Oral isotretinoin for acne: a complete overview

ABSTRACT

Introduction

Acne is one of the most common and widespread skin conditions, affecting the health as much as patients’ quality of life. A wide variety of treatments for acne, topical and systemics, could be prescribed, depending on its degree of severity. Isotretinoin, a derivative of retinol, has been widely used for the treatment of severe forms of acne and those forms not responding to conventional treatments. In literature, there are several studies describing its efficacy, also reporting side-effects related to the drug; therefore, this has led the scientific community to request further studies qualifying its characteristics and comparing its efficacy and safety with other classic acne treatments, as well as with different treatment regimes, in order to find the dose with the best efficacy/safety ratio.

Areas covered

The aim of this article is to provide a complete overview on the use of oral isotretinoin for the treatment of acne describing the efficacy, safety, and tolerability of the drug.

Expert opinion

Oral isotretinoin represents a valid therapeutic alternative in treating severe and mild-to-moderate acne lesions, also reducing scarring damage. There are no standardized protocols regarding the use of oral isotretinoin and its association with other therapies; however, the correct patient selection and a tailored treatment protocol according to acne lesions severity and type should be considered in order to obtain optimal results.

KEYWORDS:

• Isotretinoin
• acne
• treatment
• acne scars
• severe acne

Article highlights

• Acne is one of the most common skin conditions. A wide variety of treatments for acne, topical and systemics, could be prescribed

• Isotretinoin, a derivative of retinol, has been widely used for the treatment of severe forms of acne and those forms not responding to conventional treatments: it should be started at a dose of 0.5 mg/kg/day, increasing to 1 mg/kg/day, and continuing treatment until a dose of 120–150 mg/kg.

• As regard to different treatment regimens of oral isotretinoin, numerous studies have been conducted over the years. Several trials comparing the efficacy of oral isotretinoin used alone to the association of systemic, topical agents and physical treatment have also been conducted

• Although there are adverse reactions to the use of isotretinoin, the risk-benefit balance is in any case in favor of the administration of isotretinoin.

• Knowledge of the appropriate dose of the drug, periodic laboratory evaluation, the adoption of contraceptive methods in females and a correct lifestyle have positive effects on treatment process.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One reviewer is a consultant, researcher and speaker for many companies who market acne products. With regard to oral isotretinoin, they are a consultant, researcher, and speaker for Sun Pharma who markets Lidose-isotretinoin and Micronized-isotretinoin. The remaining reviewers have no other relevant financial relationships or otherwise to disclose.

Author contribution

The authors confirm contribution to the paper as follows: study conception and design: Alessia Villani, Gabriella Fabbrocini; data collection: Alessia Villani, Lucia Genco, Francesca Nastro, Francesca di Vico; analysis and interpretation of results: Alessia Villani, Lucia Genco, Francesca Nastro, Francesca di Vico; draft manuscript preparation: Alessia Villani, Gabriella Fabbrocini.

All authors reviewed the results and approved the final version of the manuscript.

Additional information

Funding

This paper was not funded.