The use of isotretinoin in low doses and unconventional treatment regimens in different types of acne: a literature review

Oral Isotretinoin and Its Uses in Dermatology: A Review

In 1982, the Food and Drug Administration (FDA) of the United States of America approved isotretinoin (13-cis-retinoic acid), a retinoid derivative of vitamin A, to treat severe recalcitrant acne vulgaris. Apart from its prescribed use for severe acne, evidence suggests that isotretinoin is commonly used off-label to treat mild-to-moderate acne, inflammatory skin conditions, genodermatoses, skin cancer, and other skin disorders. This is due to its anti-inflammatory, immunomodulatory, and antineoplastic properties. Some "off-label" use is successful, while others are ineffective. Therefore, this information is essential to clinicians for deciding on the appropriate use of isotretinoin. In this article, we aim to review the most updated evidence-based data about the use of oral isotretinoin in dermatology.

Evaluation of the efficacy of RF microneedling and oral isotretinoin in comparison with oral isotretionoin alone in the treatment of acne vulgaris

Introduction

Acne vulgaris is one of the most common skin illnesses in teenagers, affecting 80% of people aged 11-30 years. Scars on the face are caused by high inflammation, severe acne, physical manipulation of the skin, and delayed treatment.

Aim

To compare the effectiveness and safety of an automated RF micro needling device and oral isotretinoin with oral isotretinon alone alone for treating active acne.

Material and methods

A cross-sectional study of 40 moderate acne sufferers. Twenty patients with active acne were treated with an automated RF microneedling device and isotretinoin 0.5-1 mg/kg. Group B included 20 people with active acne, who were given a single dose of 0.5-1 mg/kg isotretinoin.

Results

In this cross-sectional research, 40 acne vulgaris patients were divided into 2 groups: group A: 23.8 ±3.2 years old, 58.95 ±5.5 kg, 13 females, and 7 males. There were 15 females and 5 males in group B: 24.4 ±3.7 years old and weighing 56.4 ±8.46 kg. After 12 weeks, group A shows better global acne assessment scale (GAAS) outcomes than group B than group B. After 6 months, group A showed better results than group B. The GAAS meaning global acne assessment scale did not change after 4-8 weeks of treatment. There was no age or weight difference.

Conclusions

Acne vulgaris may be treated with fractional RF microneedling. Active acne treatment with RF microneedling is safe and effective, has a quicker response, causes less scarring, and reduces recurrence.

The rates of major malformations after gestational exposure to isotretinoin: a systematic review and meta-analysis

Objective

Isotretinoin is among the most notorious human teratogens, documented originally as causing up to 30% of malformations. This systematic review and meta-analysis aimed to evaluate the rates of major malformation (MM) among isotretinoin-exposed pregnant women over the years through a systematic review and meta-analysis.

Methods

Eligible studies were searched and identified using various databases. Single-arm meta-analysis and meta-analysis of odd ratios among controlled studies were performed using Review Manager version 5.3.

Results

Ten eligible studies that combined 2,783 isotretinoin-exposed women were included in our study. The rate of MM weighted for the sample size was 15%. Three studies that included an unexposed comparison group were eligible for the meta-analysis. The pooled odds ratio of MM for isotretinoin-exposed women was 3.76. After 2006, the pooled odds ratio of MM for isotretinoin exposure was significantly lower at 1.04.

Conclusion

The current rate of MM in isotretinoin-exposed women was substantially lower after 2006.

Systematic review of low-dose isotretinoin for treatment of acne vulgaris: Focus on indication, dosage, regimen, efficacy, safety, satisfaction, and follow up, based on clinical studies

Oral isotretinoin is the most effective treatment for moderate to severe acne and its side effects are mostly dose-dependent. Low dose isotretinoin (0.5 mg/kg/day for 1 week every 4 weeks for 6-months) could be effective and even in its end result, comparable with high or optimal doses. In this systematic review, we aimed to sum up the results of clinical trials regarding indications, dosage, prescription protocol, effectiveness, side effects, patient satisfaction, recurrence rate, and follow-up period of low dose isotretinoin in treatment of acne. Cochrane, Google Scholar, Science Direct, PubMed, and Medline were searched. A total of 460 articles were searched electronically and 382 articles were excluded. About 4 were non-English and 2, before 1980. The full text of 72 articles was reviewed. Finally 15 documents met the inclusion criteria for entering this systematic review. The standard dose of isotretinoin is 0.5-1 mg/kg/day for 4 months with a total dose of 120-140 mg/kg/day. Daily doses between 0.1 and 0.3 mg/kg can be recommended for more than 6 months due to the occurrence of fewer side effects and more economical concerns. For greater effectiveness, it could be combined with other medications.

CHARACTER OF DISTRIBUTION OF HLA II ANTIGENS IN PATIENTS WITH AVERAGE AND SEVERE FORMS OF ACNE

This article presents information about the distribution of antigens of the second class in patients with papulo-pustular and nodulous forms of acne. Class II antigens distribution was estimated as the total Group and groups of patients allocated depending on the severity of the clinical picture. Association revealed the presence of severe acne with antigens of histocompatibility of HLA-complex that confirms the importance of immunogenetic factors in the pathogenesis of this condition.