One very common question we get in our daily practice is, does acne come back after oral medication?
We understand that this can be a worrying thought to some patients, especially as they think about how they have to battle acne all over again after having come so far to having it well-controlled with oral medication. Much research and scientific studies have been conducted in an attempt to answer this question, especially with regard to oral isotretinoin medication.
The relapse rates quoted in patients with acne after treatment with oral isotretinoin vary between 10% and 60%; this is highly dependent on the dosage regimen used during the acute phase of treatment, the duration of the acute phase of treatment, the length of follow-up, and the characteristics of the study population, such as severity of acne to begin with. 1 In general, an adequate cumulative dose of oral isotretinoin would be at least 120 mg/kg, the acute phase of treatment should on average be 6-9 months long, and the length of follow-up of around 2 years of completion of isotretinoin medication.
There have been a few factors that are suggested to be associated with a higher rate of acne relapse after completion of oral isotretinoin treatment. These include: male gender, young patients below 16 years of age or conversely females above 25 years old, a low cumulative dose of isotretinoin, excessive sebum production, truncal acne, conditions such as polycystic ovarian syndrome, smoking and the absence of a maintenance treatment regime after the completion of oral medication therapy. 2 Notably, most of the above factors cannot be controlled by the individual, except for smoking and the use of a maintenance treatment regime!
This brings us to the next point of the importance of a maintenance regime. Most studies suggest that a maintenance regime or protocol should be initiated after oral isotretinoin is stopped and continued for at least 1 year. Studies on oral antibiotics have also found a maintenance regime to be beneficial to prevent relapses. 3
Topical retinoids such as adapalene and topical benzoyl peroxide, used in combination, are some of the maintenance regimes that have been shown in studies to prevent relapses of acne, and may even help to continuously improve the skin over the next 6 months after discontinuation of isotretinoin. In one study, relapse occurred in only 3% of patients who were on a maintenance regime of topical retinoid and benzoyl peroxide gel.
In conclusion, do speak to your doctor regarding possible steps you can take to prevent an acne relapse after stopping your oral medication, including the use of a suitable maintenance regime. This will help you stay acne-free!
1 (Truchuelo et al. Acne Relapses and Maintenance Therapy: an Update on Definition and Prevention. Scientific Journal of Clinical Research in Dermatology 2017.)
2 (Morales-Cardona et al. Acne relapse rate and predictors of relapse following treatment with oral isotretinoin. Actas Dermosifiliogr 2013.)
3 (Poulin et al. A 6-month maintenance therapy with adapalene-benzoyl peroxide gel prevents relapse and continuously improves efficacy among patients with severe acne vulgaris: results of a randomized controlled trial. British Journal of Dermatology, 2011.)
