Acne is common among adolescents and adults. Guidelines for treatment of acne were last published by the American Academy of Dermatology in 2016.

Acne is common among adolescents and young adults, but its prevalence appears to have increased in people of all ages due to prolonged wearing of masks during the COVID-19 pandemic. Guidelines for treatment of acne were last published in 2016.

The pathogenesis of acne is multifactorial: follicular hyperkeratinization, bacteria, sebum production, androgens, and inflammation all play a role. The gram-positive microaerophilic bacteria Propionibacterium acnes promotes development of acne lesions by secreting chemotactic factors that attract leukocytes to the follicle, causing inflammation.

The oral retinoid isotretinoin (Accutane, and others) is the most effective drug available for treatment of acne.1 The FDA has recently approved a new oral isotretinoin product (Absorica – Cipher/Ranbaxy) for treatment of severe, recalcitrant nodular acne.

Isotretinoin can completely clear severe nodulocystic lesions, in some cases leading to remission that can persist for years after treatment is stopped. Mucocutaneous adverse effects include dry skin, dry eye, epistaxis, nasopharyngitis, cheilitis, alopecia, eczema, skin fragility and photosensitivity. Musculoskeletal symptoms, hypertriglyceridemia, hepatitis, pancreatitis, pseudotumor cerebri, depression and psychosis can occur.

The manufacturer’s package insert states that isotretinoin has been associated with inflammatory bowel disease, but a recent population-based cohort study found no significant association.2 The drug is a potent human teratogen (pregnancy category X); the prescriber, the pharmacist, the distributors, and the patient must register with iPLEDGE, a computer-based risk management program (www.ipledgeprogram.com).

The recommended dosage is 0.5 to 1 mg/kg/day given in 2 divided doses for 15-20 weeks. Unlike other formulations of isotretinoin, which are highly lipophilic and must be taken with a high-fat meal to achieve therapeutic plasma levels, Absorica can be taken with or without food, but serum concentrations are higher when it is taken with food. It should be taken with a full glass of water to reduce the risk of esophageal irritation. Absorica has not been shown to be more effective or better tolerated than generic formulations of isotretinoin.

1. Drugs for acne, rosacea and psoriasis. Treat Guidel Med Lett 2013; 11:1.

2. RO Alhusayen et al. Isotretinoin use and the risk of inflammatory bowel disease: a population-based cohort study. J Invest Dermatol 2012 Oct 25 (epub).

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The pathogenesis of acne is multifactorial: follicular hyperkeratinization, bacteria, sebum production, androgens, and inflammation all play a role. The gram-positive microaerophilic bacteria Propionibacterium acnes promote development of acne lesions by secreting chemotactic factors that attract leukocytes to the follicle, causing inflammation.