Modern approaches to use of systemic isotretinoin for treatment of acne

Abstract

Objective — for an in­depth analysis of the domestic and foreign literature, including reports of the results of randomized controlled clinical trials on the application of the system of the drug isotretinoin acne treatment focusing on both short­term and long­term therapeutic effects of different schemes, and modes of therapy, as well as minimizing side effects.Materials and methods. Analysis of global experience of the effectiveness of the application of systematic isotretinoin acne treatment and minimization of side effects by data retrieval (2000—2017) the Cochrane register (The Cochrane Library) controlled trials by keyword isotretinoin, acne; in resource requirements for PubMed, High Wire Press, Google Scholar directory terms and medical topics: isotretinoin + acne + treatment ; reports on the results of randomized controlled clinical trials, Research Center and literature reviews.Results and discussion. Taking into account the analysis of the results of numerous foreign and domestic research, systematic isotretinoin is a highly effective drug in treating moderate and severe forms of acne. Currently, in addition to the standard daily and cumulative doses of isotretinoin in systemic acne therapy of mild and moderate severity, a number of regimens have been suggested that suggest a slight reduction in the corresponding doses, which avoids the risk of side effects while maintaining a sufficiently high therapeutic efficacy.Conclusions. The results of numerous foreign and domestic studies indicate that at the present stage of systematic isotretinoin is most pathogenetically justified drug in the treatment of moderate and severe forms of acne, which allows reach the therapeutical effect when applying the standard regimens.The duration of treatment of moderate to severe forms of acne with standard doses (0.5—1 mg/kg/day) is 6 to 8 months, and in low doses (below 0.5 mg/kg/day) — until the required cumulative dose is reached, which is determined individually based on the state of the clinical picture and the possible side effect, may 8—11 months or more.In mild forms of acne, the use of isotretinoin is possible in the mode of low doses (below 0.5 mg/kg per day), the duration of therapy — until the clinical effect.In the treatment of acne of moderate and severe severity, as well as resistant acne, reducing the risk of side effects by reducing the daily and cumulative dose (by 20 % compared to traditional forms of isotretinoin) while maintaining the effectiveness of therapy is possible with the use of isotretinoin IDOSE® (in Ukraine is marketed under ТМ Acnetin®).These possibilities, as well as the less dependent on the absorption of isotretinoin LIDOSE® from food intakes, determine the minimum of predicted side effects; result in high drug compliance and rapid improvement of CADI, APSEA indices. The results of the studies allowed recommending isotretinoin LIDOSE® as the first­line drug for the treatment of acne with moderate to severe severity.The question remains whether Isotretinoin LIDOSE® can be used to treat acute low­dose acne severity (20 % less than normal isotretinoin) and without cumulative dose compliance.