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Consensus on the use of oral isotretinoin in dermatology - Brazilian Society of Dermatology()()
BACKGROUND: Isotretinoin is a synthetic retinoid, derived from vitamin A, with multiple mechanisms of action and highly effective in the treatment of acne, despite common adverse events, manageable and dose-dependent. Dose-independent teratogenicity is the most serious. Therefore, off-label prescrip...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Sociedade Brasileira de Dermatologia
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772596/ https://www.ncbi.nlm.nih.gov/pubmed/33036809 http://dx.doi.org/10.1016/j.abd.2020.09.001 |
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author | Bagatin, Ediléia Costa, Caroline Sousa Rocha, Marco Alexandre Dias da Picosse, Fabíola Rosa Kamamoto, Cristhine Souza Leão Pirmez, Rodrigo Ianhez, Mayra Miot, Hélio Amante |
author_facet | Bagatin, Ediléia Costa, Caroline Sousa Rocha, Marco Alexandre Dias da Picosse, Fabíola Rosa Kamamoto, Cristhine Souza Leão Pirmez, Rodrigo Ianhez, Mayra Miot, Hélio Amante |
author_sort | Bagatin, Ediléia |
collection | PubMed |
description | BACKGROUND: Isotretinoin is a synthetic retinoid, derived from vitamin A, with multiple mechanisms of action and highly effective in the treatment of acne, despite common adverse events, manageable and dose-dependent. Dose-independent teratogenicity is the most serious. Therefore, off-label prescriptions require strict criteria. OBJECTIVE: To communicate the experience and recommendation of Brazilian dermatologists on oral use of the drug in dermatology. METHODS: Eight experts from five universities were appointed by the Brazilian Society of Dermatology to develop a consensus on indications for this drug. Through the adapted DELPHI methodology, relevant elements were listed and an extensive analysis of the literature was carried out. The consensus was defined with the approval of at least 70% of the experts. RESULTS: With 100% approval from the authors, there was no doubt about the efficacy of oral isotretinoin in the treatment of acne, including as an adjunct in the correction of scars. Common and manageable common adverse events are mucocutaneous in nature. Others, such as growth retardation, abnormal healing, depression, and inflammatory bowel disease have been thoroughly investigated, and there is no evidence of a causal association; they are rare, individual, and should not contraindicate the use of the drug. Regarding unapproved indications, it may represent an option in cases of refractory rosacea, severe seborrheic dermatitis, stabilization of field cancerization with advanced photoaging and, although incipient, frontal fibrosing alopecia. For keratinization disorders, acitretin performs better. In the opinion of the authors, indications for purely esthetic purposes or oil control are not recommended, particularly for women of childbearing age. CONCLUSIONS: Approved and non-approved indications, efficacy and adverse effects of oral isotretinoin in dermatology were presented and critically evaluated. |
format | Online Article Text |
id | pubmed-7772596 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Sociedade Brasileira de Dermatologia |
record_format | MEDLINE/PubMed |
spelling | pubmed-77725962020-12-30 Consensus on the use of oral isotretinoin in dermatology - Brazilian Society of Dermatology()() Bagatin, Ediléia Costa, Caroline Sousa Rocha, Marco Alexandre Dias da Picosse, Fabíola Rosa Kamamoto, Cristhine Souza Leão Pirmez, Rodrigo Ianhez, Mayra Miot, Hélio Amante An Bras Dermatol Special Article BACKGROUND: Isotretinoin is a synthetic retinoid, derived from vitamin A, with multiple mechanisms of action and highly effective in the treatment of acne, despite common adverse events, manageable and dose-dependent. Dose-independent teratogenicity is the most serious. Therefore, off-label prescriptions require strict criteria. OBJECTIVE: To communicate the experience and recommendation of Brazilian dermatologists on oral use of the drug in dermatology. METHODS: Eight experts from five universities were appointed by the Brazilian Society of Dermatology to develop a consensus on indications for this drug. Through the adapted DELPHI methodology, relevant elements were listed and an extensive analysis of the literature was carried out. The consensus was defined with the approval of at least 70% of the experts. RESULTS: With 100% approval from the authors, there was no doubt about the efficacy of oral isotretinoin in the treatment of acne, including as an adjunct in the correction of scars. Common and manageable common adverse events are mucocutaneous in nature. Others, such as growth retardation, abnormal healing, depression, and inflammatory bowel disease have been thoroughly investigated, and there is no evidence of a causal association; they are rare, individual, and should not contraindicate the use of the drug. Regarding unapproved indications, it may represent an option in cases of refractory rosacea, severe seborrheic dermatitis, stabilization of field cancerization with advanced photoaging and, although incipient, frontal fibrosing alopecia. For keratinization disorders, acitretin performs better. In the opinion of the authors, indications for purely esthetic purposes or oil control are not recommended, particularly for women of childbearing age. CONCLUSIONS: Approved and non-approved indications, efficacy and adverse effects of oral isotretinoin in dermatology were presented and critically evaluated. Sociedade Brasileira de Dermatologia 2020 2020-10-03 /pmc/articles/PMC7772596/ /pubmed/33036809 http://dx.doi.org/10.1016/j.abd.2020.09.001 Text en © 2020 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Special Article Bagatin, Ediléia Costa, Caroline Sousa Rocha, Marco Alexandre Dias da Picosse, Fabíola Rosa Kamamoto, Cristhine Souza Leão Pirmez, Rodrigo Ianhez, Mayra Miot, Hélio Amante Consensus on the use of oral isotretinoin in dermatology - Brazilian Society of Dermatology()() |
title | Consensus on the use of oral isotretinoin in dermatology - Brazilian Society of Dermatology()() |
title_full | Consensus on the use of oral isotretinoin in dermatology - Brazilian Society of Dermatology()() |
title_fullStr | Consensus on the use of oral isotretinoin in dermatology - Brazilian Society of Dermatology()() |
title_full_unstemmed | Consensus on the use of oral isotretinoin in dermatology - Brazilian Society of Dermatology()() |
title_short | Consensus on the use of oral isotretinoin in dermatology - Brazilian Society of Dermatology()() |
title_sort | consensus on the use of oral isotretinoin in dermatology - brazilian society of dermatology()() |
topic | Special Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772596/ https://www.ncbi.nlm.nih.gov/pubmed/33036809 http://dx.doi.org/10.1016/j.abd.2020.09.001 |
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