When and how to use low-dose isotretinoin: Focus on relapse rates, and patient selection

The provided text is an excerpt from an audio recording featuring Dr. Ramesh M, who discusses the long-term treatment of acne vulgaris, particularly focusing on nodulocystic and conglobata acne which have high relapse rates. Dr. Ramesh advocates for an initial high-dose isotretinoin therapy (0.5 to 1 mg per kg body weight) for six to eight months, followed by a low-dose maintenance regimen (20 mg on alternate days or bi-weekly) for one to two years to prevent recurrence. The doctor stresses the necessity of concurrent topical treatments, such as salicylic acid peels, sunscreens, and anti-scar creams, alongside regular monitoring of the patient’s lipid profile and liver function tests. Furthermore, Dr. Ramesh highlights other indications for isotretinoin use, including sebo-melanosis, seborrhoeic dermatitis, pseudofolliculitis, severe seborrhoea, and dandruff, often recommending a lower dosage and tapering schedule for these conditions.