This expert consensus project explores the role of low-dose isotretinoin as a rejuvenative and preventive strategy for photoaging and sebaceous-driven skin changes. While isotretinoin is traditionally used for acne, increasing clinical experience suggests that carefully selected micro-dose and low-dose regimens may improve skin texture, pore size, sebaceous activity, and overall skin quality, with potential benefits in skin aging and maintenance rejuvenation programs.

This study is a non-interventional, Delphi-based expert consensus project designed to establish recommendations for the use of isotretinoin in skin rejuvenation. While isotretinoin is primarily indicated for acne, accumulating clinical evidence and practitioner experience suggest that low-dose or micro-dose regimens may contribute to improvements in skin texture, fine lines, pore size, sebaceous activity, and overall skin quality. However, standardized guidance on indications, dosing, treatment duration, monitoring, and safety precautions is limited.

A panel of expert dermatologists with practical experience in isotretinoin therapy and skin rejuvenation will be invited to participate in multiple iterative Delphi rounds. Experts will rate agreement with proposed statements using a structured Likert scale. After each round, anonymized feedback will be provided, and statements not reaching consensus will be revised and re-evaluated until stable agreement is achieved.

The final output will consist of consensus-based recommendations reflecting practical, safe, and evidence-informed guidance for dermatologists considering isotretinoin for rejuvenation purposes. The study will also identify areas of uncertainty where further research is needed, supporting the safe expansion of isotretinoin applications beyond acne management.

Inclusion Criteria:

• Board-certified dermatologists or equivalent.

  • 5 years clinical experience in dermatology.

Practical experience prescribing isotretinoin, including low- or micro-dose regimens for rejuvenation or acne.

Active engagement in clinical dermatology, teaching, research, or guideline development.

Willingness to participate in all Delphi rounds and provide informed consent.

Exclusion Criteria:

• Non-dermatology specialists.

Less than 5 years of clinical experience.

Lack of relevant isotretinoin experience.

Significant undisclosed conflict of interest with isotretinoin manufacturers.

Inability to participate in all Delphi rounds.

Target panel: 20-35 experienced dermatologists with practical knowledge of isotretinoin use for rejuvenation or acne.

Recruitment: Purposive sampling, stratified to ensure diversity in:

Practice setting (academic, private, public)

Geographic location

Years of experience

Baseline data collected: Age, sex, region, practice setting, years of experience, isotretinoin prescribing frequency, research or guideline involvement, declared conflicts of interest.

Panel retention strategy: Over-recruit by 10-20% to compensate for attrition; maintain anonymity of responses; clear instructions and timelines for participation.

Delphi studies do not collect patient data, medical records, biological samples, or identifiable clinical information. Experts only give opinions, not "IPD." Their responses are anonymized, and sharing identifiable expert-level responses is not required and often discouraged