Acne vulgaris isotretinoin

Isotretinoin (Accutane) alters keratinization in the acroinfundibulum of sebaceous glands and shrinks them, thereby reducing sebum excretion and comedo-genesis. These features underlie its usefulness in acne vulgaris, since sebum secretion is a hallmark of acne-prone skin. Furthermore, the drug has antiinflammatory activity. 

Isotretinoin is most useful for the treatment of severe recalcitrant nodular acne vulgaris. It may also be... 

The past twenty years have witnessed considerable progress in the synthesis and use of other retinoid-like molecules related to vitamin A. The aromatic retinoid etretin (8.54) and its ester etretinate (8.55) had some effectiveness in the treatment of psoriasis, a disorder of skin. 13-cA-Retinoic acid (isotretinoin) produces sebaceous gland atrophy and could prove useful in the treatment of severe acne vulgaris. Although these compounds have toxic side effects and are not in regular use, they have opened up new therapeutic possibilities. Retinoic acid (tretinoin, 8.56) has been employed in the treatment of acne. 

Barth JH, Macdonald-Hull SP, Mark J, Jones RG, Cunliffe WJ. Isotretinoin therapy for acne vulgaris a re-evaluation of the need for measurements of plasma lipids and liver function tests. Br J Dermatol 1993 129(6) 704—7. 

Isotretinoin (brand name Accutane) is used to treat severe acne vulgaris, and it has been reported to cause depression, psychosis, and suicidal ideation. Therapists who treat teens and young adults should ask about medications used for any purpose, and if they take this medication for acne, they need to be referred to their physician for a change. 

Goulden V, Layton AM, Cunliffe WJ. Long-term safety of isotretinoin as a treatment for acne vulgaris. Br J Dermatol 1994 131(3) 360-3. 

Hughes RA. Arthritis precipitated by isotretinoin treatment for acne vulgaris. J Rheumatol 1993 20(7) 1241-2. 

Zaenglein AL, Thiboutot DM. Acne vulgaris. In Horn TD, Mancini AJ, Mascaro JM, et al, eds. Dermatology. London, Mosby, 2003 531—544. Ortonne JP. Oral isotretinoin treatment policy Do we all agree Dermatology 1997 195(Suppl) 34-37. 

Altman RS, Altman LJ, Altman JS. A proposed set of new guideUnes for routine blood tests during isotretinoin therapy for acne vulgaris. Dermatology 2002 204 232-235. 

Dominguez, J., Hojyo, M.T., Celayo, J.L., Dominguez-Soto, L. and Teixeira, F. (1998) Topical isotretinoin vs. topical retinoic acid in the treatment of acne vulgaris. International Journal of Dermatology, 37, 54-55. 

Oral isotretinoin (accutane) is approved for the treatment of severe nodulocystic acne vulgaris. The drug has remarkable efficacy in severe acne and may induce prolonged remissions after a single course of therapy. It normalizes keratinization in the sebaceous follicle, reduces sebocyte number with decreased sebum synthesis, and reduces Propionibacterium acnes, the organism that proves inflammation in acne. 

Nutrition Concentrations of homocysteine and the vitamins responsible for its metabolism have been investigated in patients with moderate to severe acne vulgaris on isotretinoin treatment, before and after treatment with isotretinoin homocysteine concentrations were increased after 2 months [69 ]. This suggests that isotretinoin may increase the risk of cardiovascular disorders by causing hyperhomocysteinemia. 

Roodsari MR, Akbari MR, Sarrafi-Rad N, Saeedi M, Gheisari M, Kavand S. The effect of isotretinoin treatment of plasma homocysteine levels in acne vulgaris. Clin Exp Dermatol 2010 35(6) 624-6. 

Oil acne is treated with the usual acne vulgaris modalities, such as topical benzoyl peroxide and retinoic acid. Systemic treatment is often needed with tetracycline, erythromycin or minocycline, or with isotretinoin in severe cases. The key factor is avoiding contact with oils and grease. Work clothes should be changed daily and frequent cleansing of the skin with soap and water is advised. 

Layton AM, Knaggs H, Taylor J, Cunliffe WJ (1993) Isotretinoin for acne vulgaris - 10 years later A sfe and successful treatment. Br J Dermatol 12 292-296... 

---