Apoptosis May Explain the Pharmacological Mode of Action and Adverse Effects of Isotretinoin, Including Teratogenicity.
Acta Derm Venereol. 2017 Feb 8;97(2):173-181. doi: 10.2340/00015555-2535. Review.
Isotretinoin taken orally is used to treat acne in its severe forms and at the end of a series of inefficient treatments.
It is far from a “simple treatment” and the effects on fetus malformation (teratogenicity) need to be emphasized on repeatedly, even though many patients have difficulty in understanding the risks, and simply voice their frustration on Google that the doctor as blatantly incompetent. It would indeed become the dermatologist’s worst nightmare if a young women of childbearing age becomes pregnant.
Let’s go back to the article. The mechanism of isotretinoin was poorly understood…until now ! Reduced oily secretion (sebum) can be explained by the action of isotretinoin on sebaceous glands. It reduces its activity by reducing gland size. More precisely it induces apoptosis of sebocytes:
-induction of Tumor Necrosis Factor (TNF) ligand
-induction of Insulin-like growth factor binding protein 3
-induction of neutrophil gelatinase-associated lipocalin
Apoptosis may be the unifying mechanism of isotretinoin effects on:
–neural cells (teratogenicity)
-epidermal keratinoctes and mucosa cells (dryness of the skin and mouth/eyes)
-hair follicle cells (telogen effluvium)
-intestinal epithelial cells (inflammatory bowel disease)
-skeletal muscle cells (myalgia and creatine kinase release)
-hepatocytes (release of transaminase and very low-density lipoprotein)
The article is available for free here: https://www.medicaljournals.se/acta/con … 15555-2535
Article selected by Saurat JH, MD