Adverse effects of systemic retinoids in treatment of acne: what are doctor and patient afraid of?

Abstract

Since 1982, oral isotretinoin has been indicated for the treatment of severe nodular-cystic acne, but indications for its use have expanded significantly in recent decades. Dermatologists around the world have begun to actively use isotretinoin for moderate and even mild forms of acne, for acne that is resistant to standard treatment methods, as well as if the patient has a tendency to scar formation, which indirectly confirms that most often the benefits obtained from the use of the drug are significantly higher than the possible risk of side effects. Despite 38 years of experience with isotretinoin, currently some dermatologists unreasonably avoid prescribing the drug. Analysis of the literature and our own experience show that this attitude to acne therapy with systemic isotretinoin is usually associated with insufficient or inadequate awareness of doctors and patients. The most common reason why systemic isotretinoin therapy is not prescribed is fear of the risk of side effects during treatment.Therefore, the aim of the work was to determine the profile and frequency of side effects in acne treatment with systemic isotretinoin. For this purpose, we retrospectively analyzed 76 outpatient records of patients receiving systemic isotretinoin in the complex therapy of acne. Among the patients there were 51 women aged 13 to 42 years and 25 men aged 14 to 39 years. Roaccutane (F. Hoffmann-La Roche Ltd, Switzerland) was used as a systemic therapy for acne. The regimen of therapy with Roaccutane was as follows: for the first 2 months — 0.3—0.4 mg per 1 kg of body weight per day, then with normal biochemical parameters of liver, kidney function, lipid and carbohydrate metabolism, the daily dose increased to 0.5—0.7 mg per 1 kg of the patient’s body weight until a cumulative dose of 120 mg per kg of body weight is reached. In all patients who received Roaccutane for the treatment of acne, side effects were well tolerated, easily corrected and sometimes required only a temporary reduction in its daily dose. Changes in the biochemical blood test were transient: the indicators were restored to normal values after the end of the course of therapy.