Side-effects due to conventional topical and oral therapy are rarely a problem. Spironolactone and, to  a much lesser extent, Dianette may produce hormonally dependent side-effects. However, the side-effects of isotretinoin, the mucocutaneous ones in particular, can be severe.  If  isotretinoin is prescribed too freely,  the patient may consider the side-effects to be too extensive in relation  to the benefit. However, even though this author's department has extended its use of isotretinoin to include partial responders, those subjects who quickly relapse two or three times after  conventional therapy and subjects who are severely  distressed, even in mild acne rarely do patients complain about what can be at times  considerable  mucocutaneous  side-effects.  In order to  obtain a longterm post-therapy effect, symptomatic management of the side-effects is preferable to reducing the isotretinoin dose.

 

  In conclusion, side-effects are frequent, are very well controlled and there is usually no justification in reducing the dose of isotretinoin from 1 mg/kg/day.