Isotretinoin hormonal

Systemic therapy for acne includes antibiotics, isotretinoin and hormones (Tables 11.8 and 11.9). Oral treatment is indicated in cases of 1) moderate and severe acne 2) acne with tendency to scars development and 3) psychological distress related to acne. 

Oral isotretinoin is the treatment of choice in severe papulopustular acne and nodulocystic/conglobate acne. Hormonal therapy may be an effective alternative in female patients. 

Isotretinoin is a potent teratogen, and when it is prescribed it is vital to use one or more reliable contraceptive methods. It is therefore important to determine whether isotretinoin itself might interfere with the efficacy of hormonal contraception. In 26 women who were to be treated with isotretinoin and expected to use oral contraceptives, serum concentrations of the two components of Ortho Novum (ethinylestradiol and norethin-drone) were used as markers for any direct kinetic effect of isotretinoin, while concentrations of serum... 

Oral contraceptives Steroid adrenooortiootiopic hormone Acne therapy Isotretinoin Other... 

The most frequent offenders are cytostatic agents and anticoagulants, but hair loss can occur with a variety of common drugs, including hormones, anticonvulsants, amantadine, amiodarone, captopril, cholesterol-lowering drugs, cimetidine, colchicine, etretinate, isotretinoin, ketoconazole, heavy metals, lithium, penicillamine, valproic acid, and propranolol. 

Antibiotics such as tetracyclines and macrolides are the agents of choice for papulopustular acne. In severe papulopustular and nodu-locystic/conglobate acne, oral isotretinoin is the treatment of choice. Hormonal therapy represents an alternative effective regimen in female patients. 

Retinoids. The term retinoid refers to retinol or other closely related derivatives, either natural or synthetic. Retinoids may or may not have retinol-like (vitamin A-like) activity. Retinoids affect epithelial cells by binding to receptors inside these cells, inducing alterations in the transcription of genes. Retinoids enhance the synthesis of some proteins, such as proteins that serve as receptors for certain hormones and growth factors, and reduce the synthesis of others. Some of the most commonly prescribed treatments for acne—tretinoin, isotretinoin, and adapalene—are retinoids. (See Table 1.)... 

History of therapeutic radiation exposure Hormonal therapy (estrogen, progesterone) Isotretinoin therapy within the last 6 months Median-depth or deep resurfacing procedure within the last 3-12 months No visible adnexal structures Poor general health and nutrition status Poor physician-patient relationship Previous ionizing radiation exposure Predisposition to keloids Psychological instability Recent facehft surgery Recent use of isotretinoin (Accutane )... 

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