Vitamin A may be a viable substitute for isotretinoin in acne

Vitamin A was comparable to isotretinoin in acne management, particularly when considering efficacy and relapse rates, according to findings from a literature review analysis.

However, due to its potential for toxicity and over-the-counter accessibility, vitamin A should only be prescribed for acne management “with very careful attention to patient selection and education” and when isotretinoin is unavailable, according to the researchers.

“Recent changes to the iPLEDGE platform left providers without the ability to prescribe isotretinoin to their patients,” Madison K. Cook, BS, of the center for dermatology research in the department of dermatology at Wake Forest University School of Medicine, and colleagues wrote.

The researchers suggested that a possible substitute for isotretinoin, such as vitamin A, could have utility in circumstances when the drug is not readily available. It is notable that vitamin A previously underwent investigation as an intervention for acne.

The purpose of the literature review was to determine whether vitamin A could have utility as a substitute for isotretinoin in this patient population. The review of PubMed and Google Scholar databases yielded nine relevant studies conducted between 1931 and 2021.

Results showed that eight of those studies demonstrated efficacy of vitamin A in acne. Dosing levels ranged from 36,000 IU to 500,000 IU. The most frequently used dosing level was 100,000 IU.

Patients were treated for a duration of 1 to 7 months. Clinical improvement was observed as early as 7 weeks, with improvement also seen out to 4 months after treatment initiation.

The relapse rate was 33%, which the researchers noted is comparable to the relapse rate seen for isotretinoin.

The safety profile from the studies showed predominantly mucocutaneous events.

The generalizability of the findings may be limited by the fact that many of the studies included were published more than 50 years ago. These trials may have lacked the rigor used in current studies, according to the researchers.

“Oral vitamin A could potentially serve as a substitute for isotretinoin in acne management for select patients,” the researchers concluded. “However, due to its teratogenicity, potential for toxicity and long half-life, strict monitoring under the care of a medical provider is prudent. Since vitamin A is available without a prescription, strict monitoring cannot be assured, and especially careful patient selection and education would be essential.”