Isotretinoin: 40 years of experience

Abstract

Isotretinoin is a derivative of vitamin A (13-cis retinoic acid) and represents the first generation of retinoids. It affects all the key factors in the pathogenesis of acne and all current guidelines agree that it is still the most effective therapeutic option in the treatment of acne. In addition to conventional treatment, the modern concept of treatment allows various other protocols, so proper selection of patients and adjustment of isotretinoin treatment modality to the type and severity of acne is necessary to obtain optimal results. Although it was introduced into dermatological practice 40 years ago, this drug is still accompanied by certain controversies and doubts among doctors and patients. The main source of doubt is potential side effects such as teratogenicity, depression, suicide, and inflammatory bowel diseases. Decades of experience have shown that side effects (apart from teratogenicity) are mostly mild, reversible and rare. This paper presents modern approach regarding dosage, monitoring of patients during the treatment, as well as the identification and management of side effects.