Active Ingredient: Isotretinoin
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Disease of the sebaceous glands. Dermatology in General Medicine.
New York: McGraw-Hill; 1999. Br J Dermatol.
Isotretinoin for acne vulgaris — 10 years later: A safe and successful treatment. The cost-effectiveness of isotretinoin in the treatment of acne. Part 1.
A meta-analysis of effectiveness literature. S Afr Med J. Washington. C: 1991. Report of the Consensus Conference on Acne Classification; pp.
Clinical evaluation in acne. Treatment of acne with intermittent isotretinoin. Acne vulgaris in the elderly: The response to low-dose isotretinoin.
Chivot M, Midoun H. Isotretinoin and acne: A study of relapses. Isotretinoin and acne in practice: A prospective analysis of 188 cases over 9 years.
Efficacy of fixed low-dose isotretinoin 20 mg, alternate days with topical clindamycin gel in moderately severe acne vulgaris. Ninety-one percent will be clear of acne using this regimen 46, 47 but relapse is disappointingly frequent.
Furthermore some patients will not accept even minimal disease and become very dependent on these small doses expecting to stay on the drug for many years at this lower dosage.
It is not clear whether this approach will result in long term adverse effects and it is important to clarify with the patient that although nothing untoward has been reported to date this is clearly using the drug outside recommended guidelines and is not deemed appropriate for a female of reproductive potential.
What are the reasons for a slow response to isotretinoin? A local anaesthetic cream should be applied to the lesions for the requisite time beneath an occlusive dressing and then the lesions touched gently with light cautery 49 or hyfrecation.
This procedure should initially be performed on a test area of 10 cm 2, to ensure that the patient does not develop scarring or hypo- or hyperpigmentation. When macrocomedones are not the cause of poor response, the dosage of isotretinoin should be carefully considered as some patients will suffer a deterioration in their acne at the start of a course of isotretinoin.
Adherence to therapy must also be considered. The longest duration of treatment was 22 months and the shortest duration was 10.