Our library of drug research abstracts drawn from the medical literature is updated on a regular schedule, and you can be assured that new accutane research articles will be listed here shortly after becoming available to us.
Related Sponsors
Medical research on accutane
Evidence-based therapy for cutaneous sarcoidosis.
Drugs. 2008; 68(10): 1361-83
Doherty CB, Rosen T
Although healthcare providers have arrived at a relatively comfortable zone of accepted clinical practice in the management of cutaneous sarcoidosis, virtually every treatment is based on minimal evidence-based data and relies almost exclusively on anecdotal information. Although it would be convenient to blame this state of affairs on the lack of certainty about disease aetiology, the unavoidable fact is that little has been executed, even in the realm of well designed comparative trials. Nonetheless, worldwide accepted standard therapies for sarcoidosis include the administration of corticosteroids, antimalarials and methotrexate. A stepwise approach to patient care is appropriate, and potent topical corticosteroids (e.g. clobetasol) or repeated intralesional injections of triamcinolone (3-10 mg/mL) may be all that is needed in mild skin-limited disease. In patients requiring systemic therapy for recalcitrant or deforming skin lesions (or for widespread disease), corticosteroids (e.g. prednisone 40-80 mg/day, tapered accordingly) used alone or in combination with antimalarials or methotrexate may be indicated. Antimalarials and methotrexate are considered second-line interventions and may be used as monotherapy for steroid-resistant sarcoidosis or in patients unable to tolerate steroids. Given the concern regarding ocular toxicity, the maximum dosages of chloroquine and hydroxychloroquine should not exceed 3.5 and 6.5 mg/kg/day, respectively. Methotrexate is given in weekly doses of 10-30 mg, with the caveat that haematological, gastrointestinal, pulmonary and hepatic toxicities are possible. Despite universal acceptance as standard care, the aforementioned treatments often result in an incomplete clinical response or unacceptable adverse events. In such situations, more innovative treatment options may be used. Treatments that may well gain widespread future use include the tumour necrosis factor-alpha inhibitors infliximab and adalimumab. Experience is limited, but early reports are promising. Infliximab is administered via intravenous infusion at doses of 3-10 mg/kg at 0, 2 and 6 weeks and as indicated thereafter, whereas adalimumab is injected subcutaneously at doses of 40 mg either weekly or every 2 weeks. Because adalimumab is not approved for the management of sarcoidosis, the optimum dose administration interval is uncertain. However, it has been given in both weekly and every other week regimens. Isotretinoin, 0.5-2 mg/kg/day, has been used successfully in a handful of reported cases. However, the teratogenic potential of isotretinoin is often prohibitive considering that the primary demographic group likely to develop sarcoidosis is women of childbearing potential. Thalidomide at dosages of 50 to >400 mg/day has limited, albeit promising, supporting data. However, access is restricted in many countries because of a deserved pregnancy category X rating. Melatonin (20 mg/day) and allopurinol (100-300 mg/day) are not well studied in cutaneous sarcoidosis, and the clinical experience with tetracycline derivatives has been mixed. That said, there are compelling reports of therapeutic benefit with both doxycycline and minocycline. Because neither of these agents is associated with the severe toxicity of cytotoxic drugs, they may serve as effective therapy in some patients. Pentoxifylline (400 mg three times daily) has been of use in a small number of reported cases of pulmonary sarcoidosis, but there are no reports on its use in patients with primarily cutaneous disease. Both ciclosporin and chlorambucil have been largely abandoned given their associated toxicity and disappointingly unreliable efficacy. Finally, laser therapy is a newer modality that may provide patients with a quick and non-invasive treatment option for cutaneous sarcoidosis.
Predictive factors for acne flare during isotretinoin treatment.
Eur J Dermatol. 2008 Jun 23; 18(4): 452-456
Demircay Z, Kus S, Sur H
Flare of acne is common at the beginning of isotretinoin treatment. However, severe flare is rare. Multiple comedones, male gender and young age are reported as promoting factors. However, detailed information is still limited. Our aim was to investigate the incidence, types and course of acne flare and the predictive factors for its occurrence. 244 patients were enrolled. Acne grade was defined according to global acne grading system (GAGS) score. Flare was classified according to the increase in number of inflammatory nodules and treatment requirements of the patients. Risk factors (age, sex, duration of acne, basal acne grade, baseline numbers of comedones, papule-pustules, nodules, hyperandrogenism, and presence of sinuses) were investigated. 161 patients completed the study. 79 patients (32%) had facial and/or truncal flare. Flare was mild in 18% (n = 44), moderate in 10% (n = 24), and severe in 4.5% (n = 11) of the patients. For severe flare, male sex, severe acne, GAGS cut-off score greater than 28, presence of more than 44 facial comedones and 2 facial nodules and presence of truncal nodules were found to be predictive. Recognizing predictive factors for severe flare may help to take early precautions and to prevent severe flares which may result with permanent scars.
Am J Clin Dermatol. 2008; 9(4): 255-61
Barzilai A, David M, Trau H, Hodak E
BACKGROUND: Isotretinoin therapy for acne is often associated with mucocutaneous reactions that are usually dose dependent. OBJECTIVE: To describe the characteristics of five patients who presented with a peculiar facial rash that developed during or after a successful course of isotretinoin therapy for acne. METHODS: In this retrospective study, five patients who were treated with isotretinoin and who developed, during or following treatment, a peculiar facial eruption that has not previously been reported, are described. The clinical characteristics, laboratory findings, therapy, and course of the eruption are presented. RESULTS: The rash was characterized by small, yellow, adherent, greasy scales, either flat-topped or spiky, mostly on the cheeks, that resembled seborrheic dermatitis. Cultures obtained in one case grew Staphylococcus coagulase-negative, Acinetobacter, and Pityrosporum ovale organisms. In another patient, microscopic study showed hyperkeratotic scales with many spores and Gram-negative coccobacilli. Topical administration of ointments containing chloramphenicol 3% for 2-3 weeks was curative. CONCLUSION: Seborrheic dermatitis-like eruption may be another adverse cutaneous effect of isotretinoin treatment. Its pathogenesis probably involves a minimal toxic retinoid effect on epidermal differentiation with overgrowth of commensal microorganisms in susceptible individuals.
[How I treat... Acne by isotretinoin]
Rev Med Liege. 2008 Mar; 63(3): 115-8
Piérard-Franchimont C, Nikkels AF, Piérard GE
Acne benefits from a series of treatments. The introduction of isotretinoin was a therapeutic breakthrough which considerably improved both the evolution and the prognosis of the disease. Indications of this retinoid kept changing over the past twenty years. New clinical conditions emerged including the management of disease recurrences. The daily dosages must be selected according to the type of acne, the gender of the patient and the pharmaco-economical implications. Teratogenicity must never be neglected as it represents the dreadful adverse event of the drug. A European Directive currently marks out the way to use this retinoid.
[Low-dose isotretinoin for treatment of chronic discoid lupus in women of childbearing age.]
Actas Dermosifiliogr. 2008 Jul; 99(6): 498-9
Pérez-Crespo M, Bañuls J, Mataix J, Lucas A
Hautarzt. 2008 Jun 7;
Ochsendorf FR, Degitz K
Acne is treated according to the clinical picture and the pathophysiologically relevant mechanisms, such as seborrhea, follicular hyperkeratosis, P. acnes colonisation,and inflammation. In mild forms of acne, topical therapy is most appropriate. Comedonal acne can be treated with topical retinoids; papulopustular acne with a combination of retinoids and topical antimicrobial substances (benzoyl peroxide, antibiotics, or azelaic acid). Moderate forms or those with extrafacial involvement can be treated with oral antibiotics combined with topical retinoids or benzoyl peroxide. Acne conglobata and other severe manifestations are treated with oral isotretinoin. Women are also treated with oral contraceptives containing anti-androgenic progestins. If inflammation is prominent, initial short term treatment with oral glucocorticoids is helpful. Second-line agents include oral zinc or dapsone. Following successful treatment, topical retinoids are suitable for maintenance therapy.
Enhanced ocular isotretinoin toxicity in mitochondrial disorder.
South Med J. 2008 Jun; 101(6): 664-5
Finsterer J
Treatment Options in Insulin Resistance Obesity-Related Acanthosis Nigricans (July/August).
Ann Pharmacother. 2008 May 20;
Romo A, Benavides S
OBJECTIVE: To evaluate the literature to determine which oral and topical medications are most effective in the treatment of insulin resistance obesity-related acanthosis nigricans (IRORAN). DATA SOURCES: A MEDLINE literature search was conducted (1950-January 2008) using the search terms acanthosis nigricans (AN), metformin, rosiglitazone, octreotide, retinoic acid, acitretin, etretinate, and isotretinoin. The search was limited to articles on treatment of IRORAN in humans written in the English language. Articles were retrieved and all references were reviewed. STUDY SELECTION AND DATA EXTRACTION: Articles selected for inclusion were limited to AN related to obesity with no other underlying etiology. Clinical trials and case reports using monotherapy were included. DATA SYNTHESIS: Metformin, rosiglitazone, octreotide, vitamin D analogs, and retinoic acid have been used in the treatment of IRORAN. In one randomized trial, metformin 500 mg 3 times daily was compared with rosiglitazone 4 mg once daily. Neither treatment demonstrated significant improvements in AN; however, rosiglitazone did significantly decrease serum insulin levels. In a second clinical trial and in several case reports, AN and hyperinsulinemia did show improvement with metformin treatment. After a 6-month period, octreotide improved IRORAN, body weight, and glucose/insulin response to a meal. The improvements persisted for 6 additional months after discontinuation of octreotide. Vitamin D analogs and retinoids produced inconsistent results in 5 separate case reports. CONCLUSIONS: IRORAN is a growing problem, particularly in children and adolescents, secondary to the increase in the prevalence of obesity. Treatment of IRONAN should focus on reversal of the underlying hyperinsulinemia. Patients with IRORAN may benefit from a trial of metformin for improvement of lesions and underlying hyperinsulinemia.
A review of tazarotene in the treatment of photodamaged skin.
Clin Interv Aging. 2008; 3(1): 71-6
Ogden S, Samuel M, Griffiths CE
Chronic sun exposure leads to photodamage, which is characterized clinically by fine and coarse wrinkles, dyspigmentation, telangiectasia, laxity, roughness and a sallow appearance. Many treatments claim to reduce the signs of photodamage, however evidence from randomized controlled trials (RCT) to support these claims is limited. The use of topical retinoids, particularly tretinoin, isotretinoin and tazarotene, has been shown to significantly reduce signs of photodamage both clinically and histologically. Over recent years a number of RCTs, have affirmed that topical tazarotene is an effective and safe treatment for photodamaged skin.
Netherton's syndrome: successful treatment with isotretinoin.
J Eur Acad Dermatol Venereol. 2008 May 8;
Lazaridou E, Apalla Z, Patsatsi A, Trigoni A, Ioannides D