Male gender, severe acne, macrocomedones (obvious “black/whiteheads”, presence of truncal comedones ( “black/whiteheads” on the trunk), a higher number of facial comedones, and the presence of more than two facial nodules (large / deep lumps) are risk factors for severe acne flare during isotretinoin (Roaccutane) treatment, say researchers in Turkey.
“Flare of acne is an expected event at the beginning of isotretinoin (Roaccutane) treatment,” explain Sadiye Kus (Acibadem Hospital, Istanbul) and colleagues.
“However, severe flare, which necessitates treatment with systemic steroids or discontinuation of the drug, is rare.”
Multiple comedones (“black/whiteheads”), male gender, and young age have previously been reported as promoting factors for severe acne flare during Roaccutane treatment; however, detailed information is currently limited.
Therefore, Kus and team conducted a prospective study to investigate the incidence, types and course of acne flare and the predictive factors for its occurrence during Roaccutane treatment in patients with moderate to very severe acne. Patients received an initial dose of 0.5 mg/kg, which was increased to 1 mg/kg at the end of the first month.
Of 244 patients enrolled, 161 completed the study. Of these, 79 patients (32%) experienced a facial and/or truncal flare which was classified as mild (18%), moderate (10%), or severe (4.5%).
The predictive factors for severe flare were male gender, severe acne, a global acne grading system cutoff score of >28, the presence of more than 44 facial comedones (“black/whiteheads”) or two facial nodules (large/deep lumps), and the presence of truncal nodules.
“Recognizing these predictive factors for severe flare may help us to take early precautions such as the mechanical extraction of comedones before starting isotretinoin, pretreatment or concomitant treatment with oral antibiotics or steroids and introduction of Roaccutane in low doses,” write Kus and team in the European Journal of Dermatology.
“These measures would not only increase our treatment success but also improve patient satisfaction in those suffering from acne.”