Efficacy Of Isotretinoin Research Articles

Efficacy of Isotretinoin in The Management of Enlarged Facial Pores in Moderate and Severe Acne Vulgaris Patients

Efficacy of Isotretinoin in The Management of Enlarged Facial Pores in Moderate and Severe Acne Vulgaris Patients

Indication, Contraindication, Complication and Monitoring of Isotretinoin

Acne is the most prevalent skin disorder affecting primarily adolescents and young adults. Side effects of acne, such as scarring, dyspigmentation, and low self-esteem, can cause severe morbidity. Isotretinoin is a medication that is used to treat severe acne. The medicine was licensed by the Food and Drug Administration in 1982 to treat severe nodular acne that had been resistant to other treatments, including systemic antibiotics. Other indications of isotretinoin include moderate acne, cutaneous T-cell lymphomas, neuroblastoma, and the prevention of squamous cell carcinoma in high-risk patients. Rosacea, folliculitis, and pyoderma faciale have all been treated with isotretinoin. Some side effects are also associated with the use of isotretinoin including teratogenicity the most severe one. The purpose of this research is to review the available information about indication, contraindication, complication and monitoring of Isotretinoin. Various dermatological conditions are also treated with isotretinoin apart from the common indication of acne. Complete blood count along with the lipid profile, and liver function test are monitored in patients on isotretinoin therapy. Dry lips and dry skin are among the common side effects of isotretinoin. Due to the severe complication of teratogenicity isotretinoin is contraindicated among pregnant women. Evidence from the literature suggests that isotretinoin is the effective medication in treatment of acne and low dose of isotretinoin does not cause any complication. Evidence-based guidelines and strategies for safety and efficacy of isotretinoin can be developed by further clinical research and trials.

Isotretinoin Versus Weekly Pulse Dose Azithromycin In The Treatment Of Acne

Introduction: Acne vulgaris is one of the most common skin disorders. It mainly affects adolescent, though may present at any age. It differs from patient to patient. Thus, the treatment should be differing from individual patients. Methods: The comparative study between the efficacy of isotretinoin and pulse dose azithromycin was carried for one year. Sixty patients of moderate to severe acne were enrolled among 15 – 30 years’ group divided into two equal groups. Isotretinoin 0.5-1mg/kg body weight given to Group A and azithromycin 500mg was given to Group B three days a week for 3 months according to severity of the disease. The severity of acne was done according to Global Acne Grading Score, GAGS. Results: Maximum number of patients were having moderate type of acne i.e., 20 (66.7%) in group A and 25 (83.3%) in group B. In group A, all cases responded and the clinical response was rated as excellent in 24 (80%), good in 5 (16.67%) and fair in 1 (3.33%) case. In group B, 24 (80%) cases responded and the response was categorized as excellent in 6 (20%), good in 9 (30%), fair in 3 (10%) and poor in 6 (20%) cases. There was no response in 6 (20%) cases. The response of isotretinoin in Group A is better than azithromycin in group B [p<0.01]. Conclusions: Isotretinoin appears to be the superior than to weekly pulse dose of azithromycin in moderate to severe case of acne.

Efficacy and safety of isotretinoin in comparison to methotrexate in the patients suffering from moderate-to-severe plaque psoriasis: A prospective cohort study

Background: Psoriasis is a common dermatological disorder with both inflammatory and genetic etiology. In India, the incidence of psoriasis is on the verge of rise. Very less data is available on the efficacy of isotretinoin versus methotrexate in patients suffering from plaque psoriasis. Aims and Objective: In this prospective cohort study, we aimed at comparing the efficacy and safety of systemic isotretinoin with systemic methothotrexate in patients suffering from moderate to severe plaque psoriasis in a tertiary care medical college hospital in eastern India. Materials and Methods: It was a prospective cohort study conducted in the dermatology and pharmacology department of Burdwan Medical College between December 1, 2020, and August 31, 2021, on 60 patients suffering from moderate to severe plaque psoriasis. Patients receiving methotrexate and isotretinoin as systemic therapy of psoriasis from the dermatology outpatient department at the time of the study constituted the methotrexate and isotretinoin group, respectively. Each group had 30 patients. Psoriasis area severity index (PASI) score and dermatology life quality index (DLQI) score were utilized for evaluation of improvement in disease severity and quality of life, respectively. Different laboratory parameters and patients reported side effects were noted for evaluation of safety. Results: Fifty-eight patients completed the study (28 patients from methotrexate group and 30 patients from isotretinoin group). Both drugs were effective in managing psoriasis. 100% patients in the methotrexate group and 89.28% patients in the isotretinoin group had reached the threshold for a minimal response (25% reduction from baseline PASI score after 12 weeks of treatment). The mean percentage reduction in PASI score was 70.23±6.78 and 52.78±7.34 in methotrexate and isotretinoin group respectively at the end of 12 weeks therapy. This difference was statistically significant. Methotrexate was more effective in improving quality of life. The mean percentage reduction in DLQI score were 60.02±5.04 and 28.49±4.84 in methotrexate and isotretinoin group respectively at the end of 12 weeks therapy. This difference was statistically significant. Isotretinoin group showed fewer patient-reported side effects and lower fluctuation of laboratory parameters. Conclusions: Methotrexate is more efficacious than isotretinoin in disease remission and improving quality of life in patients suffering from mild to moderate plaque psoriasis. Isotretinoin is safer than methotrexate.

Spectacular efficacy of isotretinoin in pustular psoriasis in a child

Generalized pustular psoriasis (GPP) occurs rarely in children, it is a chronic inflammatory disorder characterized by the presence of aseptic pustules overlying on erythematous plaques with systemic symptoms such as fever and fatigue. We report the case of a GPP treated with isotretinoin with success. Our case emphasizes that isotretinoin can be considered as a good option in the treatment of pediatric psoriasis because of its short half-life but its effectiveness has not been yet established.

How safe and effective is prescribing oral isotretinoin to treat acne in patients on renal dialysis? A systematic review.

Patients on renal dialysis often develop severe acne. In spite of this, the literature remains scarce about the use of isotretinoin for the treatment of acne in this group of patients, and many clinicians remain apprehensive and hesitant to use it. To systematically review the literature surrounding the safety and efficacy of isotretinoin for the treatment of acne in patients on renal dialysis. Four electronic databases (MEDLINE, Embase, CINAHL, Emcare) were systematically searched in March 2021. The search strategy incorporated the terms 'isotretinoin', 'renal', 'kidney', 'dialysis' and 'acne', along with terms closely related to these. Studies were considered eligible if they reported the use of isotretinoin for treatment of acne in patients with renal impairment or on renal dialysis, and if they had relevant implications to this topic. The search resulted in a total of 63 results. Using the PRISMA approach, 11 articles were deemed relevant to this review: 1 randomized single-blinded placebo-controlled trial, 2 case series, 2 retrospective studies and 6 case reports. Hence the level of evidence was mostly low (Grading of Recommendations, Assessment, Development and Evaluations level 3). This review of the literature suggests that low-dose isotretinoin (10-20 mg) can safely and successfully be used to treat severe acne in patients on renal dialysis, leading to a significant improvement in their quality of life. As the current literature on this topic is scarce, more studies would be beneficial to further establish the safe use of isotretinoin in patients on renal dialysis.

Analyzing the Efficacy of Isotretinoin in Treating Dissecting Cellulitis: A Literature Review and Meta-Analysis.

Background and ObjectiveDissecting cellulitis of the scalp is a primary scarring alopecia. Isotretinoin is commonly referenced in the literature as a treatment for dissecting cellulitis. The objective of this article was to conduct a review and meta-analysis to assess the efficacy of isotretinoin for treating dissecting cellulitis of the scalp.MethodsThe following databases were searched for articles prior to 23 June, 2019: PubMed, Embase, Cochrane Central, CINAHL, and Web of Science. Multi-patient studies (more than three) that reported on the administration of isotretinoin for dissecting cellulitis were included. A pooled meta-analysis for improvement of disease burden after isotretinoin administration in patients with dissecting cellulitis of the scalp was performed. A fixed-effects model was used.ResultsFive articles were ultimately used for the quantitative meta-analysis. The overall efficacy rate of isotretinoin in treating dissecting cellulitis of the scalp was estimated to be 0.9 with a 95% confidence interval (0.81–0.97). The sensitivity analysis suggested that the overall efficacy is still very high, with a range of 0.83–0.94. Recurrence was seen in 24% (6/25) of patients. Common associated diseases amongst patients with dissecting cellulitis of the scalp were acne conglobata 20% (30/151) and hidradenitis suppurativa 19% (11/72).ConclusionsIsotretinoin is an effective treatment for improving symptoms of dissecting cellulitis of the scalp. Disease recurrence is a common finding for those who undergo successful treatment.

Transcriptome comparison of isotretinoin-effective and isotretinoin-ineffective severe acne vulgaris patients.

Oral isotretinoin is the first-line treatment of severe nodular acne. However, patients presenting ineffective or poor effective to oral isotretinoin are still a clinical problem, and its molecular genetic mechanisms remain unclear. To compare the transcriptome profiles of isotretinoin-effective and isotretinoin-ineffective severe acne vulgaris patients and analyze the potential physiological roles to better understand the mechanisms of isotretinoin efficacy differences. Peripheral blood of 43 patients with severe acne was collected before treatment. After 8-week isotretinoin, patients presented effective and ineffective to isotretinoin treatment were selected and their pretreatment peripheral blood was analyzed. High-throughput sequencing was used to detect gene expression profiles. Gene Ontology and KEGG were used to perform functional annotation and pathway enrichment analysis. Ten acne patients (3 male and 7 female, age 31±9.2) presented effectiveness by oral isotretinoin and 10 acne patients (4 male and 6 female, age 28±7.7) presented ineffectiveness were included. Comparison of gene profiles of isotretinoin-effective and isotretinoin-ineffective patients revealed 2779 differentially expressed genes: 2723 upregulated and 56 downregulated. Differentially expressed genes were enriched in RNA degradation pathway, autophagy pathway, protein ubiquitination pathway, protein processing in endoplasmic reticulum pathway, T-cell receptor signaling pathway, spliceosome pathway, mRNA surveillance pathway, cell cycle pathway, long-term potentiation pathway, and FoxO signaling pathway. Transcriptome expression differences not only participated in the acne pathogenesis, but also influenced the isotretinoin therapeutic effects. These findings might provide some evidence for exploring individualized therapy for acne patients.

Stem cell membrane-coated isotretinoin for acne treatment

BackgroundTopical isotretinoin is commonly used to treat acne. However, topical isotretinoin has side effects and can hardly permeate through the stratum corneum, the most important skin barrier. Therefore, this study aimed to demonstrate the efficacy of nanoparticles as stable carriers with great curative effects, low side effects, and strong transdermal ability.ResultsIn a rabbit model of hyperkeratinization, STCM-ATRA-NPs showed significant therapeutic efficacy. By contrast, negative therapeutic efficacy was observed in a golden hamster model of hyper sebum production. Scanning electron microscopy and Fourier transform infrared spectral analyses showed that nanoparticles could penetrate the stratum corneum. Western blotting demonstrated that the nanoparticles could enhance the transdermal efficacy of isotretinoin by reducing the effect of keratin and tight junction proteins. Further, nanoparticles enhanced endocytosis, thereby promoting drug penetration and absorption into the skin.ConclusionSTCM-ATRA-NPs were demonstrated to control isotretinoin release, reducing its side effects, and efficiently permeating through the skin by reducing the effect of keratin and tight junction proteins and enhancing endocytosis.

Clinical and biochemical evaluation of efficacy of isotretinoin in nodulocystic acne

Acne vulgaris is common dermatosis, which usually starts in adolescence and resolves by mid 20s.However in 7.17% of the Individuals acne persists beyond 25 years. Aim: To assess the clinical and biochemical evaluation of the efficacy of isotretinoin in nodulocystic acne. Objectives 1. To evaluate the efficacy of isotretinoin(1) and to monitor the clinical improvement. 2. To study effectiveness of isotretinoin in reducing seborrhea, nodule count and the devastating cosmetic effects caused by nodulocystic acne. 3. To monitor the side effects during and after treatment Materials and Methods: The 45 cases for the study were selected from the patients attending department of DVL at SIMS during the period JAN 2018 to JAN 2019. § Nclusion Criteria 1.patients who had received earlier treatment for long periods of time in the form of systemic antibiotics, topical antibiotics, benzoyl peroxide, topical retinoids and failed to respond. 2.15-35yrs of age of either sex. § Exclusion Criteria 1. Raised cholesterol levels, signs of depression, photosensitivity and those hyper sensitive to parabens were excluded from the study. 2. Females of child bearing age who were not practicing contraception, pregnant women and lactating women were excluded from the study. Methods § Before starting Treatment, a UPT was done to exclude pregnancy. All patients were evaluated for baseline CBP, blood sugar, LFT (AST, ALT, alkaline phosphatase, serum bilirubin), RFT (blood urea, sr. creatinine), sr. lipid profile (sr.triglycerides, total cholesterol, LDL,HDL).Ultrasound abdomen and pelvis was done in women to rule out PCOD. Started on 0.5mg/kg per day of isotretinoin in single daily dose after meals. Evaluated every month for a period of 15-20 weeks. Follow up every month for 3 to 4months.At the end of every month CBP, LFT, RFT, lipid profile were done. Results: Clinical improvement - 43 out of 45 patients 22.22%(10 patients out of the total 45)- flare up of acne, Dryness and fissuring of lips - 88%, xeroderma - 2%, 2% - epistaxis, myalgias - 4%, desquamation of the palms but not soles was observed - 2% patients, 2% - headache. All routine investigations, LFT, lipid profile were repeated after 1 month and after completion of treatment.Transient elevation in serum triglycerides and total cholesterol was seen in some but not significant enough to require stoppage of treatment or anti hyperlipidemic treatment. Follow up was done for a period of 3 months after completion of treatment.

The effect of low-dose isotretinoin therapy on serum androgen levels in women with acne vulgaris.

BackgroundAcne vulgaris is a common dermatologic disease that causes significant social and psychological morbidity. Isotretinoin, as a vitamin A derivative, is the most effective agent in the treatment of acne. Evidence suggests that isotretinoin’s therapeutic function is independent of hormonal mediation; however, the effect of isotretinoin on serum androgens and precursor androgen levels in humans remains unclear.ObjectiveHerein, we aim to investigate the effect of low-dose isotretinoin on androgen levels in women and postulate the role of concomitant anti-androgen therapy (e.g., spironolactone).MethodsA total of 36 women, age 18 to 30 years, with moderate-to-severe nodulocystic acne were treated with 20 mg isotretinoin (Roaccutane) daily for 3 months. A hormone panel was obtained at baseline and after completion of the treatment course. The panel included dehydroepiandrosterone (DHEA), 17-hydroxyprogestrone, testosterone, free testosterone, dihydrotestosterone (DHT), luteinizing hormone, follicle stimulating hormone, and prolactin.ResultsSerum levels of testosterone (p = .015), prolactin (p = .001), and DHT (p = .001) were significantly decreased, while serum levels of DHEA (p = .001) significantly increased after isotretinoin treatment. No significant change was found in the other hormones evaluated.LimitationsThe distribution of acne was not assessed in our patient population. We did not directly evaluate for associations between elevated DHEA levels and clinical response rates.ConclusionIsotretinoin alone can decrease androgen levels, but increase an important driver of acne pathogenesis (i.e., DHEA). The co-administration of an anti-androgenic agent (e.g., spironolactone) may optimize the therapeutic efficacy of isotretinoin by limiting iatrogenic increases in DHEA and perhaps allow for more widespread use of low-dose isotretinoin.

A randomised study to evaluate the efficacy of isotretinoin, electrodessication and comedone extraction in the treatment of comedonal acne

<p class="abstract"><strong>Background:</strong> Comedonal acne commonly seen in adolescents and young patients which is refractory to standard treatments. This study is being undertaken to determine the efficacy and adverse effects of oral isotretinoin, electrodessication and comedone extraction in patients of comedonalacne.</p><p class="abstract"><strong>Methods:</strong> A total of 120 patients of comedonal acne were enrolled and randomly divided into 4 groups of 30 patients each. Group A, B, C and D patients were treated with isotretinoin (20 mg daily), electrodessication, comedone extraction (4 weeks interval) and topical antibiotic daily for 12 weeks. The response in each group was assessed based on decrease in total comedonal count after 12 weeks of treatment. Statistical analysis was done using chi square test.<strong></strong></p><p class="abstract"><strong>Results:</strong> Eighty seven (72%) cases had predominantly closed comedones and 33 (27%) cases showed open comedones. After 12 weeks of treatment, more than 75% decrease in comedonal count was seen in 60% of patients in electrodessication group followed by 30% (isotretinoin), 13.3% (comedone extraction). The decrease in total number of comedone was significantly higher with electrodessication (84.4%) followed by isotretinoin (73%), comedone extraction (43.2%) and topical antibiotic (5.7%). After follow up of 3 months, recurrence of comedones was least with isotretinoin followed by comedone extraction and electrodessication.</p><p class="abstract"><strong>Conclusions:</strong> For comedonal acne, initial electrodessication followed by isotretinoin over 12 weeks gives the best outcome of quick remission and least recurrence. Electrodessication and comedone extraction are the preferred modalities in patients with predominantly closed and open comedones respectively.</p><p class="abstract"> </p>

Efficacy and safety of low dose oral isotretinoin in comparison with oral itraconazole in the treatment of seborrheic dermatitis among patients attending Erbil dermatology teaching center in Erbil City

Background and objective: Seborrheic dermatitis is chronic skin disease with exacerbation and remission, many topical and systemic therapies were used, including oral antifungal itraconazole, oral isotretinoin efficacy in the treatment of seborrheic dermatitis less studied. This study aimed to compare the efficacy and safety of low dose oral isotretinoin and oral itraconazole in the treatment of patients with seborrheic dermatitis. Methods: A total of 68 patients with seborrheic dermatitis were participating in a randomized, parallel-group study. One group (n = 31) took 200-mg/day oral itraconazole for one week of the first month, followed by 200 mg for the first two days of the next two months. The second group (n = 37) took oral isotretinoin 20 mg twice weekly for three months. Seborrheic dermatitis area severity index and intensity of itching and burning sensation were calculated before, during three months and one month after treatment. Results: Both drugs significantly reduced the severity of seborrheic dermatitis (P <0.05). When the two groups were compared, patients taking oral isotretinoin showed a significantly greater decrease in seborrheic dermatitis area severity index score than itraconazole group particularly in the second and third months of treatment. Conclusion: Low dose oral isotretinoin is more effective than oral itraconazole in treating seborrhea dermatitis.

Clinical response to isotretinoin and interferon-\u03b1 of two dogs with cutaneous epitheliotropic T-cell lymphoma: a case report

BackgroundThere is no specific therapy for cutaneous epitheliotropic T-cell lymphoma (CETL). The administration of retinoids in conjunction with interferon-α (IFN-α) in CETL has not been reported in dogs.Case presentationTwo dogs (Shih tzu and Miniature pinscher) presented with multiple nodular skin lesions. Histopathological examination revealed diffuse infiltrations of lymphocytes in the epidermis and dermis, with a CD3-positive immunophenotypic profile. Based on the clinical and histopathological examination, CETL was diagnosed. Both dogs were treated with isotretinoin in combination with IFN-α and showed clinical improvement with complete or partial remission. The disease in these dogs was well-controlled for more than 264 days of overall median survival time without any additional clinical signs after initiation of the treatment. In both the cases, the dogs were followed up for 27 months, and 10 months without any evidence of recurrence or metastasis, respectively.ConclusionsWe describe the clinical efficacy of isotretinoin combined with IFN-α in 2 dogs with CETL. Long-term management with isotretinoin combined with IFN-α was effective in treating CETL in these cases.

Weekly methotrexate versus daily isotretinoin to treat moderate-to-severe chronic plaque psoriasis: a comparative study

Introduction: There is paucity of data on efficacy of isotretinoin versus methotrexate in psoriasis patients. Aims: We compared the efficacy and safety of once a week methotrexate and daily isotretinoin for the treatment of moderateto-severe chronic plaque psoriasis. Methods: 43 (M: F 30:13) consenting patients having moderate-to-severe chronic plaque psoriasis were divided on alternate basis in Group-A for treatment with methotrexate (15mg/week) and Group-B for isotretinoin (30mg/d) therapy. The clinical response was assessed by the percentage reduction in the baseline PASI scores during next 12 weeks. Results: 14 patients in Group-A and 11 patients in Group-B completed the study. The mean percentage reduction in the PASI score was 79.78 ± 20.68 in the methotrexate group and 51.92 ± 23.83 in the isotoin group at the end of 12 weeks. Five patients in Group-A achieved >75% reduction in the PASI score, while only 3 patients in Group-B showed similar results at the end of 12 weeks signifying faster disease clearance with methotrexate. Isotretinoin-related serious adverse effects were fewer and did not warrant treatment discontinuation. Conclusions: Isotretinoin may be an option for alternative therapy in patients who cannot afford acetretin, are intolerant to methotrexate, have achieved its cumulative dose, or in rotational therapy.

Low-dose Vitamin "A" Tablets-treatment of Acne Vulgaris.

Background:The efficacy of isotretinoin at 0.5 to 1.0 mg/kg per day in the treatment of acne is well established and considered safe, although it is sometimes not easily tolerated because of its cutaneous side effects.Objective:The purpose of this study was to determine the efficacy of low-dose isotretinoin in the treatment of acne.Methods:In this prospective, non comparative, open-label study, 50 patients, both male and female, with moderate acne were enrolled and treated with isotretinoin at 20 mg/d (approximately 0.3-0.4 mg/kg per day) for 3 months. The patients were divided into two age groups: 12 to 20 and 21 to 35 years old. Patients were evaluated at 2-month intervals by means of clinical and laboratory examinations. A 4-year follow-up was also carried out.Results:At the end of the treatment phase, good results were observed in 90.8% of the patients aged 12 to 20 years, and in 89.6% of the patients aged 21 to 35 years. Failure of the treatment occurred in 5.2% and 7.4% of the two groups, respectively. Three patients dropped out of the study because of lack of compliance, and another patient discontinued participation because of a laboratory side effect. During the 2-year follow-up period, relapses of the acne occurred in 3.9% of the patients aged 12 to 20 years and in 5.9% of the patients aged 21 to 35 years. Elevated serum lipid levels (up to 20% higher than the upper limit of normal value) were found in 4.2% of the patients and abnormal (<twice the upper limit of normal values) liver tests were observed in 4.8%.Limitations:This was a non comparative, open-label study.Conclusion:Three months of treatment with low-dose isotretinoin (20 mg/d) was found to be effective in the treatment of moderate acne, with a low incidence of severe side effects and at a lower cost than higher doses.

Predictive markers of response to isotretinoin in female acne

Acne vulgaris is a common and chronic disorder of the pilosebaceous unit. Female acne may be a subtype differing from teenager acne. Isotretinoin is the only therapy impacting on all the major acne-related aetiological factors. All clinical studies demonstrating isotretinoin efficacy in acne patients have been performed either in teenagers or in a mixed population of teenagers and adults. To evaluate isotretinoin efficiency and tolerance in a cohort of females with acne, aged 20+ years. Study of 32 women prescribed isotretinoin according to the European recommendations (0.5 mg/kg) in two dermatology departments (France and Greece). The ECLA scale and a global evaluation using the GEA grading were used to evaluate isotretinoin efficacy. The correlation between the clinical response and the different epidemiological factors was determined. Complete response reached 59% on the face, 78% on the trunk and 43% on both the face and trunk. A significant correlation was observed between the facial response and body mass index (p = 0.02), the high-glycemic-load diet (p = 0.0009), tobacco (p = 0.05) and age at acne onset (p = 0.05). Isotretinoin at 0.5mg/kg is effective and well tolerated in mild-to-moderate acne in females over 20 years old and results were similar to those of teenagers and men. We can propose positive predictive markers of response to isotretinoin in female acne, including a low body mass index, low glycemic-load diet, no tobacco, absence of early acne onset and of lesions on the neck.

Nano-lipoidal carriers of isotretinoin with anti-aging potential: formulation, characterization and biochemical evaluation

Background: Treatment of photoaging includes non-prescription cosmeceuticals and prescription products, retinoids. Isotretinoin, an established anti-acne retinoid, is also reported to delay the aging process. However, the drug is reported to be an irritant on skin.Purpose: The present study endeavors to explore the potential of a novel set of biocompatible nano-structured systems of isotretinoin in the treatment of photoaging.Methods: Nano-lipoidal carriers (NLCs) of isotretinoin were developed, characterized and investigated in vivo for anti-aging potential in Laca mice vis-à-vis the marketed products of retinoids. The anti-aging efficacy of NLCs was measured in terms of visual and redox-biochemical parameters in ultraviolet (UV)-irradiated mice.Results: Visual observations revealed that there was no significant change (p < 0.05) w.r.t. erythema, skin sagging and wrinkles in the skin of the animals treated with NLCs formulation compared to the marketed product(s). The malondialdehyde levels were found to be significantly reduced, whereas glutathione levels were increased with the application of NLCs vis-à-vis control and test formulations. The NLCs were able to maintain the normal redox-balance of UV-irradiated skin, and were better tolerated by the animals.Conclusion: The study ratifies enhancement in the efficacy of isotretinoin against photoaging and improved skin biocompatibility after its encasement in novel topical dosage forms.

Isotretinoin is safe and efficacious in Asians with acne vulgaris

Background: Oral isotretinoin is effective for acne vulgaris but concerns remain regarding its adverse effects. Objectives: This study aims to evaluate the safety and efficacy of isotretinoin for acne vulgaris in Asian patients. Methods: We conducted a 4-year retrospective study on all patients with acne vulgaris treated with isotretinoin, between January 2005 and December 2008 at the National Skin Centre in Singapore. Medical records were reviewed for information on patient demographics, acne severity, isotretinoin dose, duration, adverse effects and outcome. Results:There were 2,255 patients, with a mean age of 22.5 years, male:female ratio of 2.5:1 and 82.3% being Chinese. The mean starting dose of isotretinoin was 0.4 mg/kg and on average, patients received 7.8 months of treatment at a mean dose of 0.5 mg/kg. Mean total cumulative dose was 95.6 mg/kg. Vast majority (93.9%) achieved complete remission or substantial improvement. Thirty-eight (2.2%) and 24 patients (2.7%) developed elevated serum levels of alanine and aspartate aminotransferases subsequent to treatment. There were 194 (12.1%) and 80 (4.8%) patients who developed hyperlipidaemia and hypertriglyceridaemia respectively. Isotretinoin was generally well-tolerated, with 6.4% (n = 145) discontinuing due to side-effects. Conclusions:This study reaffirms the overall safety and efficacy of oral isotretinoin in Asian patients with acne vulgaris.

Rosazea

Systemic isotretinoin has been known for decades as an effective and safe therapeutic option in the treatment of severe and refractory forms of rosacea. It can also be used in special treatment-resistant forms of rosacea, e.g. granulomatous rosacea, as efficacious second-line therapy. Previously, the effect of isotretinoin in rosacea has been mainly studied in small cohorts or anecdotal reports. Recently, a big randomized double-blind dose-response and comparative study revealed that an optimized dosage of 0,3 mg/kg was superior to other dosages and non-inferior to doxycycline as gold standard of systemic rosacea treatment and proved effective and safe in papulopustular and phymatous subtypes. However, the substance is still not licensed for this indication The efficacy of isotretinoin in rosacea is probably mainly related to anti-inflammatory mechanisms as well as anti-oxidative, anti-angiogenic and antifibrotic properties. The classical antiseborrheic effect of isotretinoin might play a role in special subtypes like the phymatous type or rosacea fulminans.