Oral isotretinoin is the only therapy that has impact on all causes of acne. It is the most effective antiacne therapy available. Its potential side effects are predictable and can be managed easily and effectively by concomitant use of moisturizing agents. As the primary mechanism of the action of oral isotretinoin is suppression of the activity of the sebaceous gland, mucocutaneous side effects such as dry lips, nasal passages and eyes are predicted. In the literature most authors report cheilitis, and scaling of the skin in over 90% of patients. Symptoms affecting the conjunctivae and the nasal mucosa are less frequent, occurring in 13% of patients. Drying of the nasal mucous membrane may cause epistaxis. Systemic side effects of oral isotretinoin are less frequent. Pretreatment laboratory testing is necessary to identify potential highrisk patients. Disturbances of lipid metabolism, manifested as hyperlipidemia and hypercholesterolemia, are seen. As in the case of the other retinoids, reliable contraception is mandatory for women with the childbearing potential. Because of isotretinoin ’s short half-life, contraception needs only to be extended to include one posttreatment month.
To investigate the relationships between severe acne, patient’s emotional state and isotretinoin a study was performed in 2003/2004 by Estonian dermatovenereologists from 12 centres. For this purpose, the data for 116 acne patients(72 men and 42 women) aged 13-35 years treated with isotretinoin, were analysed during a mean 18-week treatment course. The mean age of the men was 19 years, weight 72kg and daily dose 0.53mg/kg. The data for women were 21 years, 58kg and 0.54mg/kg respectively. The duration of acne was up to 1 year in 2%, 1-5 years in 68% and over 5 years in 30%of patients. Of the patients 89% had been treated with local antibiotics or with keratolytic substances and 27% had been treated with oral antibiotics before isotretinoin was started. Nobody reported the previous treatment as very effective. Changes in the laboratory tests (WBC, RBC, HKT, HGB, PLT Bilirubin, ASAT, ALAT Cholesterol, Creatinin) were analysed before treatment and at every 4 weeks of treatment. The Emotional State Questionnaire, and a self –report questionnaire for depression and anxiety, was completed before and after treatment. Depression was noted in 25% and anxiety in 17% of the acne patients; after tretment these figures it decreased to 3.8% and 6.7% respectively.
Conclusion: The most common side effects of isotretinoin are moderate cheilitis and dry skin. During 18-weeks of isotretinoin treatment no changes of clinical importance were noted in laboratory test results. This study shows that successful acne therapy with isotretinoin has a significant positive impact on the emotional state of acne patients reducing depression and anxiety.