Evaluation of Evidence for Acne Remission With Oral Isotretinoin Cumulative Dosing of 120-150 mg/kg

Background: Oral isotretinoin (ISO) is the standard of care for severe inflammatory acne and a threshold dose of 120-150 mg/kg is widely regarded as increasing remission potential. Objective: Our objective was to evaluate the evidence underlying ISO dosing of 120-150 mg/kg in acne remission. Methods: A systematic literature search was performed using keywords acne, "isotretinoin," "efficacy," "dosing," "relapse," and "emission." Results: Definitions for acne clearance, relapse/remission, and treatment endpoint vary widely across studies. Only 2 studies explicitly evaluated the cumulative dose of 120-150 mg/kg for induction of acne remissionboth low grade. Conclusion: The threshold dose of 120-150 mg/kg for oral ISO is based on past parameters of treatment duration and prior studies used vague or inconsistent definitions of clearance and remission. Optimal cumulative doses of ISO required to induce remission appears to vary with severity.