Systemic isotretinoin in the management of acne—a patient questionnaire survey

Abstract

Background: The primary aim was to investigate the appropriateness (as outlined in the South African Acne Treatment Guideline¹) for the prescription of systemic isotretinoin in the management and counselling of acne in the Nelson Mandela Bay Metropole.

Methods: A questionnaire was distributed to patients receiving systemic isotretinoin by 30 community pharmacies. The response rate was 29.2% (57 respondents).

Results: The acne medication history revealed that commercial brands of beauty products were used by 57.9% of respondents, topical benzoyl peroxide by 22.8%, and systemic cotrimoxazole by 19.3%. Only nine females used an oral contraceptive as acne treatment prior to isotretinoin. The average daily dose of isotretinoin was 44.2 (SD=16.9) mg. Half of the respondents received a suboptimal cumulative dosage of isotretinoin. The average prescribed duration of isotretinoin therapy was 6.2 months. Adequate counselling was received by only 57.9% of patients. A third of the patients who were able to fall pregnant received recommendations for contraception. Pregnancy tests were conducted in only two females. Just over 40% of patients reported a complete clearance of acne lesions.

Conclusions: Many prescribers did not follow the recommendations for isotretinoin prescription. The counselling of patients regarding isotretinoin therapy was substandard, especially with respect to pregnancy prevention.

Keywords:

• acne
• isotretinoin
• skin conditions
• drug utilisation
• questionnaire survey
• dermatology