Systemic Retinoids
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Overview
Systemic retinoids are vitamin A derivatives used to treat severe, recalcitrant nodular acne that has not responded to conventional therapy. They are among the most effective acne treatments but carry significant teratogenic risk.
How do systemic retinoids work?
Systemic retinoids bind to nuclear retinoic acid receptors (RARs and RXRs), which act as transcription factors. This dramatically reduces sebaceous gland size and sebum production (by up to 90%), normalizes follicular keratinization (preventing pore blockage), reduces Cutibacterium acnes colonization indirectly, and has anti-inflammatory effects. The combination of these four mechanisms addresses all major pathogenic factors in acne.
Drugs in this class
- Isotretinoin (Accutane, Absorica, Claravis, Myorisan, Zenatane)