Prescribing oral isotretinoin: understanding the need for caution

Abstract

Acne is a common inflammatory disorder that can occur in both adolescents and adults. Isotretinoin is used in severe forms of acne which are resistant to adequate courses of therapy with systemic antibacterials and topical solutions. It has a serious side-effect profile and is associated with a number of significant cautions and contraindications. Therefore, isotretinoin should only be prescribed by or under the supervision of physicians with both expertise in the use of systemic retinoids for the treatment of severe acne and a full understanding of the risks of isotretinoin therapy and its monitoring requirements. Isotretinoin is highly teratogenic and is therefore contraindicated in pregnancy. Oral isotretinoin causes increased skin fragility and can result in scarring, and therefore, its summary of product characteristics recommends that wax epilation, laser skin treatment and microdermabrasion should be avoided during and for at least 6 months after treatment. Thorough patient medical history records should be taken and close monitoring is required owing to the effects of isotretinoin on mental function, serum lipid levels and hepatobiliary function.