Oral isotretinoin for the treatment of dermatologic conditions other than acne: a systematic review and discussion of fu
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REVIEW
Oral isotretinoin for the treatment of dermatologic conditions other than acne: a systematic review and discussion of future directions Sherman Chu1,2 · Lauren Michelle2 · Chloe Ekelem2 · Calvin T. Sung2 · Nathan Rojek2 · Natasha A. Mesinkovska2 Received: 13 June 2020 / Revised: 29 September 2020 / Accepted: 9 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract While isotretinoin has been the gold-standard of therapy for severe acne since its approval in 1982, its anti-inflammatory properties makes it a potentially applicable and versatile therapy for a wide variety of dermatologic conditions yet to be explored. This systematic review comprehensively recounts the success of oral isotretinoin in non-acne cutaneous diseases and provide insight into future directions of isotretinoin utility. A systematic literature review was performed using PubMed. Search terms included “isotretinoin” OR “accutane” AND “skin” OR “dermatology” OR “hair” OR “nails” OR “rosacea” OR “psoriasis” OR “pityriasis rubra pilaris” OR “condyloma acuminata” OR “granuloma annulare” OR “darier’s disease” OR “non-melanoma skin cancer” OR “frontal fibrosing alopecia” OR “cutaneous lupus erythematosus” OR “hidradenitis suppurativa” OR “photodamaged skin” OR “skin aging” OR “wart” OR “flat warts” OR “plane warts” OR “lichen planus” OR “dissecting cellulitis” OR “folliculitis decalvans” OR “sebaceous hyperplasia” OR “cutaneous t-cell lymphoma” OR “mycosis fungoides.” A total of 169 studies discuss the use of oral isotretinoin for 16 non-acne dermatologic conditions, the most common being non-melanoma skin cancers (0.2–8.2 mg/kg/day), cutaneous T-cell lymphomas (0.5–2 mg/kg/day), and rosacea (0.22–1 mg/kg/day). Inflammatory conditions such as rosacea, granuloma annulare, and hidradenitis suppurativa benefit from lower oral isotretinoin dosage of 0.3–1 mg/kg/day, whereas, hyperkeratotic diseases such as psoriasis and pityriasis rubra pilaris, consistently respond better to higher dosages of up to 2–4 mg/kg/day for lesion clearance. Recurrence of disease following discontinuation of isotretinoin have been reported for rosacea, psoriasis, granuloma annulare, Darier’s disease, dissecting cellulitis, and non-melanoma skin cancers. Disease exacerbation was reported in some patients with hidradenitis suppurativa. Off-label isotretinoin is an effective treatment choice for dermatological conditions beyond acne. Further prospective, randomized human trials are needed to clarify when and how to prescribe off-label isotretinoin for maximum efficacy and safety. Keywords Isotretinoin · Dermatology · Accutane · Cutaneous
Introduction Oral isotretinoin (13-cis-retinoic acid) is a synthetic retinol analog that was first approved by the US Food and Drug Administration (FDA) in 1982 for treating severe acne. Initial research on isotretinoin was conducted to explore it as a cancer treatment, but isotretinoin’s ability to cause atrophy * Sherman Chu [email protected] 1
College of Osteopathic Medicine of the Pacific, Nor
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