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Systemic isotretinoin remains the most efficacious treatment for severe acne as well as many cases of more moderate disease that are unresponsive to other treatment modalities. Isotretinoin is the only therapy that impacts on all of the major aetiological factors implicated in acne. It achieves this remarkable efficacy by influencing cell-cycle progression, cellular differentiation, cell survival and apoptosis. Incubation of SZ 95 human sebocytes with isotretinoin leads to significantly higher intracellular concentrations of tretinoin than isotretinoin. A accutane medication cost study has demonstrated that that isotretinoin induces apoptosis in sebocytes and these effects are independent of RAR receptor activation suggesting that it is sebaceous gland involution resulting from oral isotretinoin which leads to reduced sebum production. Isotretinoin produces a significant reduction in comedogenesis by decreasing hyperkeratinisation.
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