Challenges and Solutions in Oral Isotretinoin in Acne: Reflections on 35 Years of Experience

Abstract

Acne vulgaris affects more than 80% of adolescents and young adults and forms a substantial proportion of the dermatologist’s and general practitioner’s caseload. Severity of symptoms varies but may result in facial scarring and psychological repercussions. Oral isotretinoin is highly effective but can only be prescribed by specialists. Side effects are recognized and mostly predictable, ranging from cosmetic effects to teratogenicity. These can affect patients’ quality of life and treatment adherence. This article provides a commentary on 4 key areas: the use of oral isotretinoin vs oral antibiotics, including the importance of early recognition of nonresponse to treatment, the psychological effects of acne and isotretinoin treatment, the side effects of isotretinoin therapy, and cosmetic treatment options that can help alleviate predictable side effects. The authors, who have all participated in various international expert groups, draw on relevant literature and their extensive professional experience with oral isotretinoin in the treatment of acne. The aim of this article is to provide an informative and practical approach to managing oral isotretinoin treatment in patients with acne, to help optimize treatment of this skin disease.

Keywords:

• acne vulgaris
• side effect
• psychological
• cosmetic
• management
• antibiotic

Acknowledgements

ISDIN Spain funded the publication costs of this article.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

MIH has been a speaker for Galderma, and has participated in investigations for Galderma, Isdin, and La Roche Posay. The authors report no other conflicts of interest in this work.