Isotretinoin is used primarily for severe cystic acne and acne that has not responded to other treatments. Acne treatment usually begins with topical retinoids (e.g.tretinoin, adapalene), in combination with topical antibiotics (e.g. clindamycin, erythromycin) or antiseptics (e.g. benzoyl peroxide-containing preparations), followed by oral antibiotics (e.g. doxycycline or minocycline). In women a cyproterone-containing contraceptive pill can be useful if there are no contraindications.In cases of hormonal acne, such as in women in their 20s and 30s with cyclical acne, often a course of isotretinoin can permanently improve acne obviating the need for lifelong hormonal manipulation.
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