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Isotretinoin is a medication used for the therapy of severe acne. It is sometimes employed in prevention of certain skin cancers. It is a retinoid, implying it is originated from vitamin A and is found in tiny quantities naturally in the body. Oral isotretinoin is marketed under several trade names, most usually Accutane (Roche), Amnesteem (Mylan), Claravis (Barr), Sotret (Ranbaxy), or Roaccutane (Roche); while topical isotretinoin is most usually sold under the trade names Isotrex or Isotrexin (Stiefel). Prior to the development of isotretinoin, the mainstay therapy of severe acne was oral antibiotics like the tetracyclines and erythromycin. While these medications have proven efficacy, they worked against only one initiating element of acne - the Propionibacterium acnes bacteria. The antibiotics slowly became less effective over time as more resistant types of the bacterium became prominent. An early, effective therapy of acne was high doses of the fat-soluble vitamin A. At these dose levels (sometimes 500,000 IU per day) effects like reduced production of sebum and dry hair could be observed. However the vitamin also possessed many other prominent secondary effects which impeded its widespread use. The discovery of a new alternative The discovery of the retinoic acid by-product isotretinoin, and its production in 1982 by Hoffmann-La Roche, was a great step forward in the therapy of acne. The artificial element provided better therapeutic benefit than vitamin A, while also inducing fewer adverse effects. In February 2002, Roche's patents for isotretinoin expired and there are now many other companies selling cheaper generic alternatives of the drug. Today isotretinoin is commonly prescribed after other acne therapies have failed to produce results. The therapy of acne commonly starts with topical medications (e.g. benzoyl peroxide, adapalene, etc), followed by oral antibiotics (or a combination) and in third place isotretinoin treatment. This is because other therapies, while less effective than isotretinoin, have been linked with far fewer adverse effects and lower cost. Contrary to the previous statement, if isotretinoin is used at minor quantities, many of the adverse effects are diminished or non-existent. Women should ask a doctor about taking 5mg a day if there is a possibility of pregnancy. Isotretinoin is now available over the internet from countries where it can be dispensed without a prescription, at a much lower total cost. Isotretinoin dramatically reduces the production of sebum and reduces the sebaceous glands. It stabilizes keratinization and impedes comedones from appearing. The exact mechanism of action is unknown, however it is clear that like other retinoids, Isotretinoin works by modifying DNA transcription. This action reduces the size and output of sebaceous glands, makes the cells that are sloughed off into the sebaceous glands less adhesive, and therefore less capable to promote comedones.
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