Makindo Medical Notes

⚠️ Specialist use only. ❌ Potent teratogen → contraindicated in pregnancy. Fertile females must use strict contraception (usually 2 methods) during therapy and for at least 1 month after stopping.

📖 About

Always check the BNF link here.

• Retinoid reserved for severe acne unresponsive to other therapies.
• Dermatology specialist initiation only.
• Reduces sebum and keratin production → shrinks sebaceous glands.

⚙️ Action

• ⬇️ Sebum production.
• ⬇️ Keratinisation and follicular occlusion.
• Indirect antimicrobial effect (↓ Propionibacterium acnes growth).

💉 Indications

• Severe acne vulgaris resistant to conventional treatment.
• Papulopustular rosacea (specialist use).
• Occasionally severe seborrhoea or hidradenitis suppurativa (off-label).

🔄 Interactions

• ⚠️ Avoid with Vitamin A → risk of hypervitaminosis A (stomatitis, epistaxis, skin changes).
• ⚠️ Avoid with tetracyclines → risk of idiopathic intracranial hypertension.

⚠️ Cautions

• Fertile females → strict pregnancy prevention programme.
• Psychiatric history (depression, suicidal ideation) → monitor mood closely.
• Regular monitoring of LFTs and lipids (triglycerides may rise).

⛔ Contraindications

• 🚫 Pregnancy or breastfeeding.
• 🚫 Sexually active fertile females not using effective contraception.
• 🚫 Renal or hepatic impairment.
• 🚫 Hypertriglyceridaemia.
• 🚫 Hypervitaminosis A.

💥 Side Effects

• 💧 Dry mucous membranes & skin, cheilitis, epistaxis, alopecia.
• 🧪 ↑ Triglycerides, hepatitis, raised LFTs.
• 🧠 Idiopathic intracranial hypertension (rare, esp. with tetracyclines).
• 🧠 Mood changes, depression, rarely psychosis/suicidality.
• 🩸 Anaemia, thrombocytopenia, neutropenia (rare).

📊 Dose

• 0.5–1 mg/kg/day PO for 16–24 weeks (≈4–5 months).
• Doses up to 2 mg/kg/day may be used for severe or truncal acne.
• Repeat course may be considered if relapse occurs after at least 8 weeks off treatment.