Accutane is presently approved by the FDA only for the
treatment of severe recalcitrant nodulocystic acne. While dosages
of 0.1, 0.5, and 1.0 mg/kg/day orally seem equally effective in
inducing a remission of acne, there is a significantly higher
relapse rate in patients rate in patients treated at lower doses.
As the goal of accutane therapy is not only the clearing of
active disease but the indefinite maintenance of clearing, it is
recommended that patients be treated with 1 mg/kg/day for 16-20
weeks. Extensive truncal lesions, which do not respond as quickly
or completely as facial lesions, may require dosages of 1.5-2.0
mg/kg/day. Accutane is supplied in 10,20, and 20 mg capsules.
Most patients are treated with 40 mg twice daily. Patients should
be advised not to ingest any vitamin A supplements during their
treatment course.
Other indications
Accutane has also been shown to be effective for a variety
of other skin disorders, but it is not yet approved by the FDA
for these indications. These include several variants of acne:
hidradenitis suppurativa, gram negative folliculitis, and
rosacea.
Retinoids also have an antineoplastic effect. Several patients
with the basal cell nervus syndrome, an autosomal dominant
disorder in which patients develop multiple basal cell
carcinomas, have been treated. Accutane resulted in reduction
in tumor sizes, but usually did not completely destroy the
tumors. Retinoids are also being studied for possible future
roles in cancer prevention. Accutane and other retinoids (
especially etretinate, an aromatic retinoid not yet available in
the US) have been used to treat a wide variety of keratinizing
skin disorders, such as psoriasis, keratosis follicularis,
ichthyosis, pityriasis rubra pilaris, and others. Discussion
of this is beyond the scope of this paper. Although the drug is
very effective for several of these disorders, the major problem
is that long-term treatment is required for these chronic
diseases, and long-term safety of retinoids has not been
established.
Accutane is an exceedingly useful drug,
producing dramatic prolonged remissions after four to five weeks
in most patients with severe nodulocystic acne. it has
side effects, teratogenicity, and cost (about $600 for a four- to
five- month course of treatment).
Wash the skin
Avoid oily substances
Shampoo the hair daily
Don`t "pop" pimples
Exercise regularly
Don't stop the acne medicine
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