Isotretinoin

In 2011, isotretinoin was the preferred treatment for severe, resistant acne vulgaris, offering significant improvement and potential long-term remission. It works by dramatically reducing sebaceous gland activity and sebum production. The recommended dosage is 0.5 to 1 mg/kg/day, with a total cumulative dose of 120 to 150 mg/kg. About one-third of patients may experience lasting remission. Side effects include mucocutaneous dryness, altered blood lipids, and increased liver enzymes, but are generally reversible. The most severe side effect is teratogenicity, leading to the implementation of the iPLEDGE program to prevent fetal exposure. The document also notes that isotretinoin does not reduce bone mineral density in short-term use and lacks evidence of causing psychiatric events or inflammatory bowel disease. Monitoring guidelines include monthly checks for fasting lipids, liver function, and pregnancy, with additional attention to signs of suicidality or behavioral changes. Despite its risks, isotretinoin is considered safe when used with caution and informed consent, as there is insufficient evidence linking it to inflammatory bowel disease or psychiatric events.