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Vol. 104. Issue 1.
Pages 61-66 (January - February 2013)
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Vol. 104. Issue 1.
Pages 61-66 (January - February 2013)
Original Article
DOI: 10.1016/j.adengl.2012.05.021
Acne Relapse Rate and Predictors of Relapse Following Treatment with Oral Isotretinoin
Tasa de recaída y factores pronóstico de recaída después del tratamiento con isotretinoína oral en pacientes con acné quístico
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C.A. Morales-Cardona??
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camiderm@yahoo.com

Corresponding author.
, G. Sánchez-Vanegas
Oficina de Docencia e Investigación, Centro Dermatológico Federico Lleras Acosta Empresa Social del Estado Bogotá D.C., Colombia
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Figures (1)
Tables (6)
Table 1. Relapse Rates After Treatment With Oral Isotretinoin According to International Studies.
Table 2. Classification of Cystic Acne Severity According to the Number of Inflammatory Lesions.
Table 3. Variables.
Table 4. Kaplan-Meier Survival Functions.
Table 5. Risk Factors for Relapse: Bivariate Analysis.
Table 6. Predictive Factors for Relapse in the Multivariate Analysis (Cox Regression).
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Abstract
Background

Relapse rates in patients with acne after treatment with oral isotretinoin vary between 10% and 60% depending on the dosage regimen used, the length of follow-up, and the characteristics of the study population. The aim of this study was to determine the acne relapse rate within 2 years of completion of isotretinoin therapy and to identify the prognostic factors associated with relapse.

Material and methods

We studied a series of patients with cystic acne who had received a cumulative therapeutic dose of at least 120mg/kg of oral isotretinoin. Data were analyzed using descriptive and analytical statistical methods. The relapse rate was expressed as the number of events divided by the amount of person-time. Factors predicting relapse were identified using multivariate Cox regression analysis.

Results

A total of 142 patients were followed up for 24 months or until relapse occurred. The relapse rate was 15 events per 100 person-years of follow-up. The risk of relapse was twice as high among men. The protective effect of maintenance treatment with topical retinoids was 32% for each month of use. The risk of relapse was 3.5 times higher among women not receiving antiandrogen therapy.

Conclusions

The relapse rate in our study was high and similar to that reported in the literature, Maintenance treatment with topical retinoids in men and women and androgen treatment in women helped to prevent relapse.

Keywords:
Isotretinoin
Acne
Relapse
Prognosis
Resumen
Introducción

Las recaídas después del tratamiento con isotretinoína oral varían entre el 10 y el 60% según los esquemas utilizados, el tiempo de seguimiento y las características de la población estudiada. El objetivo de este estudio fue establecer la tasa de recaída durante los 2 primeros años de seguimiento postratamiento e identificar los factores pronóstico asociados con la recaída.

Material y método

Se realizó un estudio de seguimiento a una cohorte de pacientes con acné quístico que completaron una dosis terapéutica total de mínimo 120mg/kg de isotretinoína oral. Se analizaron los datos utilizando herramientas de estadística descriptiva y analítica. Se calculó la tasa de recaída empleando el número de eventos sobre el denominador persona tiempo. Los factores pronóstico se establecieron a través del método de análisis multivariado de regresión de Cox.

Resultados

Se siguieron 142 pacientes durante 24 meses o hasta la ocurrencia del evento. La tasa de incidencia de recaída fue de 15 eventos por 100 personas/año de seguimiento. El riesgo de recaer fue el doble en los pacientes de sexo masculino. El tratamiento de mantenimiento con retinoides tópicos brindó una protección del 32% por cada mes de uso. Las mujeres que no tomaron tratamiento antiandrógeno tuvieron un riesgo de sufrir recaída 3,5 veces mayor.

Conclusiones

La tasa de recaída en nuestra población es alta y similar a la comunicada en otros estudios. El tratamiento de mantenimiento con retinoides tópicos en hombres y mujeres, y el tratamiento antiandrógeno en mujeres, ayudan a evitar recaídas.

Palabras clave:
Isotretinoína
Acné
Recurrencia
Pronóstico

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