Weekend systemic isotretinoin for maintaining acne remission: a novel approach

Background Oral isotretinoin is a highly effective treatment for nodulocystic acne. However, relapse rates can reach 60% post-treatment, necessitating maintenance therapy. Objective To compare the efficacy and tolerability of two 12-months maintenance regimens: weekend oral isotretinoin and alternate-day topical adapalene gel, following successful oral isotretinoin therapy Patients and methods A total of 60 acne patients were randomized into three groups: group A received oral isotretinoin at a cumulative dose of 120–150 mg/kg, followed by topical adapalene; group B received the same cumulative dose as group A, followed by weekend oral isotretinoin; and group C received oral isotretinoin until clearance, followed by weekend oral isotretinoin. Results Time to acne clearance showed nonsignificant difference between groups ( P =0.563). However, group A had a significantly higher rate of relapse (85%) compared with groups B (35%, P =0.001) and C (45%, P =0.008). Time to relapse was the shortest for group A versus either group B or C ( P =0.001 for each) with no significant difference between the latter two groups ( P =0.579). Side effects during maintenance were significantly less severe than during the initial treatment phase. Conclusion Maintenance therapy is crucial to prevent acne relapse. The study provides a novel, practical comparison of long-term maintenance regimens using low-dose oral isotretinoin versus topical adapalene in preventing acne relapse after isotretinoin treatment. Weekend oral isotretinoin is an effective and well-tolerated option for maintaining remission.