Nodular acne

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... 

Isotretinoin should be prescribed only by prescribers who have demonstrated special competence in the diagnosis and treatment of severe recalcitrant nodular acne, are experienced in the use of systemic retinoids, have read the SMART Guide to Best Practices, signed and returned the completed SMART letter of understanding, and obtained yellow self-adhesive Accutane qualification stickers. Do not prescribe or dispense Accutane without a yellow self-adhesive Accutane qualification sticker. 

Severe recalcitrant nodular acne Nodules are inflammatory lesions with a diameter of 5 mm or greater. The nodules may become suppurative or hemorrhagic. Severe, ... 

Clinical improvement in nodular acne occurs in association with a reduction in sebum secretion. The decrease in sebum secretion is temporary, is related to the dose and duration of treatment with isotretinoin, and reflects a reduction in sebaceous gland size and an inhibition of sebaceous gland differentiation. Pharmacokinetics ... 

Minimal skeletal hyperostosis and calcification of ligaments and tendons has been observed by x-ray in prospective studies of nodular acne patients treated with a single course of therapy at recommended doses. The skeletal effects of multiple isotretinoin treatment courses for acne are unknown. 

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

Isotretinoin is a retinoid, recently approved for use in capsule form (10-20 mg). It decreases the amount of sebum that sebaceous glands produce. Isotretinoin exhibits antiproliferative and antiandrogenic effects on the sebaceous glands. It also interacts with the formation of androgens in sebaceous glands. It is indicated in the treatment of severe nodular acne, acne conglobata and recalcitrant acne. It is available in International market under the brand name ACCUTANE by Roche pharmaceuticals. 

TABLE 95—8. Typical Pharmaceutical Care Plan for Moderate Nodular Acne ... 

Isotretinoin is prescribed for severe, recalcitrant nodular acne, moderate acne unresponsive to oral antibiotics, and acne that produces scarring. It also is used commonly for other related disorders, such as Gram-negative folliculitis, acne rosacea, and hidradenitis suppurativa. 

Although isotretinoin is approved for the treatment of severe, recalcitrant, nodular acne, it is commonly used in other acne clinical type such as significant acne unresponsive to other treatments which results in significant physical or emotional scarring. Isotretinoin is effective... 

A 22-year-old man who had taken isotretinoin 20 mg bd for 5 days for nodular acne developed melena. Upper gastrointestinal endoscopy showed edema and hyperemia of the gastric mucosa of the body and antrum. Flexible sigmoidoscopy showed edema and hyperemia of the mucosa of the rectum and sigmoid colon, with numerous erosions. To exclude the possibility of small bowel involvement, he underwent video capsule endoscopy, which showed diffuse and extensive intestinal inflammation with aphthae and multiple linear, irregular-shaped jejunal ulcers. Isotretinoin was withdrawn and he had a complete resolution. 

Although nodular-cystic forms required eight to ten applications, a significant improvement of the coexisting post-acne superficial scarring was noted. The procedure was well tolerated and patient compliance was excellent [12]. In the treatment of atrophic acne scars (Fig. 2.6),... 

Dermal exposure to ethyl bromide can result in bro-moderma, which is an erythematous, nodular, or acne-form rash over the face and possibly the entire body. 

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