Treatment of Resistant Acne Vulgaris in Adolescents Using Dietary Supplementation with Magnesium, Phosphate and Fatty Acids (Omega 6 and 7): Comparison with 13-Cis-Retinoic Acid.

The burden of disease associated with acne vulgaris has continued to increase over time in the world population. This continued growth suggests that there is an unmet dermatologic need for this condition worldwide. Potential sequelae of acne, such as scarring, depigmentation, and marked emotional and psychological problems (e.g., low self-esteem), can lead to significant morbidity. The purpose of this study was to investigate whether dietary supplementation with magnesium, phosphate, omega 6 (linoleic acid calcium salt - C18:2 fatty acid Ca salt), and omega 7 (palmitoleic acid calcium salt - C16:1 fatty acid Ca salt) would help patients with acne vulgaris, and to compare with isotretinoin (13-cis retinoic acid). Magnesium has anti-inflammatory properties. Linoleic and palmitoleic acids have bactericidal activity against Staphylococcus aureus and Cutibacterium acnes (formerly known as Propionibacterium acnes). A single-blind randomized study was conducted in which 257 patients were treated with the above dietary supplementation (group A) and 275 patients with isotretinoin (group B) for 6 months. All patients in group A (100%) reported complete regression of symptoms after 6 months of treatment. On the other hand, 187 subjects (68%) in group B reported complete resolution of symptoms during the same period. The difference between the groups (p < 0.05) was statistically significant. The study was approved by the CEP/CONEP. This natural formulation promotes regression and/or cure of acne vulgaris symptoms and has better results than drugs (such as isotretinoin), without significant side effects.

Isotretinoina: Possível Interferência na Cicatrização Pós-Exodontia / Isotretinoin: Possible Interference in Postextraction Healing

A farmacovigilância é definida como "a ciência e atividades relativas à identificação, avaliação, compreensão e prevenção de efeitos adversos ou quaisquer problemas relacionados ao uso de medicamentos". Os medicamentos têm tanto o potencial de trazer benefícios quanto o de causar danos. O ácido 13-cis-Retinoico ou isotretinoina é um retinoide antiacne de referência no tratamento de doenças dermatológicas não responsivas a terapias convencionais, como a acne cística severa. Os efeitos adversos descritos na bula do medicamento implicam alterações em vários sistemas do corpo humano. Aqueles relacionados ao tecido ósseo, como a calcificação dos ligamentos e tendões, a redução na densidade óssea, o fechamento epifisário e hipercalcemia, possuem maior relevância na odontologia, levantando a hipótese para possível interferência na cicatrização dos alvéolos, após exodontia. Este artigo teve por objetivo realizar uma revisão de literatura reunindo informações sobre a possibilidade de interferência da isotretinoina em cirurgias maxilofaciais. Apesar da escassez de dados científicos conclusivos sobre a interferência da isotretinoína na cicatrização alveolar em humanos, estudos recentes sobre as vias de sinalização dos retinoides abrem novas perspectivas de pesquisa na influência dos retinoides no tecido ósseo alveolar. Esta possibilidade reforça a importância de uma atualização sobre os efeitos adversos da isotretinoína, bem como da anamnese criteriosa em pacientes com histórico de acne severa a fim de evitar complicações.

Pharmacovigilance is defined as "the science and activities related to identification, evaluation, understanding and prevention of adverse effects or problems related to the use of drugs". All drugs have both the potential to cause harm and benefit. 13-cis-Retinoic acid or isotretinoin is a reference anti-acne retinoid in the dermatological diseases treatment not responsive to conventional therapies, such as severe cystic acne. The drug-related side effects described in the medicine package insert imply changes in various human body systems. Those related to bone tissue, such as ligaments and tendons calcification, bone density reduction, epiphyseal closure and hypercalcemia, have great relevance for dentistry, raising the hypothesis of a possible interference in alveoli wound healing after extraction. This article aimed to conduct a literature review in gathering information about the possibility of isotretinoin interference in maxillofacial surgeries. In despite of the scarcity of conclusive scientific data about the influence of isotretinoin on human alveolar wound healing, recent studies on retinoid signaling pathways open new research perspectives for the isotretinoin interference on alveolar bone tissue. This possibility reinforces the importance of an isotretinoin drug-related side effects update, as well as a patients' careful anamnesis with historical severe acne, in order to avoid complications

Is It Safe to Operate on Patients Taking Isotretinoin?

BACKGROUND: Oral isotretinoin is increasingly being used to treat acne and other dermatological conditions. The number of patients who take isotretinoin and wish or need to undergo plastic surgery may be following a similar pattern. Although skin healing is an important concern in the case of patients who use isotretinoin, it is definitely not the only relevant issue when planning surgical intervention. METHODS: Eleven important points regarding surgery safety in patients taking oral isotretinoin were defined. A literature search of the PubMed database was conducted by employing the keywords isotretinoin OR 13-cis-retinoic acid. This returned the largest possible number of studies about isotretinoin. RESULTS: Forty-seven studies matched the selection criteria. Most animal experimental models suggested that isotretinoin at doses commonly used to treat acne is not detrimental to wound healing. Human studies are controversial. However, healing of skeletal muscle could be at increased risk of necrosis. CONCLUSIONS: Association between isotretinoin and problematic skin healing after surgery is being challenged. Also, recommended time between discontinuation of isotretinoin and surgery should be reviewed. While muscle flaps may be endangered in patients taking isotretinoin, healing of other tissues and systemic effects that could compromise surgery safety are rare or detectable before surgery. LEVEL OF EVIDENCE V: This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.