Use of oral isotretinoin to treat acne in the public system: a hospital-based retrospective cohort

Abstract

Acne is a chronic and multifactorial disease that involves inflammation of pilosebaceous units. 1 It mostly affects the face, but may also 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. For this reason, acne needs to be treated as early as possible, and its management should be directed towards prevention of scars. 2,3 Measures such as proper hygiene and sunlight protection form part of the topical and/or systemic therapy for acne, according to the severity of the disease. 4 For moderate or severe forms of acne that do not respond to conventional therapy, and which tend to leave scars, oral isotretinoin is the first-line therapy. 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 Despite the high efficacy of isotretinoin, its use can cause some adverse events, which vary according to the daily dose. The most common and controllable are mucocutaneous conditions (cheilitis, xerophthalmia, nasal dryness and irritative dermatitis); elevated liver enzymes and triglycerides; and changes to cholesterol levels (increased low-density lipoprotein cholesterol and decreased high-density lipoprotein cholesterol). These changes are generally mild and occur early on (after 6 to 8 weeks), and do not have any significant repercussions for the patient's subsequent follow-up. The effects are transient and reversible, and discontinuation of the treatment is only rarely required. 7,8

Alterações Em Cavidade Oral Associada Ao Uso Da Isotretinoína 121

“…Em estudo com 279 paciente sob o uso da isotretinoína oral, pode-se observar que 55,25% dos pacientes manifestaram queilite angular e que 71,12% já receberam a prescrição prévia do hidratante labial como agente preventivo a essa condição. Apenas um paciente manifestou hipocromia dos lábios, o qual não foi submetido a um tratamento especí co (23) .…”

“…Queilite angular, xerostomia, ssuras e rachaduras dos lábios e abcesso labial. (2019) (23) Estudo de coorte prospectivo Dose inicial diária de 20g/dia, com duração de 9 a 12 meses.…”

Comparing the effects of isotretinoin 20 mg versus azithromycin 500 mg in the management of acne vulgaris: a randomized clinical trial

“…13,14 In a retrospective study that has been conducted to determine the effectiveness of isotretinoin in the treatment of acne, the authors suggested that isotretinoin is considered as a first-line therapy in patients in whom the response of conventional therapies are exhausted. 15 As isotretinoin is a synthetic analogue of vitamin A (retinol), in addition to inhibiting sebocyte differentiation and the function of sebaceous gland, it works in skin regeneration and repair. [16][17][18] Although a greater number of researches are available on data search in which the effects of two treatment strategies are determined and compared in AV patients, very few literatures are available on data search in which the effects of two treatment strategies were identified and compared on the levels of microribonucleic acid (miRNA) that were found to be high among patients with AV.…”

“…According to the Federal Drug Authority, USA, a recommended dose of isotretinoin is 0.5–1.0 mg/kg/day for 4–8 months 13,14 . In a retrospective study that has been conducted to determine the effectiveness of isotretinoin in the treatment of acne, the authors suggested that isotretinoin is considered as a first‐line therapy in patients in whom the response of conventional therapies are exhausted 15 . As isotretinoin is a synthetic analogue of vitamin A (retinol), in addition to inhibiting sebocyte differentiation and the function of sebaceous gland, it works in skin regeneration and repair 16–18 .…”

Efficacy of adding systemic glucocorticosteroids to standard therapy in adolescents with severe acne: a randomized controlled trial

“…Со стороны специалистов здравоохранения: Безопасность. Многие дерматологи откладывают терапию изотретиноином или назначают его в заниженных дозах, опасаясь развития побочных эффектов [19]. Так как тератогенность является дозонезависимым эффектом, то беременность или ее планирование являются основным противопоказанием для назначения ретиноидов [20].…”