7 replies to this topic

[Fredrik]

Oral isotretinoin in photoaging: clinical and histopathological evidence of efficacy of an off-label indication

Background: Despite evidences of the beneficial clinical effects of oral isotretinoin in the treatment of cutaneous photoaging, scientific evidences are still scarce, mainly supported by histopathological and morphometric studies. Objectives To analyse possible clinical and morphological changes resulting from the treatment of photoaging with oral isotretinoin.


Methods: Thirty female patients, aged 40 to 55 years, phototypes II to IV, with moderate to severe photoaging were randomly assigned to two groups of 15 each. Group I (G I) patients were treated with 10 mg of isotretinoin and group II (G II) with 20 mg of oral isotretinoin thrice a week for 3 months. Skin biopsies were performed before and after the end of therapy, and the various sections were submitted to specific staining for collagen and elastic fibres. To analyse the changes, morphometric studies were performed, and the results obtained were analysed by Student's t-test (paired and non-paired). Clinical results of therapy regarding texture, colouring and aspect of the wrinkles were assessed by both physician and patient.


Results: The increase in the amount of collagen fibres was statistically significant with both dosage regimens (mean, 37.8%, increasing to 44.4%; P = 0.029 with the 10-mg dosage; and mean, 36.6%, increasing to 41.9%; P = 0.01 with the 20-mg dosage). A pattern pointing toward a decrease in the number of elastic fibres was found (mean, 15.3-12%; P = 0.014 with the 10-mg dosage; mean, 15.5-14%; P = 0.125 with the 20-mg dosage). Additionally, there was improvement in the general aspect of the skin, regarding texture, wrinkles depth and skin coloration.


Limitations: Despite ethical considerations, a lack of a control group using placebo may render the results less accurate.


Conclusion: Low dosages of oral isotretinoin seem to be an effective therapeutic option for cutaneous photoaging.

PMID: 18811602

Edited by Fredrik, 30 September 2008 - 12:25 AM.

[davpet]

Fredrik,

What is your feeling on this, would you try it ?

Does such a low-dose have any known side-effects ?

I'm sure using this with tretinoin would have a synergistic effect.

[Fredrik]

Fredrik,

What is your feeling on this, would you try it ?

Does such a low-dose have any known side-effects ?

I'm sure using this with tretinoin would have a synergistic effect.

I´ve already used it at a moderate dose for three months...against acne when I was younger. Excellent effect against acne, as close to a cure you can get. But I wouldn´t use it continuously to prevent photodamage. Vitamin A and its metabolites affect bone remodeling among other things. Oral tretinoin, for instance, is a drug used against specific cancers.

I don´t know what the long-term effects of low dose isotretinoin would be. Some derms use it for patients with psoriasis and extreme sebum production.

I recommend you stick to localized topical treatment with retinoids for now.

[kismet]

 Limitations: Despite ethical considerations, a lack of a control group using placebo may render the results less accurate.

Why? Why no placebo and no control with a topical retinoid? We can't really draw any conclusions from this study...
30mg isotretinoin/week equals <5mg/d, but the UL for retinol is around 3mg/d. Assuming they are similarly effective it's still too much I guess, those two substances should have somehow similar pharmacokinetics anyway.

Edited by kismet, 30 September 2008 - 03:29 PM.

[blood]

Interesting first hand account of low dose isotretinoin use for wrinkles/ pigmentation (see the posts by Josee):
http://www.essential...d.php?tid=37983

The dose was a 20 mg pill every second day, for a 3 month cycle. Side effects were minimal.

Edited by blood, 11 July 2013 - 07:59 AM.

[nupi]

20mg is not that low a dose. If I am not totally mistaken, I had that every day for it's primary use and it did have some quite noticeable side effects.

[blood]

In the study referred to by Fredrik, patients took 10 or 20 mg doses three times/ week (so total weekly dose of 30 or 60 mg).

Jossee on the essentialdayspa forum was taking 20 mg every second day (so 10 mg/ day).

So these doses are much lower than a typical dose for treatment of acne or rosacea.

Before/ after pic:
http://www.dermato-s..._photoaging.pdf

Edited by blood, 23 July 2013 - 08:29 AM.

[8bitmore]

Interesting data and very accessible PDF posted by blood, thanks. I am interested/concerned about the effect observed on elastic fibers in the skin:

"A pattern pointing toward a decrease in thenumber of elastic fibres was found (mean, 15.3–12%; P=0.014 with the 10-mg
dosage; mean, 15.5–14%; P=0.125 with the 20-mg dosage)."

When reading the base study the authors go into further detail and remark that:

"[the use of isotretinoin] showing decrease of elastotic material"

This is of course a good thing since excessive elastotic material is common sideeffect of UV radiation - however.. there's also the point that most anti-wrinkle studies seem to focus on stopping the breaking down of elastic fibers by inhibiting elastase (e.g: http://www.ncbi.nlm....pubmed/16650179). So: on one hand we WANT elastic fibers and on the other hand we don't (at least not in the wrong configuration!). Can someone here help me understand this a bit more?

(also: on another note: in the full paper the authors make it clear that they think 10mg thrice a week works better than 20mg thrice a week and that going even lower (i.e. 5mg thrice a week) might even be preferable so there seems little reason to be scared about having to take 20mg doses; there's simply no need)

edit: fixed wrong dosage comment at the end

Edited by 8bitmore, 23 July 2013 - 12:47 PM.