What is Treatment of choice in severe cystic acne: and explain in detail?
Ans. (a) IsotretinoinRef Katzung 11th ed. /1308, 1455; KDT 854* 13-cis-Retinoic acid (Isotretinoin) is an analogue of vitamin A. It is used for the treatment of severe cystic acne* Isotretinoin (Accutane) is a synthetic retinoid currently restricted to the treatment of severe cystic acne that is refractory to standard therapies.* It appears to act by inhibiting sebaceous gland size and function.* Half life-10-20 hours.* Common side effect: hypervitaminosis A, dryness of skin and mucous membrane.* Teratogenic effect: Extremely high risk of CNS, face, ear, and other malformations. Risk is equal throughout all the three trimester.Also Know* AI-trans vitamin A (Tretinoin): effective topical agent in the treatment of acne vulgaris. It is a potent comedolytic and stimulate epidermal cell turnover, resulting in peeling.* Benzoyl peroxide is an effective topical agent in the treatment of acne vulgaris# MOA of benzoyl peroxide- its antimicrobial activity against P acnes and to its peeling and comedolytic effects.* Azelaic acid effective in the treatment of acne vulgaris.# MOA of azelaic acid- antimicrobial activity against P acnes as well as an in vitro inhibitory effect on the conversion of testosterone to dihydrotestosterone.