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Marius Rademaker's Talks on Isotretinoin and Atopic Dermatitis

Marius Rademaker practices dermatology in Hamilton, New Zealand.
He has been at the forefront of research into the use of isotretinoin for acne and other disorders as well as the treatment of atopic dermatitis with methotrexate.

Here are notes from his presentations at Hot Spots in Dermatology
August 17 - 19, 2018, Kahuku, Hawaii

1. Isotretinoin:  Download Notes from Marius Rademaker’s Talks on Isotretinoin
2. Methotrexate: for Atopic Dermatitis : Download Marius Rademaker on Atopic Dermatitis

Key References:

1. Download Isotretinoin- Dose Duration Relapse

2.We do not have a pdf.  Here is the citation + the abstract:

Methotrexate for treatment of atopic dermatitis in children and adolescents

Marius Rademaker et. al.

Int. J. Dermatoil 2014 https://doi.org/10.1111/ijd.12314 (06 March 2014)

Abstract: Low‐dose methotrexate is becoming established as a second‐line treatment for atopic eczema in the adult population, but there has been a paucity of data to support its use for this indication in the pediatric population.

Methods A retrospective review was undertaken of patients aged 18 years and under started on methotrexate between January 2005 and April 2010, at a hospital‐based dermatology department in New Zealand.

Results: Thirty‐one patients (17 females, mean age 10 years, range 3–18 years) were reviewed. Methotrexate was found to be effective or very effective in 75% and ineffective in 25%. The mean duration of treatment for those who responded to methotrexate was 14 months (range 2–38 months), 74% of patients were still on treatment at the time of last review. The most common adverse effect was minor nausea in four patients (14%) and non‐significant elevation of liver enzymes (four patients). No serious adverse effects were noted.

Conclusion: In our experience, methotrexate has a good safety/tolerability profile when used in low dose for the treatment of atopic dermatitis in children and adolescents and appears to be effective. Formal comparative studies are needed.

 

Isotretinoin: Dose, Duration and Relapse

Article by Marius Rademaker, Hamilton, NZ

Abstract below...  Download Isotretinoin- Dose Duration Relapse

With 30 years of clinical use, it is appropriate to review the use of isotretinoin. While the standard dose of 0.5 to 1 mg/kg per day for 4 months to acumulative dose of 120–140 mg/kg per day has servedus well in the management of acne vulgaris, there is emerging evidence that much lower dosages (as low as 5 mg/day) are just as effective but have significantly fewer adverse effects.
Relapse of acne vulgaris continues to be a problem but we are beginning to recognise that this is related less to the cumulative dose and more to the length of sebaceous gland suppression.
Other factors important for relapse include
1. a macrocomedonal pattern of acne, smoking and age,
 2.both younger (under 14 years) and older ( women over 25 years).

After 30 years of use, we now understand why isotretinoin is such an effective drug. Not only does it clear acne in almost all patients, long-term remission can be achieved in 70–80% of patients with a single course. Important changes in the use of isotretinoin include using a lower daily dose for a longer period of time. New indications continue to emerge, particularly as a potential treatment for both intrinsic and extrinsic (photo) aging. Teratogenicity however, remains a very significant concern.

Key words: acne vulgaris, adverse effects, dose, isotretinoin, relapse, retinoid.