Clinical, Cosmetic and Investigational Dermatology (Dec 2019)
Challenges and Solutions in Oral Isotretinoin in Acne: Reflections on 35 Years of Experience
Abstract
Vincenzo Bettoli,1,2 Aurora Guerra-Tapia,3–5 Maria Isabel Herane,2,5,6 Jaime Piquero-Martín2,5,71Department of Clinical Medicine and Oncology, O.U. Dermatology, Teaching Hospital, Azienda Ospedaliera – University of Ferrara, Ferrara, Italy; 2Member of Global Alliance to Improve Outcomes in Acne, Philadelphia, PA, USA; 3Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain; 4Faculty of Medicine, Universidad Complutense, Madrid, Spain; 5Member of GILEA/GILER (Grupo Ibero-Latinoamericano para el Estudio del Acné/Rosácea; Ibero-Latin American Group for the Study of Acne/Rosacea), Buenos Aires, Argentina; 6Department of Dermatology, Universidad de Chile, Santiago de Chile, Chile; 7Department of Dermatology, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, VenezuelaCorrespondence: Vincenzo BettoliDepartment of Clinical Medicine and Oncology – O.U. of Dermatology -Teaching Hospital, Azienda Ospedaliera – University of Ferrara, Via A.Moro 8, Cona, Ferrara, ItalyTel +39 335 6588455Fax +39 05321 4075390Email [email protected]: Acne vulgaris affects more than 80% of adolescents and young adults and forms a substantial proportion of the dermatologist’s and general practitioner’s caseload. Severity of symptoms varies but may result in facial scarring and psychological repercussions. Oral isotretinoin is highly effective but can only be prescribed by specialists. Side effects are recognized and mostly predictable, ranging from cosmetic effects to teratogenicity. These can affect patients’ quality of life and treatment adherence. This article provides a commentary on 4 key areas: the use of oral isotretinoin vs oral antibiotics, including the importance of early recognition of nonresponse to treatment, the psychological effects of acne and isotretinoin treatment, the side effects of isotretinoin therapy, and cosmetic treatment options that can help alleviate predictable side effects. The authors, who have all participated in various international expert groups, draw on relevant literature and their extensive professional experience with oral isotretinoin in the treatment of acne. The aim of this article is to provide an informative and practical approach to managing oral isotretinoin treatment in patients with acne, to help optimize treatment of this skin disease.Keywords: acne vulgaris, side effect, psychological, cosmetic, management, antibiotic
