Abstract
Acne vulgaris (AV) occurs in more than 80% of dermatological cases in adolescents and young adults and affects the quality of life. Oral isotretinoin, a metabolite product of vitamin A, is well-known to be the most effective treatment for severe nodulocystic AV and moderate AV that does not respond to other therapeutic modalities. Thus, this literature review was conducted to explain the mechanism of action, effectiveness, contraindications, side effects, and safety of oral isotretinoin in AV, which provided essential information for dermatologists. Furthermore, isotretinoin is the only treatment modality that has implications for the entire pathogenesis of acne. It contributes to decreasing corneocytes’ adhesion, supporting cellular proliferation and follicular renewal, induction of cell apoptosis, and immune regulation. The effectiveness of AV therapy with isotretinoin has expanded as it is also indicated for moderate to severe AV that does not respond well to topical combination therapy or systemic antibiotics. However, isotretinoin is included in Category X drugs and may induce many side effects from mucocutaneous effects to teratogenicity. From this extensive literature review, it can be concluded that isotretinoin is one of the treatment modalities for acne with good effectivity due to its mechanism of actions that affect the entire acne pathogenesis. Considering the various side effects of isotretinoin, its use requires adequate clinical assessment and monitoring by a dermatologist.
Highlights
Acne vulgaris (AV) is a broad-spectrum multifactorial disease
Oral isotretinoin is well-known to be the most effective treatment for severe nodulocystic AV and moderate AV that does not respond to other therapeutic modalities
Oral isotretinoin was initially approved as a treatment for severe AV by The United States Food and Drug Administration (FDA) in 1982
Summary
Acne vulgaris (AV) is a broad-spectrum multifactorial disease. The clinical manifestations include white and black comedones, papule, pustule, node, and cyst [1]. Oral isotretinoin was initially approved as a treatment for severe AV by The United States Food and Drug Administration (FDA) in 1982 [7] Over the two decades, isotretinoin is still a clinically effective anti-acne therapy resulting in long-term remission and significant improvement in many patients. Retinoid contributes to decreasing corneocytes’ adhesion, supporting cellular proliferation and follicular renewal, induction of cell apoptosis, and immune regulation [9] Through these mechanisms, isotretinoin may alter comedogenesis, decrease sebum production and colonization of Propionibacterium acnes, and promote anti-inflammatory effects [8]. Total load of acne, an examination of acne severity, and side effects Acne severity and total acne lesion
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