Oral isotretinoin in the treatment of moderate to severe acne: efficacy, safety, and current evidence

Abstract

Acne vulgaris is a chronic multifactorial inflammatory dermatosis that predominantly affects adolescents and young adults and may cause significant physical, emotional, and psychosocial repercussions. Among the therapeutic alternatives available for resistant moderate and severe forms of the disease, oral isotretinoin remains the most effective systemic treatment, being capable of promoting prolonged remission and significant reduction of inflammatory lesions. The present study aimed to analyze current scientific evidence regarding the efficacy, safety, and main therapeutic aspects related to the use of oral isotretinoin in the treatment of moderate to severe acne. This study consists of an integrative literature review with a qualitative and descriptive-analytical approach, conducted through bibliographic searches in the PubMed/MEDLINE, ScienceDirect, Wiley Online Library, Journal of the American Academy of Dermatology, JAMA Dermatology, and Dermatologic Therapy databases. Studies published within the last ten years were included, comprising clinical trials, systematic reviews, meta-analyses, clinical guidelines, and observational studies related to oral isotretinoin. The findings demonstrated high therapeutic efficacy of isotretinoin in the control of moderate to severe acne, with significant clinical improvement and positive impact on quality of life. The most frequent adverse events were mucocutaneous and dose-dependent, whereas severe laboratory abnormalities showed low incidence. Recent evidence also indicates a trend toward rationalization of laboratory monitoring and increasing therapeutic individualization, especially regarding low-dose regimens and the definition of optimal cumulative dose. It is concluded that oral isotretinoin remains the treatment of choice in selected cases of moderate to severe acne, supported by robust scientific evidence and contemporary dermatological guidelines.