Acne is a familiar skin problem that often occurs among adolescents. Acne can be of various types, but its severe form is the hardest to treat and is likely to leave permanent scars. At present, oral isotretinoin, or 13-cis-retinoic acid, is the best oral retinoid and the best drug for treatment of severe acne. Oral medications like Accutane containing retinoic acid has been in use for treating acne treatment for over a couple of decades. .
Oral 13-cis-retinoic acid has a number of advantages. In addition to having anti-inflammatory properties, it has the capability of reducing sebum secretion, comedone formation as well as incidence of propionibacterium or P. acnes infection. In this way, oral 13-cis-retinoic acid affects all four pathogenic factors of severe acne and is the only drug that can do so. It is because of this that oral 13-cis-retinoic acid is universally effective during active therapy and is successful in almost 90 percent of cases.
Oral 13-cis-retinoic acid can be used for patients with severe acne that is resistant to treatment with combined oral and topical therapy; or, mild or moderate acne that resists long-term oral or topical treatment; or in those cases where there are severe scarring and mental problems. However, medications containing retinoic acid such as Accutane should not be used during pregnancy or lactation and by people with hepatic and renal problems.
For most patients of severe acne, six-month treatment using drugs containing retinoic acid may be enough, but it is better to continue the treatment at a lower dosage for some more time. Nearly 40% of patients become acne-free after one course of treatment, 40% suffer a recurrence of low intensity that is treatable with medications to which the acne was previously resistant and 20% will require repeated treatment with oral 13-cis-retinoic acid in the future.
It is found that that the treatment becomes difficult for patients younger than 16 years, or those with severe acne on the trunk or adult women. The first two categories might need several courses of oral isotretinoin or 13-cis-retinoic acid. Relapses occur mostly among patients with severe acne who receive a low dosage treatment. The chance of a prolonged remission becomes brighter if a total dose of 120mg to 150mg of isotretinoin per kg of body weight is achieved. In most cases of severe acne, the dosage may begin at 20mg to 40mg per day which can rise to 40mg to 80mg over several months.
Their efficacy notwithstanding, oral medications containing retinoic acid poses high risks because of their side effects and should be used only in cases of severe acne. These medications can affect pregnant women, with almost half of them suffering spontaneous abortions and 25% having neonatal cardiovascular or bone related abnormalities. People using oral 13-cis-retinoic acid may develop some serious complications that can affect several organs, including the liver, intestines, eyes, ears, and skeletal system.
Psychological problems like depression, irritability and suicidal tendencies have been observed during and after treatment with isotretinoin. It is essential to monitor the psychological status of the patient carefully and he/she should have physicians and counselors at hand for immediate help in case of emergency.