2021 Volume 38 Issue 4 Pages 629-634
The use of oral isotretinoin, which improves acne by suppressing sebum secretion and abnormal follicular keratinization, is recommended by global guidelines for the treatment of acne conglobata and severe acne vulgaris. However, this approach is not yet approved in Japan. We surveyed members of the Japan Organization of Clinical Dermatologists (JOCD) and the Japanese Society of Aesthetic Dermatology (JSAD) regarding their experience of treating patients with acne conglobata and severe acne vulgaris who were refractory to standard treatments and required isotretinoin. Responses were obtained from 565 of 4,539 (12.4%) JOCD members and 158 of 2,711 (5.8%) JSAD members. Acne conglobata, which we defined as “a type of intractable acne or pyoderma that frequently occurs in males and has a large number of comedones and cysts/nodules not only on the face but also on the back,” was encountered by 81.7% of the respondents. Among them, 48.6% experienced 1–2 cases per year. A total of 81.7% of these respondents mentioned that acne conglobata cannot be treated effectively with standard treatment alone, whereas 85.6% stated that oral isotretinoin was necessary. Severe acne vulgaris, for which conventional treatments are insufficiently effective, was encountered by 90.8% of the respondents, while 75.0% of these respondents mentioned that oral isotretinoin was required for treatment. In addition, 5.1% of doctors prescribed isotretinoin off-label. In this study, acne conglobata and severe acne vulgaris, for which conventional treatments are insufficiently effective, although rare, were encountered by most dermatologists in Japan. This study revealed that most dermatologists agree to the need for oral isotretinoin for the treatment of acne conglobata and severe acne vulgaris. To improve the current standard treatment for acne, the early approval of oral isotretinoin seems to be desired, after confirmation of its efficacy and safety by clinical trial to avoid serious side effects such as teratogenicity.