Treatment of cystic acne with 13-cis-retinoic acid

13-cis-Retinoic acid (Accutane) is an effective new agent for the treatment of severe cystic acne. The most encouraging feature associated with use of this drug is the persistence of remissions even after administration has been discontinued. The cutaneous side effects are mild to moderate and are usually well tolerated. Careful monitoring of the serum lipids is necessary. In 4 of our 10 patients, the levels of triglycerides became elevated. Of these four patients, three had lowering of the high-density lipoprotein fraction. In three of our most severely affected patients, nonhealing erosions with heaped-up granulation tissue developed at the sites of large acne cysts, which healed promptly after therapy was completed. For the present, we emphasize that use of Accutane should be reserved for severe acne that is unresponsive to conventional treatment; in such cases, careful clinical and laboratory monitoring is imperative.