Is isotretinoin (13-cis retinoic acid) effective for treating perforating folliculitis?

From the Research

Isotretinoin is a highly effective treatment option for perforating folliculitis, and the recommended dosage is at least 0.4 mg/kg/day for a duration of at least 3 months, as supported by the most recent and highest quality study 1. The treatment of perforating folliculitis with isotretinoin has been studied in various clinical trials, with the most recent study published in 2018 showing promising results 1. This study found that patients who received oral isotretinoin at a dose of 0.4 mg/kg/day or higher for a duration of 3 months or longer had a better response to treatment and a lower risk of relapse.

Key Considerations

• The medication works by reducing sebum production, normalizing follicular keratinization, and decreasing inflammation, which addresses the underlying pathophysiology of perforating folliculitis.
• Before initiating treatment, baseline laboratory tests including lipid profile, liver function tests, and pregnancy test for women of childbearing potential are essential.
• Monthly monitoring of these parameters is necessary throughout treatment.
• Common side effects include dry skin, cheilitis (dry lips), and photosensitivity, which can be managed with moisturizers, lip balm, and sun protection.
• Strict pregnancy prevention is mandatory for female patients due to the teratogenic effects of isotretinoin, requiring two forms of contraception.
• Patients should be counseled about potential mood changes and monitored for signs of depression.
• Isotretinoin should be taken with food to enhance absorption.

Treatment Outcomes

• Improvement is typically observed within 2-3 months, but completing the full course is important to reduce relapse risk.
• The study by 1 found that 82% of patients healed after treatment, and 66% of patients who received the recommended dose and duration of treatment never relapsed.
• Other studies, such as those published in 1986 2 and 2015 3, also support the use of isotretinoin for the treatment of folliculitis, but the 2018 study 1 provides the most recent and highest quality evidence.