanted to assess whether initial daily doses ! 0.5 mg/kg can further reduce the occurrence of flares during the first month of isotretinoin administration. Between October 2002 and October 2007, 132 acne patients (67 males and 65 females, mean age 20.3 years) whose clinical features are reported in table 1 , group 1, were treated with oral isotretinoin at an initial daily dose ̂ 0.2 mg/kg. The dosage was subsequently increased by 5 mg every 2 weeks, until the maximum tolerated dose (between 0.5 and 1 mg/kg of body weight) was reached. All patients were treated until acne clearing, without exceeding a total cumulative dose of 150 mg/kg. With the aim of