Isotretinoin maintains its role in moderate-to-severe acne
Isotretinoin is widely accepted as standard of care and has solid evidence for select patients who have nodulocystic disease or who have moderate-to-severe inflammatory acne that is recalcitrant to treatment with other agents.
“Obviously, we want to be appropriately selecting patients based on their personal risk factors,” Dr. Schlosser says. “There is controversy about the potential association with [isotretinoin and] inflammatory bowel disease, as well as mood changes or depressive symptoms. There have been some suggestions … but the evidence is not conclusive. But we still advocate that all dermatologists discuss potential associations with their patients and review potential side effects of the medicine. Then, monitor their patients throughout the entire treatment course. Of course, it’s imperative that patients be counseled about the birth defect potential of the medication, and that all prescribers adhere to the strict requirements of the iPLEDGE system.”
Are physical modalities recommended?
In-office procedures, including laser treatments and chemical peels, have been shown to offer slight improvements in acne, according to Dr. Schlosser.
“But the guidelines actually don’t recommend those procedures for routine acne treatment, and that’s simply because there is not enough data out there to suggest their benefit over other topical modalities, like topical retinoids,” she says. “[Physical modalities] may have some adjunctive benefit for select patients, but they wouldn’t necessarily replace other treatments.”