Trends and Opinion of Isotretinoin Use for Acne Treatment by Dermatologists in Western Area of Saudi Arabia: A Cross-Sectional Survey

  • Amal A Kokandi Department of Dermatology, Faculty of Medicine, King Abdulaziz University, Saudi Arabia.
Keywords: Isotretinoin; dermatologists


Background: Acne is a common disease. Variety of treatment methods are available. Oral isotretinoin is an effective treatment but has some precautions.  Methods: In this study, the attitude of dermatologists in western area of Saudi Arabia toward isotretinoin and their practice are being studied through online questionnaire survey. Results: More than half of responding dermatologists used the dose of 0.5mg per kg per day. Variable dosing, length of therapy, and laboratory investigations were reported. All responding dermatologists did laboratory investigations before commencing therapy and most did it as well after one month. Most of responding dermatologists thought it was safe to perform laser hair removal during or shortly (1-2 months) post isotretinoin therapy, but laser resurfacing was not thought to be safe to do while on therapy. The most common side effects encountered with oral isotretinoin were skin and lip dryness and chelitis. All dermatologists counselled females for teratogenicity and pregnancy prevention. There were variable responses to depression, blood donation abstinence and irritable bowel syndrome. Conclusions: In conclusion, isotretinoin is an effective therapy for acne. There is a controversy among physicians on the dose, length of therapy and laboratory follow up. Controversies for depression, irritable bowel syndrome still exist.


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1. Gollnick HP, Zouboulis CC. Not all acne is acne vulgaris. Deutsches Ärzteblatt international. 2014; 111(17): 301-312.
2. Cunliffe WJ, van de Kerkhof PC, Caputo R, Cavicchini S, Cooper A, Fyrand OL, Gollnick H, Layton AM, Leyden JJ, Mascaró JM, Ortonne JP, Shalita A. Roaccutane treatment guidelines: results of an international survey. Dermatol. 1997; 194(4): 351-357.
3. Nast A, Dréno B, Bettoli V, Bukvic Mokos Z, Degitz K, Dressler C, Finlay AY, Haedersdal M, Lambert J, Layton A, Lomholt HB, López-Estebaranz JL, Ochsendorf F, Oprica C, Rosumeck S, Simonart T, Werner RN, Gollnick H. European Evidence-based (S3) Guidelines for the Treatment of Acne. J Eur Acad Dermatol Venereol. 2016; 30(8): 1261-1268.
4. Lee YH, Scharnitz TP, Muscat J, Chen A, Gupta-Elera G, Kirby JS. Laboratory Monitoring During Isotretinoin Therapy for Acne: A Systematic Review and Meta-analysis. JAMA Dermatol 2016; 152(1): 35-44.
5. Nagler AR, Orlow SJ. Dermatologists' attitudes, prescription, and counseling patterns for isotretinoin: a questionnaire-based study. J Drugs Dermatol 2015; 14(2): 184-189.
6. Zouboulis CC. The truth behind this undeniable efficacy—recurrence rates and relapse risk factors of acne treatment with oral isotretinoin. Dermatology. 2006; 212: 99–100.
7. Ganceviciene R, Zouboulis CC. Isotretinoin: state of the art treatment for acne vulgaris. J Dtsch Dermatol Ges. 2010 ;8 (Suppl 1) :S47-59.
8. Rasi A, Behrangi E, Rohaninasab M, Nahad ZM. Efficacy of fixed daily 20 mg of isotretinoin in moderate to severe scar prone acne. Adv Biomed Res 2014; 31(3): 103.
9. Kotori MG. Low-dose Vitamin "A" Tablets-treatment of Acne Vulgaris. Med Arch 2015; 69(1): 28-30.
10. Owen CE. Treating acne with high-dose isotretinoin. JAMA 2014; 311(20): 2121-2122.
11. Rademaker M. Making sense of the effects of the cumulative dose of isotretinoin in acne vulgaris. Int J Dermatol 2016; 55(5): 518-523.
12. Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, Bowe WP, Graber EM, Harper JC, Kang S, Keri JE, Leyden JJ, Reynolds RV, Silverberg NB, Stein Gold LF, Tollefson MM, Weiss JS, Dolan NC, Sagan AA, Stern M, Boyer KM, Bhushan R. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 2016; 74(5): 945-973.
13. AlGhamdi KM, Khurram H, Asiri YA, Mandil A. Dermatologists' level of compliance with the prescriptionguidelines of isotretinoin for females of childbearing potential. Int J Dermatol 2011; 50(9): 1094-1098.
14. Reilly BK, Ritsema TS. Managing nonteratogenic adverse reactions to isotretinoin treatment for acne vulgaris. JAAPA 2015; 28(7): 34-39.
15. Chandrashekar BS, Varsha DV, Vasanth V, Jagadish P, Madura C, Rajashekar ML. Safety of performing invasive acne scar treatment and laser hair removal in patients on oral isotretinoin: a retrospective study of 110 patients. Int J Dermatol 2014; 53(10): 1281-1285.
16. Prather HB, Alam M, Poon E, Arndt KA, Dover JS. Laser Safety in Isotretinoin Use: A Survey of Expert Opinion and Practice. Dermatol Surg 2017; 43(3): 357-363.
17. Blasiak RC, Stamey CR, Burkhart CN, Lugo-Somolinos A, Morrell DS. High-dose isotretinoin treatment and the rate of retrial, relapse, and adverse effects in patients with acne vulgaris. JAMA Dermatol 2013; 149(12): 1392-1398.
18. Rademaker M. Adverse effects of isotretinoin: A retrospective review of 1743 patients started on isotretinoin. Australas J Dermatol 2010; 51: 248–253.
19. Bremner JD, Shearer KD, McCaffery PJ. Retinoic acid and affective disorders: the evidence for an association. J Clin Psychiatry 2012; 73(1): 37-50.
20. Ludot M, Mouchabac S, Ferreri F. Inter-relationships between isotretinoin treatment and psychiatric disorders: Depression, bipolar disorder, anxiety, psychosis and suicide risks. World J Psychiatry 2015; 5(2): 222-227.
21. Wolverton SE, Harper JC. Important controversies associated with isotretinoin therapy for acne. Am J Clin Dermatol 2013; 14(2): 71-763.
22. Lee SY, Jamal MM, Nguyen ET, Bechtold ML, Nguyen DL. Does exposure to isotretinoin increase the risk for the development of inflammatory bowel disease? A meta-analysis. Eur J Gastroenterol Hepatol 2016; 28(2): 210-216.
23. Etminan M, Bird ST, Delaney JA, Bressler B, Brophy JM. Isotretinoin and risk for inflammatory bowel disease: a nested case-control study and meta-analysis of published and unpublished data. JAMA Dermatol 2013; 149(2): 216-220.
How to Cite
Kokandi AA. Trends and Opinion of Isotretinoin Use for Acne Treatment by Dermatologists in Western Area of Saudi Arabia: A Cross-Sectional Survey. Int Arch BioMed Clin Res [Internet]. 2017Sep.23 [cited 2021May9];3(3):10-5. Available from:

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