Isotretinoin Dosing — SCE Dermatology MCQ

Correct answer: E — 120-150 mg/kg total cumulative dose (typically achieved over 4-6 months at 0.5-1 mg/kg/day)

The target cumulative dose of Isotretinoin for acne is 120-150 mg/kg, typically achieved over 4-6 months. Starting dose is usually 0.5 mg/kg/day, increasing to 1 mg/kg/day as tolerated. This cumulative dose target is associated with optimal long-term remission rates. Lower cumulative doses are associated with higher relapse rates. Some dermatologists use a low-dose approach (0.25-0.5 mg/kg/day for longer duration) to achieve the same cumulative dose with fewer side effects. Monitoring includes: monthly pregnancy tests (females), fasting lipids at baseline and 1-2 months, and LFTs. Tretinoin is teratogenic — reliable contraception is mandatory in women, and the Pregnancy Prevention Programme must be followed.

Reference: BAD 2023 Acne Guidelines; BNF