Abstract
Acne needs to be treated early to prevent negative psychosocial impacts. In severe or moderate forms, which tend to leave scars, oral isotretinoin is the first-line therapy. However, concern about its adverse events, especially in developed countries, delays effective treatment. In contrast, isotretinoin is widely prescribed in Brazilian private clinics. To describe the use of isotretinoin for treating acne in a Brazilian public hospital, and to analyze whether its prescription is effective or belated. Retrospective cohort study in a public hospital. Clinical and therapeutic data were obtained from the medical records of patients who were undergoing or had undergone acne treatment with isotretinoin in this hospital's general dermatology outpatient clinic over the last seven years, up to April 2018. 1526 medical records from patients with acne were analyzed. Isotretinoin was prescribed for 279 patients (18.28%) with mild (1.19%), moderate (57.37%), severe (35.85%) or conglobata (5.57%) forms of acne vulgaris. Sequelae of acne were present at the start of most of these patients' treatment. An initial daily dose of 20 mg was usually prescribed. The average initial dose/weight ratio was 0.33 mg/kg/day. The average total dose/weight ratio was 127.61 mg/kg. There were only a few cases of laboratory abnormalities. Sequelae of acne at the onset of treatment reveal delayed indication of isotretinoin, which can have negative psychosocial impacts on quality of life. Isotretinoin should be indicated early to prevent this. Its use is supported by its lack of laboratory alterations and controllable adverse events.
Highlights
Acne is a chronic and multifactorial disease that involves inflammation of pilosebaceous units.[1]
In comparison with a recent analysis on isotretinoin prescription in Brazilian private clinics, which showed that 76.7% and 94.6% of dermatologists would prescribe the drug in cases of moderate and severe acne respectively,[15] indication of isotretinoin in the public hospital studied here over the period analyzed was only implemented for a small percentage (18.28%) of the patients diagnosed with acne
The large presence of acne sequelae at the onset of treatment revealed the existence of delayed indication of drug treatment, which may lead to scars and may have a strong negative psychosocial impact on quality of life
Summary
Acne is a chronic and multifactorial disease that involves inflammation of pilosebaceous units.[1] It mostly affects the face, but may affect the chest and back, and it presents different cutaneous lesions depending on the severity of the disease It affects 80% to 90% of adolescents, but can occur at any age, and it has negative psychosocial impacts that may be permanent. Some authors have stated that isotretinoin should be the first-line drug because of the chronic and unpredictable course of acne.[5] Isotretinoin is a synthetic analogue of vitamin A that acts epigenetically, through inhibiting sebocyte differentiation and sebaceous gland function and modulating toll-like receptors, regeneration and skin repair It is used in monotherapy and is highly effective, leading to healing or longstanding remission, prevention and reduction of scars.[6]. Its use is supported by its lack of laboratory alterations and controllable adverse events
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