Treatment-resistant Acne Research Articles

The effect of isotretinoin on the development of depression in patients after anti-acne treatment

This paper reviews the existing scientific literature on the relationship between isotretinoin, a vitamin A derivative used to treat severe acne, and the development of depression in patients undergoing treatment. Isotretinoin is highly effective for cases of treatment-resistant acne due to its anti-inflammatory, antibacterial properties, and ability to regulate sebum secretion and keratinization. However, its use is also associated with numerous adverse effects, particularly psychiatric disorders, including depression. The connection between isotretinoin use and the onset of depressive symptoms remains controversial, with studies providing conflicting evidence. This review aims to critically examine the current research to clarify the potential risks of depression associated with isotretinoin.

Challenges to Contraceptive Counseling With Isotretinoin Treatment and Future Directions for Dermatologists

Accutane, also known as isotretinoin, is an oral systemic retinoid utilized in the treatment of severe, treatment-resistant acne. Isotretinoin is a pregnancy category X drug, meaning that studies have documented congenital defects in pregnant patients on isotretinoin. Known abnormalities include ear abnormalities, facial dysmorphia, cleft palate, CNS abnormalities, thymus gland abnormalities, and parathyroid hormone deficiencies. With teratogenicity well-documented with isotretinoin use, the iPLEDGE system was created to educate prescribers, pharmacists, and patients about the risks of isotretinoin use. Utilizing iPLEDGE, individuals of child bearing potential (ICBP) are required to document two negative pregnancy tests before the initiation of isotretinoin therapy with two documented forms of birth control. We conducted a literature review utilizing the terms: accutane, isotretinoin, contraception, and birth control. We found that amongst multiple articles, the most popular primary contraceptive methods in iPLEDGE were abstinence (47% of users) and combined oral contraceptives (31% of users). Individuals have attributed their lack of contraceptive use to fear of birth control health impacts and belief in the equivalent effectiveness of non-accepted methods (e.g. withdrawal and natural family planning. Despite the establishment of iPLEDGE to systematically reinforce counseling requirements, the incidence of isotretinoin-exposed pregnancies continues to persist with approximately 100-200 pregnancies annually. Given these findings, it is clear that counseling is tantamount to dispelling misconceptions regarding contraception and optimizing rates of patient compliance. Despite this importance, counseling remains a large issue for dermatologists. Only half of board-certified dermatology residents surveyed in 2023 felt comfortable providing counseling on adverse effects of combined oral contraceptives (COCs), and only 38.8% felt comfortable providing counseling directions for COCs. Solutions for this include quickly accessing a referral to primary care or OB/GYN and potentially new avenues that are more easily accessible such as the progestin-only oral contraceptive pill that was recently approved for over the counter use by the United States Food and Drug Administration.

A Comparative Analysis to Evaluate the Outcome and Effectiveness of Increasing the Therapeutic Agents for the Treatment of Acne Vulgaris

Abstract Background: Acne vulgaris is a long-term inflammatory condition impacting the pilosebaceous units. The guidelines largely rely on expert opinions in light of certain facets of acne treatment. Before initiating our study, we conducted a prescription analysis involving 100 patients diagnosed with acne vulgaris. We noted that in the majority of these cases, the established guidelines were not adhered to. Therefore, we decided to conduct this study at our institute to see if there is any additional benefit of adding multiple drugs to the treatment regimen and to find out if there is a way to rationalize the same. Materials and Methods: For the study, 120 patients with acne vulgaris, graded 2 and 3 according to the Investigator’s Global Assessment (IGA) Scale, were enrolled and divided into four groups. Patients were followed up for 8 weeks with visits at 4, 6, and 8 weeks. Group A was given clindamycin gel, Group B was given clindamycin gel + benzoyl peroxide gel (BPO) (2.5%), Group C was given clindamycin gel + BPO gel (2.5%) + oral doxycycline 100 mg, and Group D was given clindamycin gel + BPO gel (2.5%) + oral isotretinoin 20 mg. Results: This study showed that combination therapy with isotretinoin showed maximum reduction in IGA as well as in the total number of inflammatory lesions. Group C had similar efficacy to combination therapy with Group D as the results were not significantly different. Conclusions: The guidelines recommend adhering to protocols, specifically reserving isotretinoin for cases of very severe and treatment-resistant acne.

Adalimumab Treatment in a Case of Treatment-Resistant Acne Conglobata

Adalimumab Treatment in a Case of Treatment-Resistant Acne Conglobata

Isotretinoin Treatment-Induced Sacroiliitis

Isotretinoin, which is commonly used for the treatment of severe and treatment-resistant acne vulgaris, is associated with many adverse effects including musculoskeletal pain and arthralgia, and rarely sacroiliitis. Isotretinoin-induced sacroiliitis is typically limited with the discontinuation of isotretinoin and usually reduces with non-steroidal anti-inflammatory drugs. In this article, we present a patient using isotretinoin for her facial acne, lived inflammatory pain in her lower back and right hip region after 8 weeks of isotiretionin treatment and diagnosed sacroiliitis. As a result we want to draw attention to the fact that this drug can cause low back pain and sacroiliitis as a side effect.

A patient with chronic sacroiliitis undiagnosed for three years after isotretinoin use

BackgroundIsotretinoin (ISO) is a synthetic vitamin A derivative which has been used for treatment-resistant acne vulgaris. Although most musculoskeletal side effects of ISO are common, including myalgia, arthralgia, and back pain, sacroiliitis is one of the uncommon side effects. ISO-induced sacroiliitis usually completely resolves within a few months by the cessation of the drug.Case presentationIn this paper, we present a 26-year-old female patient with chronic sacroiliitis that was probably induced by ISO and not resolved by the discontinuation of the drug.ConclusionIn this patient, sacroiliitis was overlooked for three years. Therefore, ISO usage should be considered in the differential diagnosis of sacroiliitis and low back pain.

Tuberous sclerosis masquerading as treatment-resistant acne vulgaris

Tuberous sclerosis masquerading as treatment-resistant acne vulgaris

A Case Report of Isotretinoin-induced Manic Psychosis.

Isotretinoin, an oral vitamin A derivative, used to treat severe treatment-resistant acne. Psychiatric side effects of isotretinoin particularly depression and suicidal thoughts have been well documented. We report a case of isotretinoin-induced manic psychosis in a young female without a family history and history of mental illness.

Acne conglobata and adalimumab: use of tumour necrosis factor-α antagonists in treatment-resistant acne conglobata, and review of the literature

Acne conglobata (AC) is a chronic, severe, inflammatory variant of acne characterized by development of cystic nodules, abscesses and sinus tracts. AC may prove resistant to conventional acne therapy. The off-label use of adalimumab for the treatment of AC has been reported recently. We present a 26-year-old man with AC resistant to conventional treatment, who was treated with 40 mg adalimumab every other week, with significant clinical improvement. We review the evidence for the use of tumour necrosis factor antagonists in AC and related conditions. This case provides further evidence supporting the role of adalimumab in the treatment of AC.

New and emerging treatments in dermatology: acne

Topical retinoids, benzoyl peroxide, azelaic acid, and topical and oral antibiotics remain the milestone of treatment for mild to moderate acne vulgaris. Oral isotretinoin is useful for the treatment of severe nodular acne, treatment-resistant acne, and acne with a risk of physical or psychological scarring. Hormonal treatment in female acne is useful in resistant or late-onset acne. With increasing concerns regarding teratogenicity of isotretinoin and increasing antibiotic resistance, there is a clear need for therapeutic alternatives to these long-used treatments. Research in the pathogenesis of acne has allowed for new therapies and future perspectives regarding acne to evolve. They include low-dose long-term isotretinoin regimens, insulin-sensitizing agents, 5alpha-reductase type 1 inhibitors, topical photodynamic therapy, new combination formulations, dietary interventions, and antiinflammatory agents such as lipoxygenase inhibitors.

Concomitant administration of vitamin E does not change the side effects of isotretinoin as used in acne vulgaris: A randomized trial

Background: Isotretinoin treatment is frequently associated with reversible, dose-related side effects. Recent studies claimed that combining vitamin E with high-dose isotretinoin ameliorated isotretinoin-induced side effects. Objective: The purpose of this double-blind, randomized study was to determine the effects of a fixed dose of vitamin E on the side effects of isotretinoin for treatment-resistant acne vulgaris. Methods: One hundred forty subjects were randomly assigned to one of two treatment programs with isotretinoin (1 mg/kg) together with either vitamin E (800 IU/day) or a vitamin E placebo for 20 weeks. The incidence, severity, and duration of the side effects (eg, dry eyes, dry lips) were assessed. Results: A fixed 800 IU/day dose of vitamin E did not improve the incidence, severity, or duration of side effects associated with isotretinoin (1 mg/kg per day). Conclusion: Vitamin E did not significantly ameliorate retinoid side effects when combined with 1 mg/kg of isotretinoin in the treatment of acne. (J Am Acad Dermatol 2000;43:777-84.)

Spread of antibiotic-resistant bacteria from acne patients to personal contacts-a problem beyond the skin?

Spread of antibiotic-resistant bacteria from acne patients to personal contacts-a problem beyond the skin?

Androgen Excess in Women with Acne Alone Compared with Women with Acne and/or Hirsutism

Acne is known to be one of the features of hyperandrogenism. The aim of the present work was to study women with persistent acne and without other evidence of hyperandrogenism, such as hirsutism, alopecia, or irregular menses. Among 87 female patients with acne and/or hirsutism, we defined three groups: group 1 (n = 29), patients having treatment-resistant acne without menstrual disturbance, alopecia, or hirsutism; group 2 (n = 27), patients with acne and hirsutism; and group 3 (n = 31), patients with hirsutism alone. Clinical chemistry criteria for hyperandrogenism were based on elevated values of one or more of the following parameters: plasma testosterone, delta-4-androstenedione, dehydroepiandrosterone, urinary 5 alpha-androstane 3 alpha-17 beta-diol, and 17-ketosteroids (with chromatography). Plasma and urine samples were drawn between the 18th and 25th days of the cycle. Among group 1 patients, we found 25 subjects (86%) with hyperandrogenism, according to these laboratory criteria. The etiologies were: polycystic ovary syndrome (36%), adrenal hypersecretion (40%, of which 12% showed secondary polycystic ovaries), isolated increase in 5 alpha-androstane 3 alpha-17 beta-diol (20%), and hyperandrogenism without diagnosis (4%). The parameters were found to be more elevated in these patients than in a control group of 30 normal volunteer women. In groups 2 and 3, the findings were essentially the same as in group 1, except for increased levels of testosterone and the testosterone/SHBG ratio. Furthermore, it was evident that persistent acne may be an isolated sign of hyperandrogenism.

Cyproterone acetate in acne

Androgens stimulate and estrogens inhibit sebaceous gland activity. The androgenic stimulation is influenced to a variable degree by accelerated peripheral conversion of precursor androgens or by elevated hormone-receptor levels in the target organ sebaceous gland. This has led to the use of cyproterone acetate (CPA) as an antiandrogen in the management of treatment-resistant acne. The oral contraceptive Diane containing 2 mg of CPA and 0.05 mg of ethinylestradiol has proved to be highly effective in several studies reported over the last 15 years. Treatment with CPA is indicated in women with severe inflammatory acne or acne with marked premenstrual exacerbations, as well as in all women with acne who want to use oral contraceptives. With the trend to reduce the estrogen component of oral contraceptives, Diane has been replaced by Diane 35, which contains only 0.035 mg of ethinylestradiol. In a double-blind multicentre study the use of Diane and Diane 35 has been compared for the treatment of acne. Diane...