Mode of action of accutane in the treatment of cystic acne.
Acne is a disease of the pilosebaceous unit. The pathogenesis
of acne is believed to include several factors. Among them are
excessive sebum production, abnormal keratinization of follicular
epithelium, proliferation of 'Propionibacterium acnes',
inflammation, and hormonal regulation of sebaceous glands.
Accutane effect several of these mechanisms, but its exact
mode of action is not known. Accutane causes pronounced but
temporary inhibition of sebum production and atrophy of sebaceous
glands. In general, after two weeks of standard therapy
(1mg/kg/day), sebum production is decreased by more than 50% and
by the end of a four- to five- month treatment period, it is
reduced by greater than 90%. While there are some patients who
continue to have decreased sebum production months to years after
cessation of therapy, the sebum production of the vast majority
returns to the baseline level within a few months. Since sebum
production returns to normal in most patients, this is obviously
not the sole mechanism for the prolonged remission of acne seen
in these individuals. Many of these patients continue to improve
even after therapy is discontinued.
Some investigators believe that accutane inhibits
follicular keratinization in patients with acne. They postulate
that this prevents the formation of comedomes (whiteheads and
blackheads), the precursors of inflammatory acne lesions.
Accutane does decrease the quantity of 'Propionbacterium
acnes' in treated patients. This organism is normal flora within
the follicles. Increased numbers of these bacteria in patients
with acne produce various chemotactic factors and enzymes that
may increase inflammation. The decreased number of these bacteria
in accutane-treated patients is thought to be a result of
decreased sebum production, producing a poor environment for the
proliferation of this organism. Therefore, the decreased
bacterial counts are thought to be secondary, and not the primary
mechanism of action of Accutane.
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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