The importance of retinol (vitamin A) was discovered during World War. The retinoid drug project was launched in 1968 to synthesize compounds similar to vitamin A by chemical manipulation of its molecule to improve clinical efficacy and safety. The use of these substances in therapy dates back some 3000 years to ancient Egypt, where liver was used to treat endemic night blindness. The modern history of retinoids, however, began in 1909 when an essential factor in the viability of an embryo in the fatty extract of the egg yolk, called vitamin A, was discovered. Retinoids finally were introduced into the treatment of dermatoses including photoaging more than two decades ago. While the use of isotretinoin has revolutionized the treatment of acne vulgaris, isotretinoin is increasingly recognized as a useful therapeutic option for many other cutaneous conditions. We review the evidence underlying the use of isotretinoin for a variety of dermatological indications including hidradenitis suppurativa, sebaceous gland pathology, rosacea, scarring alopecia, cosmetic dermatology, and non-melanoma skin cancer prophylaxis amongst other uses, and thus consider alternative uses within dermatology practice. The studies found benefit of isotretinoin, however most trials lacked statistical power and in many cases the use was limited to case series. Isotretinoin, if used within the correct cohort with appropriate pretreatment counseling regarding side-effects, is a well-tolerated medication with potential as either an adjunctive treatment or a second-line agent in those recalcitrant cases unresponsive to first-line therapy.

Isotretinoin, Dermatology