Treat JR.
- July 2022 - Medscape
When adolescents have acne that does not respond to isotretinoin, it is necessary to ensure that they take the drug along with fatty foods, which are known to increase its bioavailability. So advises James R. Treat, MD, a pediatric dermatologist working at Children's Hospital of Philadelphia.
If the patient's acne worsens beyond the first two months of treatment, especially if nodule-cystic lesions appear, there is no need to increase the daily dosage. "One should reduce the dose and consider adding steroids" in order to prevent acne fulminans, as is recommended in an article published in the Journal of the American Academy of Dermatology in 2017.
Lesion manipulation is another reason for the failure of isotretinoin therapy. In these cases, where a strong anxiety component is present, isotretinoin finds some contraindication. Off-label use of N-acetylcysteine, an antioxidant and cysteine propharmaceutical, has been shown to be "extremely effective" in patients with significant excoriations. In a randomized trial of adults aged 18-60 years, 47 percent of patients taking doses of 1,200-3,000 mg daily of N-acetylcysteine for 12 weeks reported marked improvement in skin pathology, compared with 19 percent of those taking placebo (P = .03).
A review of the literature shows that adalimumab, etanercept, and infliximab used to treat isotretinoin-resistant acne produce significant improvements in acne after about 3-6 months of therapy.