Overview
What is it?
Oral isotretinoin, also known as 13-cis-retinoic acid, is a derivative of vitamin A. It was approved by the FDA in 1982 for treating severe acne that does not respond to other treatments. It is also used off-label for other dermatological conditions due to its anti-inflammatory and immunomodulatory properties .
How does it work?
Oral isotretinoin works by targeting multiple factors that contribute to acne. It reduces the size of sebaceous glands, decreases sebum production, and regulates cell growth to prevent clogged pores. It also has anti-inflammatory effects and reduces the population of acne-causing bacteria, such as Cutibacterium acnes. Additionally, it normalizes the skin's immune response, helping to clear acne more effectively .
What are the benefits?
Oral isotretinoin is highly effective for treating severe acne, including nodular and cystic acne. It can lead to long-term remission and is often used when other treatments fail. Low-dose regimens are also effective for milder acne and have fewer side effects. Isotretinoin not only clears acne but can also improve the psychological distress associated with severe acne .
Effectiveness
What does the research say?
Research shows that oral isotretinoin can completely clear acne in 61% of patients, though 39% may experience a relapse within 18 months. High-dose regimens (≥220 mg/kg cumulative dose) have lower relapse rates (26.9%) compared to lower doses (47.4%). Low-dose regimens (0.1–0.3 mg/kg/day) are effective with fewer side effects but may have a higher chance of relapse .
Side Effects
Dry skin and lips (cheilitis)
Dry skin and lips are the most common side effects, often requiring moisturizers and lip balms .
Increased sensitivity to sunlight
Isotretinoin can make your skin more sensitive to sunlight, so sunscreen is recommended .
Elevated cholesterol and triglyceride levels
Some patients may experience elevated cholesterol and triglyceride levels, which should be monitored during treatment .
Muscle and joint pain
Muscle and joint pain are reported by some patients, though these symptoms are usually mild .
Mood changes or depression
Mood changes, including depression, have been reported, though research is mixed on whether isotretinoin directly causes these effects .
Teratogenicity (risk of birth defects)
Isotretinoin is highly teratogenic, meaning it can cause severe birth defects if taken during pregnancy. Strict contraception is required for women of childbearing age .
Evidence
Clinical Studies & Trials
[1] Oral Isotretinoin and Its Uses in Dermatology: A Review
This review discusses the mechanisms, benefits, and side effects of oral isotretinoin for treating severe acne and other dermatological conditions.
View study[2] Acne vulgaris
This review highlights the effectiveness of isotretinoin for severe acne, its mechanisms of action, and common side effects.
View study[3] Acne Transcriptomics: Fundamentals of Acne Pathogenesis and Isotretinoin Treatment
This paper explores how isotretinoin targets multiple pathways in acne pathogenesis, including sebum production and inflammation.
View study[4] Efficacy and relapse rates of different Isotretinoin dosages in treating acne vulgaris: systemic review
This review examines the efficacy and relapse rates of various isotretinoin dosages for acne treatment.
View study[5] Adverse Events in Isotretinoin Therapy: A Single-Arm Meta-Analysis
This meta-analysis evaluates the side effects of isotretinoin therapy in acne patients.
View study[6] Isotretinoin treatment for acne and risk of depression: A systematic review and meta-analysis
This study investigates the controversial relationship between isotretinoin use and depression.
View study[7] Isotretinoin and dermatosurgical procedures
This review examines the safety of performing dermatosurgical procedures on patients taking isotretinoin.
View study[8] Systemic retinoid therapy
This paper discusses the use of systemic retinoids, including isotretinoin, for treating skin disorders.
View study[9] Isotretinoin and Timing of Procedural Interventions: A Systematic Review With Consensus Recommendations
This review addresses the timing of dermatosurgical procedures in patients on isotretinoin.
View study[10] Accutane (isotretinoin) and psychiatric adverse effects
This review discusses the psychiatric side effects associated with isotretinoin use.
View study[11] Use of isotretinoin and risk of depression in patients with acne: a systematic review and meta-analysis
This meta-analysis explores the relationship between isotretinoin use and depression in acne patients.
View study[12] Oral isotretinoin for acne
This review evaluates the efficacy and safety of oral isotretinoin for acne treatment.
View study