Isotretinoin is a medication categorized as an acne medication and an antineoplastic agent. It is indicated for severe recalcitrant nodular acne.1 According to Lexicomp®, the off-label uses are moderate acne and high-risk neuroblastoma in children. The mechanism of action is it reduces sebaceous gland size and reduces sebum production in acne treatment. In neuroblastoma, it decreases cell proliferation and induces differentiation. The trade names in the United States for isotretinoin are Absorica®, Claravis®, Myorisan® and Zenatane®. The contraindications include hypersensitivity to isotretinoin or any component of the formulation, sensitivity to vitamin A or parabens in the case of Zenatane® or pregnant women or those who may become pregnant.…show more content… When administered, isotretinoin inhibits sebaceous gland function and keratinization. In nodular acne, there is a reduction in sebum secretion which is related to the dose and duration of isotretinoin treatment. Retinoids can affect the keratinization process, although the mechanism of antikeratinization has not yet been determined. The effects show a decrease in keratin precursors, tonofilaments and tonofibrils, desmosomes become smaller and less well-developed, and microvilli appear on the cell surface. The stratum corneum becomes less well organized, losing its superficial layers and becoming thinner. The synthesis of amorphous material between and within cells is increased. However, within a few weeks, the keratinocytes adapt and the retinoid-induced changes are less pronounced. The recommended initial dose for severe recalcitrant nodular acne in adult patients is 0.5 to 1 mg/kg/day given orally with food in 2 divided doses.2 The absorption within the body is enhanced by a high fat diet.3 In very severe acne with scarring or primarily affecting the trunk, the dose may be increased to 2 mg/kg/day.2 The duration of treatment is 15 to 20 weeks. Therapy may be discontinued if the total cyst count has been reduced by more than 70% before the 15 to 20 weeks. The dose should be adjusted based on side effects and disease progression. A second course of
