From the Guidelines
Oral isotretinoin is the most effective treatment option for severe cystic acne in male adolescents.
Treatment Options
- Oral isotretinoin: strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy 1
- Topical retinoids: serve as the cornerstone of acne treatment and are recommended for initial treatment and maintenance as monotherapy or used in combination with other topical or oral agents 1
- Benzoyl peroxide: strongly recommended for acne treatment 1
- Topical antibiotics: strongly recommended for acne treatment, but systemic antibiotic use should be limited 1
- Oral doxycycline: strongly recommended for acne treatment 1
Important Considerations
- Monitoring: patients undergoing treatment with isotretinoin should be monitored for depression, anxiety, suicidal ideation/suicidality, and other neuropsychiatric adverse effects 1
- Pregnancy prevention: mandatory for persons of childbearing potential prescribed isotretinoin 1
- Dosing: daily dosing of isotretinoin is conditionally recommended over intermittent dosing based on low certainty evidence 1
- Formulation: either standard isotretinoin or lidose-isotretinoin can be used based on high certainty evidence 1
From the Research
Treatment Options for Cystic Acne in Male Adolescents
- The mainstays of acne treatment have remained largely unchanged over recent years, with a global movement away from antibiotic monotherapy toward their more restrictive use 2.
- Isotretinoin is classically reserved for nodulocystic acne and has become the drug of choice by dermatologists for moderate to severe acne 2, 3.
- Oral isotretinoin can be effective in treating cystic acne in adolescents, including those with cystic fibrosis, and is well tolerated with no significant side effects 4.
- However, isotretinoin may have side effects, including the potential to trigger autoimmunity in genetically susceptible individuals 5.
- Other treatment options for cystic acne include intralesional triamcinolone, oral antibiotics, and incision and drainage (I&D) of cysts, which can be effective in preventing the need for surgical excision 6.
Considerations for Treatment
- Treatment of acne should be adapted to the type of acne and patients should be informed that it is long and difficult, with no significant response expected before 2 to 3 months of regular treatment 3.
- Isotretinoin should be used only in severe acne after failure of at least 3 months of a well-conducted classical treatment and in nodulo-cystic acne, due to its major side effect of teratogenicity 3.
- Incision and drainage (I&D) and culture of cyst contents can identify cases of cysts related to Cutibacterium acnes, and I&D combined with conservative acne management can prevent the need for surgical excision in some patients 6.