Volume 29, Issue 163, September 2025

Isotretinoin dosing in acne vulgaris: consensus or conviction?

Wojciech Modzelewski^1♦, Danuta Borowska²

¹Faculty of Medicine, Medical University of Warsaw, 61 Żwirki i Wigury Street, 02-091 Warsaw, Poland
²Faculty of Medicine, Medical University of Gdańsk, M. Skłodowskiej- Curie 3a Street, 80-210 Gdańsk, Poland

^♦Corresponding author
Wojciech Modzelewski Faculty of Medicine, Medical University of Warsaw, 61 Żwirki i Wigury Street, 02-091 Warsaw, Poland

ABSTRACT

Isotretinoin (13-cis-retinoic acid) was approved in 1982 by the U.S. Food and Drug Administration (FDA) for the treatment of nodulocystic acne. Currently, it is also used in the management of other dermatological conditions; however, its optimal dosing remains a subject of ongoing debate. An increasing body of research supports the superiority of low daily doses of isotretinoin compared to the originally approved higher doses. Low-dose regimens demonstrate comparable short-term efficacy—i.e., throughout treatment—while offering better tolerability and a lower incidence of adverse effects. Nevertheless, the persistence of acne remission after treatment—reflecting long-term efficacy—remains a topic of debate. Traditionally, reaching a cumulative dose of 120–150 mg/kg of body weight has been regarded as the key factor in achieving sustained remission. Recent studies, however, suggest that using low-dose oral isotretinoin until the acne is completely cleared, and then continuing treatment for another 2–3 months, can achieve similar effectiveness while causing significantly fewer side effects.

Keywords: acne vulgaris, isotretinoin, treatment, dosage

Medical Science, 2025, 29, e181ms3673

PDF

DOI: https://doi.org/10.54905/disssi.v29i163.e181ms3673

Published: 27 September 2025