In addition to the laboratory tests that need to be performed to ensure that a woman is not pregnant, both men and women must get additional laboratory studies. A complete blood count, liver function test, and a lipid profile is checked at baseline and four weeks after starting isotretinoin. Elevated triglyceride levels occur in about […]

Since RAR are found in many organs of the body, isotretinoin can cause numerous side effects (Table 9). This profile of adverse effects closely mimics those of hypervitaminosis A (96). Mucocutaneous side effects are the most common and are dose dependent. The most frequently encountered mucocutaneous side effects are: cheilitis, generalized xerosis, and dry mucosa. […]

There is variation in the dosing of isotretinoin with daily doses ranging from 0.1 to 2 mg/kg. Typically, 0.5-2 mg/kg/day is recommended for 16-20 weeks to reach a total cumulative dose of 120-150 mg/kg. A lower starting dose may be necessary in patients with significant inflammatory acne to prevent flares in the first month of […]

Isotretinoin (13-cis retinoic acid) is an oral retinoid that has been available for the treatment of acne since 1971 in Europe, and since 1983 in the United States. The Food and Drug Administration (FDA) indication for the use of isotretinoin is severe, nodulocystic acne that has not been helped by other treatments, including antibiotics. However, […]

Oral contraceptives have several mechanisms of action in treating acne. They reduce androgen production by both the ovaries and the adrenal glands. Oral contraceptives also reduce free serum testosterone by increasing sex hormone-binding globulin. Sebum production is decreased with oral contraceptive use, possibly due to androgen reduction or possibly directly due to increased levels of […]

Flutamide is a potent anti-androgen that is used to treat prostate cancer, and can also be useful for acne (82). It is administered at 250 mg twice daily in combination with an oral contraceptive. Liver function tests must be monitored in patients on flutamide as it can cause fatal hepatitis (83). Patients with adrenal hyperandrogenism […]

Cyproterone acetate is a hydroxy-progesterone that blocks the binding of androgens to their receptors. It also inhibits the synthesis of androgens in the adrenal glands and in the skin. Cyproterone acetate is not available in the United States but is available in Canada and Europe. It is incorporated in an oral contraceptive pill at 2 […]

The anti-androgens include the androgen receptor blockers spironolactone, cyproterone acetate, and flutamide. Spironolactone is an aldosterone antagonist that also blocks the androgen receptor (72). Oral spironolactone reduces sebum excretion by 45-50%. It is taken 25-100 mg orally twice a day. Patients frequently experience breast tenderness and menstrual irregularities with spironolactone. These side effects increase with […]

Hormonal therapy is another treatment option for females with acne. Hormonal therapy may be helpful in acne patients with hirsutism, irregular menstrual periods and/or other signs of hyperandrogenism. Patients who have failed isotretinoin or oral antibiotics may still benefit from hormonal therapy. Women with flares of acne around the time of menses and those with […]