Continuing medical educationOral retinoid therapy for dermatologic conditions in children and adolescents☆
Section snippets
Background
The term “retinoids” includes all compounds, synthetic and natural, that possess vitamin-A activity. Vitamin A cannot be synthesized in vivo by the human body and must, therefore, be acquired through diet. In mammals, vitamin A exists in interconvertible forms as retinol (vitamin-A alcohol), which is the main storage form; retinal (vitamin-A aldehyde), which is necessary in its 11-cis-isomer form for visual function; and retinoic acid (vitamin-A acid). Early evidence that retinoids play a role
Acne
Of all the currently available systemic retinoids, first-generation isotretinoin is the most effective against acne vulgaris. Although the exact mechanism of action is unknown, retinoids are thought to normalize follicular keratinization, reduce sebum production, and decrease 5α-dihydrotestosterone formation and androgen receptor-binding capacity.10, 11, 12 Isotretinoin is indicated for nodular acne that is refractory to traditional management, including topical medications and systemic
Mucocutaneous
Mucocutaneous toxicities are the most commonly observed side effects of oral retinoid use and are generally treatable, dose-dependent, and reversible. Cheilitis is the most common manifestation and occurs in virtually all patients on isotretinoin. In fact, absence of cheilitis in a patient apparently unresponsive to isotretinoin should raise suspicion of noncompliance. This cheilitis generally responds to continual application of topical emollients. Lubrication to the anterior nares is also
Monitoring guidelines
In healthy children taking systemic retinoids for acne or DOKs, laboratory tests of liver function and serum lipids should be performed before treatment, 1 month after initiation of treatment, and every 3 months thereafter. Pregnancy prevention program guidelines should be followed before treatment and on a monthly basis thereafter. For those requiring prolonged treatment with retinoids, baseline and yearly bone studies should be considered; however, the optimal bone study to perform remains
Conclusions
The use of oral retinoids for dermatologic conditions in children and adolescents should be considered in the framework of short-term versus long-term therapy. Numerous studies have shown that a standard 20-week course of isotretinoin for nodulocystic acne is generally well tolerated and safe. Acute mucocutaneous toxicities and mild laboratory abnormalities are common and reversible, and rarely a cause for cessation of therapy. Bony side effects from short-term retinoid therapy are rare; the
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2022, Dermatologic ClinicsComparing the frequency of isotretinoin-induced hair loss at <0.5-mg/kg/d versus ≥0.5-mg/kg/d dosing in acne patients: A systematic review
2022, JAAD InternationalCitation Excerpt :In a recent review of postmarketing adverse events, hair loss was reported in 932 cases (9% of all dermatologic adverse events), 62.7% of which occurred in patients between 15 and 30 years of age.16 With the exception of teratogenicity, the incidence and severity of side effects associated with isotretinoin are generally dependent on the dose and reversible with drug discontinuation.11,17,18 In the past, a typical treatment regimen was started at 0.5 mg/kg/d and increased to 1.0 mg/kg/d to reach a cumulative dose of 120 to 150 mg/kg.18-20
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Funding sources: None.
Disclosures: Dr Orlow served as a consultant to Hoffman-LaRoche from 2000 to 2001.