Objective: Acne flare-ups are frequent in the early phase of isotretinoin treatment. Severity varies from one patient to another. Clinical factors favoring a potentially severe course were assessed on the basis of 6 cases.
Case reports: Six male patients, mean age 16.5 years, with inflammatory acne with a major retentional component were studied. Isotretinoin administered at a daily dose 0.5 mg/kg led to explosive development of massive nodulocystic lesions or pyogenic granulomas within two months. The lesions healed at withdrawal of isotretinoin and administration of antibiotics and antiinflammatory drugs. There was important scar sequellae.
Discussion: Four concomitant factors were identified which contribute to the development of acne flare-ups: sex (male), young age, retentional form of acne and daily isotretinoin dose 0.5 mg/kg.