PROLONGED REMISSIONS OF CYSTIC AND CONGLOBATE ACNE WITH 13-CIS-RETINOIC ACID

Fourteen patients with treatment-resistant cystic and conglobate acne were treated for four months with oral 13-cis-retinoic acid, a synthetic isomer of naturally occurring all-trans-retinoic acid. The average dose was 2.0 mg per kilogram per day. Thirteen patients experienced complete clearing of their disease; the other had 75 per cent improvement, as determined by the number of acne nodules and cysts present before and after therapy. Prolonged remissions, currently lasting as long as 20 months after discontinuation of therapy, have been observed in all 14 patients. Clinical toxicity was limited to the skin and mucous membranes in most patients and was dose dependent and rapidly reversible upon discontinuation of therapy. The mechanism of action of 13-cis-retinoic acid in the therapy of acne probably involves a direct inhibitory effect of the drug on the sebaceous gland. (N Engl J Med 300:329–333, 1979) IN an attempt to find an agent with a greater therapeutic index than vitamin A or its naturally occurring derivative, all-trans-retinoic acid, new analogues (synthetic retinoids) have been developed for the primary purpose of chemoprophylaxis of cancer.1 Because of the historical use of the naturally occurring retinoids in acne,2 3 4 we studied oral 13-cis-retinoic acid (13-cis-RA), a geometric isomer of the naturally occurring all-trans-retinoic acid, as treatment for scarring, antibiotic-resistant, cystic and conglobate acne in 14 patients. Materials and Methods We administered 13-cis-RA (Ro-4–3780, Hoffmann-La Roche, Incorporated, Nutley, New Jersey) to. © 1979, Massachusetts Medical Society. All rights reserved.