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Oral isotretinoin is successfully used for the treatment of moderate and severe acne vulgaris and prevention of acne scars and its psychosocial sequels. Acne flare as an adverse event of this agent, which is characterized by an initial exacerbation of acne, develops worsening lesions and increases the risk of scar development. For the first time, the efficacy of carboxytherapy was assessed in the management of acne flare in patients with moderate to severe acne vulgaris under isotretinoin therapy. This study is a case series of 10 subjects with moderate to severe facial acne. Along with initiation of isotretinoin, carboxytherapy was randomly performed on one side of the face. The response to treatment was studied through evaluation of the number of inflammatory and non-inflammatory acne lesions, modified total lesion count (mTLC), modified acne severity index (mASI), subjective satisfaction, and scar correction. The minimum age of the subjects was 24.4 years. The male to female ratio was 2:8. The effect of carboxytherapy on decrease of papule counts and mASI (as important index of acne flare) and increase of subjective satisfaction was statistically significant. In comparison with the control group, the effect of carboxytherapy on white and black comedone, pustule, and cyst counts, and mTLC was better in the interventional group, their differences were not statistically significant. In addition to overcoming acne flare, carboxytherapy could decrease scar severity. No significant side effects were reported. Carboxytherapy can be considered as an effective and safe adjuvant therapy with oral isotretinoin to overcome acne flare and decrease risk of acne scarring. [ABSTRACT FROM AUTHOR]

Background: Although often overlooked, drug-induced pancreatitis is a frequent cause of pancreatitis. Pancreatic drug toxicity is defined according to the classification by Mallory et al. and Trivedi et al. Isotretinoin is only classified as possibly toxic to the pancreas (class 3). We report the first case of recurrence of pancreatitis after rechallenge, which argues for a modification of the classification of drug-induced pancreatitis. Case presentation: We present here the case of a 20-year-old Belgian man who suffered several episodes of acute pancreatitis for which no etiology could be identified despite an exhaustive assessment. Eventually, as a precaution, isotretinoin was discontinued and there was no recurrence until it was reintroduced. Conclusion: This is the 25th case described in the literature, but the first with a positive rechallenge on two occasions. This case therefore implies that isotretinoin should definitely be considered a class 1 toxic drug for the pancreas and should be incriminated in acute pancreatitis in patients treated with this drug. [ABSTRACT FROM AUTHOR]

Isotretinoin is a systemic treatment agent used in patients with severe acne vulgaris. It has been reported to have side effects associated with depression, sleep apnea, and hypersomnia. There are some studies in the literature suggesting that isotretinoin may cause sleep disturbances. The aim of this study was to investigate whether sleep quality is affected in acne vulgaris patients receiving isotretinoin treatment. Fifty patients with acne vulgaris who were receiving isotretinoin treatment and who were referred to the dermatology polyclinic were included in the study. Two Pittsburgh Sleep Quality Index (PSQI) questionnaires, consisting of 7 components and 19 items, were administered to the patients, one during the treatment period and one before the treatment period. Scores ranged from 0 to 21, with scores of 5 and above indicating poor sleep quality. Before isotretinoin treatment, the average PSQI score of male patients was 11.5 ± 4.95, while after treatment it was 18.0 ± 6.69. In female patients, the average PSQI score before treatment was 9.50 ± 4.81, During treatment, it was observed as 14.0 ± 6.28. An increase in scores was observed in both sexes after isotretinoin. The change before and after treatment was considered significant (P < 0.001). In our study, we observed a negative effect of isotretinoin on sleep quality. Some experimental studies have shown that retinoic acids can affect the pathways in the brain that regulate sleep, but further research is needed in this area. [ABSTRACT FROM AUTHOR]

Isotretinoin is commonly used to treat acne, and its effects on sleep have been documented. However, its impact on chronotype features remains unclear. This study aimed to investigate the effect of isotretinoin on sleep duration and chronotype features, considering body mass index (BMI), anxiety, and depression levels as covariates. Among the 106 participants, 55 were systemic-medication-free for acne treatment, and 51 were in their sixth month of isotretinoin therapy. Acne severity was assessed using the Global Acne Grading System. Participants completed the Pittsburgh Sleep Quality Index, the Reduced Morningness–Eveningness Questionnaire, and the Hospital Anxiety and Depression Scale. Sleep duration was significantly shorter in the isotretinoin-treated group compared to the systemic medication free group. A tendency toward an evening chronotype predicted the likelihood of being in the isotretinoin-treated group. In the follow-up of patients undergoing isotretinoin treatment, a psychodermatological perspective should include consideration of sleep duration and chronotype features. [ABSTRACT FROM AUTHOR]

Introduction and objective: Acne vulgaris is a common chronic inflammatory skin disease affecting hair and sebaceous follicles, characterized by skin lesions most commonly appearing on the face. Several factors predispose individuals to the development of acne, including hormonal imbalances, genetic predisposition, and the use of certain medications. This review aims to evaluate and summarize first-line and advanced pharmacological treatments for acne vulgaris, highlighting their efficacy, safety, and emerging therapies for optimal management. Review methods: The literature review utilized databases covering sources from PubMed, Google Scholar, Scopus, and Web of Science using the search terms encompassing the following keywords: 'acne vulgaris' and 'topical retinoid therapy', 'benzoyl peroxide', 'azelaic acid', 'topical antibiotics', 'oral antibiotics', 'contraceptive agents', 'antiandrogen therapy', 'isotretinoin'. Brief description of the state of knowledge: Current treatment methods range from topical therapies (i.e. antibiotics and retinoids) for mild cases to systemic medications (i.e. antibiotics, retinoids, and hormonal) for moderate to severe acne. In most cases, treatment should start with topical therapy. Summary: Early intervention is crucial to mitigate the risk of scarring and psychosocial consequences. Emerging therapeutic strategies have the potential to enhance treatment outcomes. [ABSTRACT FROM AUTHOR]

This review examines the impact of oral retinoids, particularly isotretinoin, on incisional wound healing across surgical specialties. Commonly prescribed for dermatologic conditions, concerns persist regarding oral retinoids' potential adverse effects on wound healing, prompting the widespread practice of discontinuing these medications before surgery. We performed a PubMed search and analyzed research published regarding the use of oral retinoids in a variety of surgical subspecialties: dermatologic, plastic, ophthalmologic, orthopedic, ENT/otologic, and maxillofacial. Contrary to conventional practices, our review challenges the necessity of discontinuing oral retinoids before surgery in many instances based currently available research. Our literature review underscores the need for individualized risk-benefit assessment when deciding whether to hold retinoid therapy prior to surgical intervention as well as the need for more data surrounding systemic retinoids and wound healing interactions. While encouraging a reevaluation of current practices, we advocate for evidence-based decision-making in perioperative care across various surgical specialties in collaboration between dermatologists and surgeons. [ABSTRACT FROM AUTHOR]

Purpose: To develop a simple, subjective, and reliable grading scale for isotretinoin-induced meibography changes. Methods: After analyzing meibography images obtained from systemic isotretinoin users, a grading scale was proposed and named “meibography health score.” The score ranged from 1 to 3, with decreasing gland reflectivity and identifiable margins. A total of 11 medical professionals were asked to grade 10 meibography images obtained from isotretinoin users using the proposed scale and were divided into three groups: (A) ophthalmologists with experience with meibography, (B) ophthalmologists with no experience with meibography, and (C) radiologists. The kappa statistic was determined to test interrater reliability. Results: The overall kappa was approximately 0.64. The kappa scores for Groups A, B, and C were 0.78, 0.59, and 0.90, respectively. Grade 2 had the lowest kappa scores (0.62, 0.35, and 0.82 for A, B, and C, respectively) and grade 3 the highest (0.78, 0.90, and 1.0 for A, B and C, respectively). Furthermore, Group C had the highest kappa scores and Group B the lowest. Conclusion: The meibography health score exhibited good interrater reliability, particularly in severe cases. [ABSTRACT FROM AUTHOR]