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Journal of Drugs in Dermatology : JDD Jun 2022Recent changes to the iPLEDGE platform left providers without the ability to prescribe isotretinoin to their patients. A potential substitute for isotretinoin could be... (Review)
Review
BACKGROUND
Recent changes to the iPLEDGE platform left providers without the ability to prescribe isotretinoin to their patients. A potential substitute for isotretinoin could be beneficial when the drug is unavailable. Prior to the FDA approval of isotretinoin, a vitamin A derivative, vitamin A was studied for its use in acne management.
OBJECTIVE
To review the potential of vitamin A to serve as a substitute for isotretinoin when the latter drug is inaccessible.
METHODS
We conducted a review of published literature from 1931 to 2021, regarding the use of vitamin A in acne treatment, using PubMed and Google Scholar databases. Nine studies were selected after reviewing articles for relevancy to our topic.
RESULTS
Eight out of the 9 studies noted improvement in patients’ acne with vitamin A use. Ranges of doses used were 36,000 I/U daily to 500,000 I/U daily, with 100,000 I/U daily being the most common. Side effects were mainly mucocutaneous in nature.
LIMITATIONS
Many of the trials included in our review were published over 50 years prior and lack standardized components of clinical trials today.
CONCLUSION
Oral vitamin A could potentially serve as a substitute for isotretinoin in acne management for select patients. However, due to its teratogenicity, potential for toxicity, and long half-life, strict monitoring under the care of a medical provider is prudent. Since vitamin A is available without a prescription, strict monitoring cannot be assured, and especially careful patient selection and education would be essential. J Drugs Dermatol. 2022;21(6):683-686. doi:10.36849/JDD.6781.
Topics: Acne Vulgaris; Administration, Oral; Dermatologic Agents; Humans; Isotretinoin; Vitamin A
PubMed: 35674761
DOI: 10.36849/JDD.6781 -
Der Hautarzt; Zeitschrift Fur... Sep 2021Acne vulgaris is one of the most frequent dermatological diseases with a lifetime prevalence of about 85%. The clinical spectrum shows a great variety. Key factors of...
Acne vulgaris is one of the most frequent dermatological diseases with a lifetime prevalence of about 85%. The clinical spectrum shows a great variety. Key factors of pathogenesis are increased sebum production, hyperkeratinization of the follicular infundibulum, inflammatory processes, and a dysbiosis of the skin microbiome. In addition to endogenous factors (e.g., disturbances of the androgen metabolism) or other hormonal changes, exogenous factors (e.g., diet, mechanical irritation or the use of inappropriate cosmetics) can also play an important role. The clinical spectrum is broad, extending from neonatal Acne (A.) to adult A., from comedonal A. to fulminant A., from cosmetic A. to A. excoriée (skin picking disorder). The psychological effects of acne can be profound and can cause a severe reduction in quality of life. Therefore, in addition to an effective therapy with regular medical check-ups and good adherence, it is always necessary to consider psychological aspects.
Topics: Acne Vulgaris; Adult; Humans; Infant, Newborn; Quality of Life; Sebum; Skin; Skin Diseases
PubMed: 34374820
DOI: 10.1007/s00105-021-04856-8 -
Dermatologic Therapy Apr 2022Acne vulgaris is one of the most common dermatologic complaints. Recently, isotretinoin has been used as an off-label indication for the treatment of mild-to-moderate... (Meta-Analysis)
Meta-Analysis Review
Acne vulgaris is one of the most common dermatologic complaints. Recently, isotretinoin has been used as an off-label indication for the treatment of mild-to-moderate grades of acne not responding to conventional treatment. Its conventional recommended dose is 0.5-1.0 mg/kg per day to the cumulative dose of 120-150 mg/kg. To qualify the state of evidence and analyze the efficacy of the low-daily dose and the pulsed doses of isotretinoin in treating mild-to-moderate acne patients with regards to response and relapse rates. Systematic review and meta-analysis using an electronic literature search were performed. The 320 potentially relevant articles were included and reviewed. The level of evidence is moderate to low as conducted by the GRADE quality of evidence assessment. The pooled statistical estimate for response to treatment in the group comparing low-daily doses with conventional dose showed an overall benefit for conventional dose. On the other hand, pooled data from the group comparing the low-daily dose with the pulsed doses yielded an overall beneficial effect from using the low-daily dose compared with the pulsed doses on achieving the response. Given all of the available studies, the quality of evidence is low. It appears that conventional dose isotretinoin improves the odds of prolonged remission in adults with mild-to-moderate acne vulgaris compared to the low doses.
Topics: Acne Vulgaris; Administration, Oral; Adult; Dermatologic Agents; Humans; Isotretinoin; Recurrence
PubMed: 35000295
DOI: 10.1111/dth.15311 -
American Family Physician Jun 2017
Topics: Acne Vulgaris; Administration, Oral; Administration, Topical; Anti-Bacterial Agents; Consensus; Dermatologic Agents; Dermatology; Diet Therapy; Humans; Practice Guidelines as Topic
PubMed: 28671431
DOI: No ID Found -
Actas Dermo-sifiliograficas Oct 2023Acne fulminans is a severe and rare form of inflammatory acne. Lesion severity and subsequent scarring has a negative impact on the patient's quality of life. We... (Review)
Review
Acne fulminans is a severe and rare form of inflammatory acne. Lesion severity and subsequent scarring has a negative impact on the patient's quality of life. We conducted a narrative review of the literature on acne fulminans based on a search for relevant English- and Spanish-language articles published in Medline. We included case reports and case series. The main aim was to describe the clinical and demographic characteristics of patients with acne fulminans. A secondary aim was to determine whether quality of life was affected by the site or extent of lesions. We reviewed 91 articles describing 212 cases of acne fulminans. The mean age of the patients (91.94% male) was 16.6 years. A personal and family history of acne vulgaris was reported for 97.63% and 54.90% of patients, respectively. A trigger was identified in 44.79% of cases. The main cause was pharmacologic (96.63%) and the main drug isotretinoin (65.28%). The sites most often affected were the face (89.31%), the posterior trunk (77.86%), and the anterior trunk (74.81%). The predominant disease subtype was acne fulminans with systemic symptoms (59.12%), which were mostly general (97.06%). Systemic corticosteroids were the most widely used treatment (81.03%). The impact of the disease on quality of life was reported for 2 patients. In conclusion, acne fulminans mainly affects the face and trunk of male adolescents with a history of acne vulgaris. The main subtype was acne fulminans with systemic symptoms, and most patients were treated with systemic corticosteroids. The effect of acne fulminans on quality of life is underreported.
Topics: Adolescent; Humans; Male; Female; Quality of Life; Acne Vulgaris; Isotretinoin; Adrenal Cortex Hormones
PubMed: 37245603
DOI: 10.1016/j.ad.2023.05.018 -
The British Journal of Dermatology Jul 2015This review focuses on the subject of acne in women, a disease that is increasingly common and that can also affect men. Adult acne differs from the type of acne that... (Review)
Review
This review focuses on the subject of acne in women, a disease that is increasingly common and that can also affect men. Adult acne differs from the type of acne that occurs in teenagers, and it may persist beyond adolescence or have its onset at an older age (adult-onset acne or late acne). Acne can have a negative impact on the quality of life of patients at any age, leading to a negative body image and decrease in self-esteem, and in older patients it can result in discrimination in the workplace and in other social environments. Acne in women must be understood as a specific problem, and here we discuss the pathogenesis, clinical presentation, psychology and treatment of this very prevalent problem.
Topics: Acne Vulgaris; Adult; Androgen Antagonists; Anti-Bacterial Agents; Cicatrix; Dermabrasion; Dermatologic Agents; Female; Humans; Retinoids
PubMed: 25597414
DOI: 10.1111/bjd.13638 -
The Medical Letter on Drugs and... Feb 2024
Topics: Humans; Acne Vulgaris
PubMed: 38294764
DOI: 10.58347/tml.2024.1695a -
Der Hautarzt; Zeitschrift Fur... Aug 2014Acne vulgaris is worldwide the most common skin disease. Acne is an inflammatory disorder in whose emergence androgens, PPAR ligands, the IGF-1 signaling pathway,...
Acne vulgaris is worldwide the most common skin disease. Acne is an inflammatory disorder in whose emergence androgens, PPAR ligands, the IGF-1 signaling pathway, regulating neuropeptides and environmental factors are probably involved. These factors interrupt the natural cycling process in the sebaceous gland follicle and support the transition of microcomedones to comedones and inflammatory lesions. Proinflammatory lipids and cytokines are mediators for the development of acne lesions. Bacterial antigens can potentate the inflammatory phenomena. Acne is predominantly treated with combination therapy. Selecting a treatment regimen depends on the exact classification of acne type and severity. The development of scars is the main criterion for the choice of systemic therapy. Retinoids for mild comedonal acne and the combination of retinoids with antibiotics and/or benzoyl peroxide for mild to moderate papulopustular acne are the drugs of first choice for topical treatment. The use of topical antibiotics is not recommended any more because of the development of resistant bacterial strains. Systemic antibiotics, in combination with topical retinoids and/or benzoyl peroxide, for moderate papular/nodular acne and isotretinoin for severe nodular/conglobate acne are the columns of systemic acne treatment. Systemic anti-androgens are used in women against moderate papulopustular acne. Due to advances in the understanding of the underlying inflammatory mechanisms in recent years the development of new therapeutic agents with good efficacy and better side effect profile should be expected in the future.
Topics: Acne Vulgaris; Anti-Bacterial Agents; Anti-Inflammatory Agents; Combined Modality Therapy; Dermatologic Agents; Humans; Retinoids
PubMed: 25113333
DOI: 10.1007/s00105-014-2853-9 -
Anais Brasileiros de Dermatologia 2017Acne fulminans is a rare and severe variant of acne. In Brazilian medical journals, cases are infrequently reported, confirming its rarity. We followed five young male...
Acne fulminans is a rare and severe variant of acne. In Brazilian medical journals, cases are infrequently reported, confirming its rarity. We followed five young male patients with this severe variant of cutaneous lesions, accompanied by also severe systemic symptoms: fever, anorexia, weight loss, and arthralgia. All had a good response to corticosteroids (prednisone), but had significant scarring.
Topics: Acne Vulgaris; Adolescent; Arthralgia; Disease Progression; Fever; Glucocorticoids; Humans; Male; Necrosis; Prednisone; Propionibacterium acnes; Severity of Illness Index; Superantigens; Young Adult
PubMed: 29267432
DOI: 10.1590/abd1806-4841.20176546 -
Advances in Experimental Medicine and... 2022Acne vulgaris results from a complex interaction between environment and genetic factors. While colonization of the pilosebaceous unit with Propionibacterium was...
Acne vulgaris results from a complex interaction between environment and genetic factors. While colonization of the pilosebaceous unit with Propionibacterium was previously considered to be the main cause of acne, the contribution of host-related factors that allow the growth of the bacteria and its immune response against bacterial components are now considered to be more important. Many of these host characteristics have a genetic base that is either involved in the regulation of the immune responses or the steroid hormones metabolisms. This chapter aims to explore the functions of these genes and their role in the pathogenesis of acne.
Topics: Acne Vulgaris; Humans; Immunogenetics; Propionibacterium acnes; Skin
PubMed: 35286695
DOI: 10.1007/978-3-030-92616-8_6