The role of isotretinoin in acne therapy: why not as first-line therapy? facts and controversies

Clin Dermatol. 2010 Jan-Feb;28(1):24-30. doi: 10.1016/j.clindermatol.2009.03.005.


Acne is one of the most prevalent diseases in dermatology: Millions of people worldwide experience this distressing condition. To determine the appropriate therapeutic strategy, there is a strong need for a standardized classification system of acne. The exact molecular mechanism of action of isotretinoin is not completely understood; however, oral isotretinoin targets simultaneously at all major mechanisms of acne pathogenesis. Various mass media reports about the risk of teratogenicity and depression from isotretinoin usage as well as the creation of intense prevention programs have created an obstacle to the use of the most active available drug against acne, presenting isotretinoin as a very dangerous regimen. According to recommendations of several international experts, which we share, oral isotretinoin may be prescribed not only to patients with severe disease but indications should be broadened to also include patients with less severe forms of acne, especially in cases with scarring, significant psychologic stress, or failure to respond to conventional therapy.

Publication types

  • Review

MeSH terms

  • Acne Vulgaris / classification
  • Acne Vulgaris / diagnosis*
  • Acne Vulgaris / drug therapy*
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / adverse effects
  • Dermatologic Agents / administration & dosage*
  • Dermatologic Agents / adverse effects
  • Dose-Response Relationship, Drug
  • Drug Resistance, Microbial
  • Europe
  • Evidence-Based Medicine*
  • Humans
  • Isotretinoin / administration & dosage*
  • Isotretinoin / adverse effects
  • Maximum Tolerated Dose
  • Mental Disorders / chemically induced
  • Patient Education as Topic
  • Product Labeling
  • Recurrence
  • Severity of Illness Index
  • Stomatitis / chemically induced
  • United States
  • Vision Disorders / chemically induced


  • Anti-Bacterial Agents
  • Dermatologic Agents
  • Isotretinoin