Isotretinoin

The retinoid isotretinoin (68) has been found to reduce the incidence of secondary malignancies in patients treated for head and neck cancer. In addition, the use of trans-m m.oic acid in patients having M3 leukemia has been reported to induce complete, although temporary, remissions (32). 

Retinoic acid (RA) describes a group of vitamin A acid (synonym Vitamin A1 acid) derivatives such as all-irans-retinoic acid (tretinoin), 9-cis-retinoic acid and 13-cis retinoic acid (isotretinoin). Retinoic acids act through binding to retinoic acid and retinoid X response elements. 

Up to now, far more than 5000 retinoic acid analogs have been synthesized, out of which the following three generations have been established for therapy of various disorders First, the nonaromatic retinoids (3-carotene (provitamin A), alWraras-retinoic acid (RA) (tretinoin) and 13-cis-RA (isotretinoin), second, the monoaromatic retinoid derivatives trimethyl-methoxyphenyl analog of RA (etretinate) and9-(4-methoxy-2,3,6-trimethylphenyl)-... 

Isotretinoin COOH Topical 0.05% cream Oral 0.251.0 mg/kg/ d Cystic acne, recalcitrant nodular acne Rosacea gram-negative folliculitis pyoderma faciale hidradenitis suppurativa cancer prevention... 

C gH, P 603-35-0) see Acrivastine Betacarotene Calcipotriol Canthaxanthin Cefixime cis-Cefprozil Etretinate llopfost Imiquimod Isotretinoin Repaglinide Retinol Tretinoin... 

C15H24O 520S-9J-5) see Isotretinoin Retinol Tretinoin vinylmagnesium bromide... 

We do not discontinue use of any of the patient s medications including anticoagulants, aspirin or nonsteroidal anti-inflammatory drugs. Systemic isotretinoin (Acutane) is considered to be a contraindication to any external treatment of the skin. We feel that the minimal... 

It is important to obtain details regarding isotretinoin (Accutane, Roacutane) treatment and history of keloid or hypertrophic scar formation. Isotretinoin use necessitates a delay period of 6-12 months (depending on the skin thickness and oiliness) until chemical peel is performed. Active acne is not a contraindication for chemical peel. In these cases the peel is combined with systemic antibiotics for 2-3 weeks. It is always advisable to consider isotretinoin treatment after the peel to avoid acne flare and scar reappearance. 

After the procedure, the patient is advised to use water-based lotion creams and potent sunscreens. The erythema gradually resolves over about a 2-month period. During this time, makeup foundation is encouraged. In patients with dark skin (Fitzpatrick skin type 3 or 4), the application of Kligman preparation is recommended to prevent reactive hyperpigmentation. Systemic Isotretinoin is required in some patients and can be prescribed as soon as 2-3 weeks after the procedure, if no other surgical intervention is planned in the near future. 

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. 

Before treating a patient with acne scars always obtain information regarding oral isotretinoin use in the last year, history of keloids or hypertrophic scars. This will avoid further scarring and side effects. 

Oral Isotretinoin (13-cis-retinoic acid) efficacy is based on its specific actions against all four factors implicated in acne pathogenesis. Isotretinoin targets are 1) sebum suppression ... 

Fig. ii.2oa-c. Improvement of papulo-pustular acne (a) after 3 sessions pf 25% TCA peeling (b, c). This patient has been treated with oral isotretinoin 6 months before peeling procedure. 

Estrogens, furosemide, hydrochlorothiazide, interferon alfa-2b, isotretinoin, propofol, and protease inhibitors (e.g., indinavir, nelfinavir, ritonavir, and saquinavir)... 

Isotretinoin Central nervous system, ear, and heart malformations... 

FIGURE 62-1. A spectrum of acne lesions is seen on the face of a 1 7-year-old male comedones, papules, pustules, and erythematous macules and scars at the site of resolving lesions. The patient was successfully treated with a 4-month course of isotretinoin there was no recurrence over the next 5 years. 

Isotretinoin is effective in up to 80% of patients with severe nodulocystic acne who are unresponsive to other topical and oral treatment regimens.8,23,24 Isotretinoin works on the four... 

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