Take home message: Low dose oral isotretinoin (5mg/day) for 8 months is treatment option in persistent acne vulgaris in adult females (Study fron New Zealand)



-Unfortunately: Acne in females tends to persist after puberty. In OUR experience at least 10% of women over 40 still have the condition.
-Treatments with topicals are often not sufficient and oral antibiotics once stopped are often accompanied by a rapid return of lesions.
-Oral isotretinoin at low dose is a treatment option. It combines effectiveness with compliance (a tablet!).
-Women must not get pregnant while on medication. Women need to start the medication at least one month after the last period and pregnancy plans can be started one month after stopping the medication
Mood changes can be watched, but often the self perception of adult ladies with acne is one of infantilization leading to depression
-In our experience and many colleagues around the world, this is an often used treatment in this population group…indeed guidelines would be most welcome as treatment duration is undetermined.



-Acne vulgaris is usually considered a young persons disease. Unfortunately acne requiring intervention continues to effect 30% of women in the 3rd decade of life, 20% of 4th decade, 10% of 5th decade and 5% of those in their 60s.
-Guidelines for the management of acne are almost exclusively designed for adolescents and young adults. -Unfortunately most of the algorithms used are inappropriate or ineffective for persistent adult acne. In addition there have been very few trials of specific treatment of adult persisting acne.
-Whilst topical retinoids and benzoyle peroxide are effective short term, compliance falls after 6-months of therapy. In female patients, hormonal therapy (eg. spironolactone or cyproterone acetate) is effective, but should probably not be continued for more than 12-24 months. There is increasing disquiet regards the use of antibiotics in the management of acne.
-We recently demonstrated the effectiveness of 8-months of isotretinoin 5mg/day, in 60 adults (25-55 years) with persistent adult acne. Lesion count fell from 11.3±8.1 to 1.3±3.1 by 32-weeks. Median remission lasted 24-months; most patients who relapsed elected to restart isotretinoin at 5-10 mg twice per week. No significant adverse effects were observed.
Low dose isotretinoin (5mg/day) is safe and effective, and should be considered first-line therapy in persistent adult acne, although it continues to be contraindicated in pregnancy. It is time to develop specific guidelines for the management of persistent adult acne.



Reference: Regional Congress of Dermatology (RCD) 2016 – Singapore. RCD16-0029 Acne & Rosacea PERSISTENT ADULT ACNE – A NEW PARADIGM IS NEEDED M. Rademaker1 1Univerity of Auckland, Waikato Clinical Campus- Waikato Hospital, Hamilton, New Zealand