13-cis-Retinoic Acid: It’s Therapeutic Implications and Adverse Effects (original) (raw)

A Survey on the most common side effects of Isotretinoin among A Group of Syrian Patients

Acne vulgaris is considered one of the most important cutaneous conditions affecting people in the society at the ages of adolescence and youth. There are many topical treatments along with systemic treatments that can be used to treat it. Isotretinoin is one of the most popular medications that can be used to treat acne vulgaris. Its use can be accompanied by serious side effects; especially teratogenicity. We aimed of this study to evaluate the most common side effects associated to oral isotretinoin intake among the Syrian society to increase the awareness among young adults. We designed an electronic questionnaire containing 20 questions and directed to patients who are treated with oral isotretinoin; taking in consideration the privacy of the questionnaire. 320 individuals (292 females-28 males from all Syrian communities answered the questionnaire. Among all participants, 8.4% had taken oral isotretinoin without a medical prescription and 55% (176 of 320) had not done liver function tests before starting the course. We noticed that the most frequent side effect was chapped and dry lips 96.3%, and secondly dermatoxerasia 81.6%. It was surprising that 55.6% of all participants suffered from mood disorders and depression. These results confirm the importance of the survey in shedding light on isotretinoin side effects and increasing the awareness of its possible complications, in addition to educate the patients about the effects of this medication on the mental state along with mood disorders that may be associated to long-term use.

Low dose of isotretinoin: A comprehensive review

Dermatologic Therapy, 2020

Isotretinoin is a first-generation retinoid initially approved for treatment of sever cases of acne vulgaris (nodulocystic acne). Due to its broad anti-inflammatory and immunomodulatory properties, it has been used beyond its initial approval in a myriad of other indications. Adverse effects of isotretinoin vary from xerosis to teratogenicity. Herein, we reviewed the literature, through date-unlimited Pubmed search, from inception till December 2019, using the following search terms: 'lowdose Isotretinoin' & 'Dermatology', "isotretinoin & safety", "isotretinoin, off-label uses", "isotretinoin& male fertility", "isotretinoin, iPLEDGE system", aiming to deliver a therapeutic update relevant to clinical practice. All English-language articles were considered with no limitation based on the articles' type. Low dose isotretinoin is not limited to old and novel dermatological conditions, but also showed promising results in the field of infertility and safety in the field of gastroenterology.We also highlight on the safety profile of the drug and experts' recommendations to enhacee safety measures to decrease fetal risk while on isotretinoin.

Consensus on the use of oral isotretinoin in dermatology - Brazilian Society of Dermatology

Anais Brasileiros de Dermatologia, 2020

Background: Isotretinoin is a synthetic retinoid, derived from vitamin A, with multiple mechanisms of action and highly effective in the treatment of acne, despite common adverse events, manageable and dose-dependent. Dose-independent teratogenicity is the most serious. Therefore, off-label prescriptions require strict criteria. Objective: To communicate the experience and recommendation of Brazilian dermatologists on oral use of the drug in dermatology. Methods: Eight experts from five universities were appointed by the Brazilian Society of Dermatology to develop a consensus on indications for this drug. Through the adapted DELPHI methodology, relevant elements were listed and an extensive analysis of the literature was carried out. The consensus was defined with the approval of at least 70% of the experts. Results: With 100% approval from the authors, there was no doubt about the efficacy of oral isotretinoin in the treatment of acne, including as an adjunct in the correction of scars. Common and manageable common adverse events are mucocutaneous in nature. Others, such as growth retardation, abnormal healing, depression, and inflammatory bowel disease have been

Challenges and Solutions in Oral Isotretinoin in Acne: Reflections on 35 Years of Experience

Clinical, Cosmetic and Investigational Dermatology, 2019

Acne vulgaris affects more than 80% of adolescents and young adults and forms a substantial proportion of the dermatologist's and general practitioner's caseload. Severity of symptoms varies but may result in facial scarring and psychological repercussions. Oral isotretinoin is highly effective but can only be prescribed by specialists. Side effects are recognized and mostly predictable, ranging from cosmetic effects to teratogenicity. These can affect patients' quality of life and treatment adherence. This article provides a commentary on 4 key areas: the use of oral isotretinoin vs oral antibiotics, including the importance of early recognition of nonresponse to treatment, the psychological effects of acne and isotretinoin treatment, the side effects of isotretinoin therapy, and cosmetic treatment options that can help alleviate predictable side effects. The authors, who have all participated in various international expert groups, draw on relevant literature and their extensive professional experience with oral isotretinoin in the treatment of acne. The aim of this article is to provide an informative and practical approach to managing oral isotretinoin treatment in patients with acne, to help optimize treatment of this skin disease.

Low-dose isotretinoin in acne vulgaris

International Journal of Medical Science and Public Health, 2016

Oral isotretinoin (13-cis-retinoic acid) is the only drug that counteracts all the pathogenetic mechanisms that contribute to the development of acne through its broad effects on cellular differentiation, apoptosis, inflammation, and sebaceous gland activity. It results in a significant reduction in sebum production, influences comedogenesis, lowers surface and ductal P. acnes, and exhibits anti-inflammatory properties. [2] Proper use of isotretinoin in acne can minimize the scarring and postacne hyperpigmentation and induce long-term remission. [3] In 1982, US FDA-approved isotretinoin for use in severe recalcitrant nodular acne. [4] In recent days, isotretinoin is recommended in a dose of 1 mg/kg/day with a total cumulative dose of 120-150 mg/kg. The use of such a high dose (1-2 mg/kg/day) leads to a number of dose-dependent mucocutaneous, systemic, and biochemical side effects, which require regular monitoring and lead to a poor compliance. [3] One of the ways of reducing the dose-dependent adverse events and Background: Oral isotretinoin is the only drug counteracting all the pathogenetic mechanisms causing acne. Its proper use can minimize scarring and induce long-term remission. Objective: To assess the efficacy and safety of low-dose (0.5 mg/kg/day) isotretinoin in cases of acne vulgaris with the help of this prospective, single-arm, interventional study. Materials and Methods: Cases with grades II (resistant cases), III, and IV acne vulgaris were enrolled. They were given oral isotretinoin for 4 months. After the completion of 4 months, those with complete clearance of lesions were switched to pulse therapy (1 week on, 3 weeks off), while those with new lesions were continued on isotretinoin for another 2 months. The total duration of therapy was for 6 months, and posttherapy cases were followed up for 6 months to check for relapse. Result: A total of 96 patients were enrolled in the study. At 2-, 4-, and 6-months therapy, complete clearance was seen in 26.7%, 46.7%, and 93.3% in acne grade II (n = 15); 7.9%, 26.3%, and 60.5% in grade III (n = 38); 0%, 26.3%, and 52.6% in grade IV (n = 38) patients, respectively, and 7.4% and 14.1% cases on pulse and continuous therapies, respectively, showed recurrence 6 months after stoppage of therapy. The most common adverse drug reaction was cheilitis (89%). All mucocutaneous adverse events subsided with time, none warranting discontinuation of therapy. Conclusion: Low-dose isotretinoin (0.5 mg/kg/day) therapy has a good efficacy and is associated with minimal side effects, improving patients' compliance and acceptability.

Systemic isotretinoin in the management of acne - a patient questionnaire survey : original research

South African Family Practice, 2009

The acne medication history revealed that commercial brands of beauty products were used by 57.9% of respondents, topical benzoyl peroxide by 22.8%, and systemic cotrimoxazole by 19.3%. Only nine females used an oral contraceptive as acne treatment prior to isotretinoin. The average daily dose of isotretinoin was 44.2 (SD=16.9) mg. Half of the respondents received a suboptimal cumulative dosage of isotretinoin. The average prescribed duration of isotretinoin therapy was 6.2 months. Adequate counselling was received by only 57.9% of patients. A third of the patients who were able to fall pregnant received recommendations for contraception. Pregnancy tests were conducted in only two females. Just over 40% of patients reported a complete clearance of acne lesions.

Updated Physician's Guide to the Off-label Uses of Oral Isotretinoin

The Journal of clinical and aesthetic dermatology, 2014

While oral isotretinoin is renowned for its ability to treat acne vulgaris, many of its off-label uses continue to go underappreciated. Since the last review on the unapproved indications of isotretinoin, relevant publications have surfaced with new recommendations. This article attempts to provide physicians with the latest information regarding successful and unsuccessful use of isotretinoin as an effective treatment for dermatological conditions, such as rosacea, psoriasis, pityriasis rubra pilaris, condyloma acuminatum, granuloma annulare, Darier's disease, systemic cutaneous lupus erythematosus, nonmelanoma skin cancer, and hidradenitis suppurativa. Variations in dosage regimens and isotretinoin viability as an alternative to other standard treatments are also discussed in relation to these conditions.

Vitamin E does not reduce the side-effects of isotretinoin in the treatment of acne vulgaris

International journal of dermatology, 2005

Isotretinoin is widely used in the treatment of severe, recalcitrant, nodular acne. Mucocutaneous side-effects are seen in the great majority of patients and some of them have elevations in their serum lipid and liver enzyme profiles. Recently, it has been shown that addition of vitamin E decreased the toxicity of high-dose retinoids. The purpose of this investigator-blinded, randomized study was to assess whether vitamin E would reduce the side-effects of isotretinoin in the treatment of acne vulgaris. Eighty two patients were randomly assigned to one of two treatment groups with isotretinoin (1 mg/kg/day) alone or combined with vitamin E (800 IU/day). The treatment duration was 16 weeks. Mucocutaneous side-effects such as facial erythema, facial dryness, cheilitis and serum lipid and liver enzyme profiles were assessed. There was no difference in the incidence and severity of side-effects related to isotretinoin between the two treatment groups. Eight hundred IU/day vitamin E did ...

THERAPEUTIC EFFICACY OF ISOTRETINOIN IN THE TREATMENT OF ACNE VULGAR: A BIBLIOGRAPHICAL REVIEW (Atena Editora)

THERAPEUTIC EFFICACY OF ISOTRETINOIN IN THE TREATMENT OF ACNE VULGAR: A BIBLIOGRAPHICAL REVIEW (Atena Editora), 2024

Objective: To analyze the therapeutic efficacy of isotretinoin in the treatment of moderate to severe acne, considering its safety and impact on patients' quality of life. Method: Literature review using the PubMed database, with search terms such as "isotretinoin", "moderate to severe acne", "clinical results and quality of life". 31 articles were analyzed. Results: Acne vulgaris is prevalent in puberty and adolescence, with oral isotretinoin being a primary therapeutic option. Recent studies indicate improvements in quality of life, despite adverse effects such as anxiety, depression and suicidal ideation, related to the severity of acne and a history of psychological conditions. There is no therapy with fully proven efficacy. Final considerations: Oral isotretinoin has favorable clinical results and improved self-esteem, but more research is needed to benefit patients with moderate to severe acne.