Oral isotretinoin therapy for acne vulgaris
- Cindy Owen, MD
Cindy Owen, MD
- Assistant Professor of Medicine
- University of Louisville
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — Dermatology
- Professor of Dermatology and Public Health
- Denver VA Medical Center, University of Colorado School of Medicine and Colorado School of Public Health
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Professor of Pediatrics and Medicine (Dermatology)
- Dell Medical School, University of Texas, Austin
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
- Mark V Dahl, MD
Mark V Dahl, MD
- Section Editor — Acne and Rosacea
- Professor Emeritus
- Mayo Clinic College of Medicine
Oral isotretinoin (13-cis retinoic acid) is effective for the treatment of severe recalcitrant nodular acne. However, isotretinoin is associated with multiple adverse effects and is teratogenic. Thus, it must be used with appropriate caution in selected patients.
This topic will discuss clinical use of oral isotretinoin and related safety concerns. The pathogenesis, clinical manifestations, diagnosis, and conventional treatment of acne vulgaris are discussed separately. (See "Pathogenesis, clinical manifestations, and diagnosis of acne vulgaris" and "Hormonal therapy for women with acne vulgaris" and "Treatment of acne vulgaris".)
MECHANISM OF ACTION
Oral isotretinoin counteracts the pathogenic factors that contribute to the development of acne vulgaris [1,2]. Therapy leads to shrinkage of sebaceous glands and a marked attenuation of sebum secretion. The decrease in sebum results in the inhibition of the sebum-dependent bacterium Propionibacterium acnes (P. acnes), which is a key promoter of inflammation in acne vulgaris. Oral isotretinoin also inhibits comedogenesis by fostering keratinocyte differentiation and by normalizing desquamation.
Oral isotretinoin is effective for the treatment of acne vulgaris [3-10]. The first study to show the benefit of oral isotretinoin was a case series of 14 patients with treatment-resistant severe acne . After four months of treatment, 13 out of 14 patients experienced complete clearance of their disease.
Indications — In the United States, the Food and Drug Administration (FDA) approved usage of oral isotretinoin only for severe, recalcitrant, nodular acne. "Severe, recalcitrant, nodular acne" is defined as acne with many (greater than 5 mm) inflammatory nodules that is unresponsive to conventional therapy, including systemic antibiotics.
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- MECHANISM OF ACTION
- CLINICAL USE
- RESPONSE TO THERAPY
- Low dose isotretinoin
- High-dose isotretinoin
- ISOTRETINOIN SAFETY
- Teratogenicity and the iPLEDGE program
- Mucocutaneous side effects
- Inflammatory bowel disease
- Other side effects
- Psychiatric effects
- Monitoring and discontinuation
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS