Isotretinoin prescribing guidelines for acne: how to avoid common mistakes

Acne is a common dermatological condition. The disease is multifactorial in nature, with observed functional changes in the epidermal barrier, which impacts both the course of acne and the choice of treatment. Topical agents are traditionally prescribed for mild-to-moderate cases of the disease. However, the lack of immediate results and potential adverse reactions significantly reduce treatment compliance. Isotretinoin is the only drug that targets all aspects of acne pathogenesis. This systemic retinoid also demonstrates high efficacy as a monotherapy. Nevertheless, the perception persists that isotretinoin is unsafe for acne treatment. Despite decades of successful clinical use, specialists still face challenges in rationally prescribing this medication. The study presents a retrospective analysis of 542 medical records of patients who presented with acne to one of the branches of the Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology (MSPCDC). The results indicate that isotretinoin was prescribed to 67% of these patients, but specialists do not always select the appropriate dosage regimen. Isotretinoin is indicated for moderate-to-severe acne and cases refractory to other therapies. It is teratogenic during the course of pregnancy and for one month following discontinuation. Women of childbearing potential must be warned about this. The key to effective acne therapy with systemic retinoids is achieving the target cumulative dose (at least 100 mg/kg for isotretinoin-Lidose), which typically requires a long-term treatment (at least 8–12 months) and a drug dose of 0.5—0.8 mg/kg/day. In addition, it is important to inform patients about the need for long-term therapy, possible adverse events that can be easily managed with the use of appropriately selected skincare products, and the achievement of significant visible treatment results within 2 to 4 months..