İzotretinoin, retinolden türetilen sentetik bir retinoiddir. Sistemik izotretinoin, yıllardır şiddetli akne vulgaris tedavisinde kullanılmaktadır. İzotretinoin, akne vulgarisin 4 etiyopatogenik faktörüne tek başına etki eden tek ilaçtır. Bunun yanı sıra sistemik izotretinoin immünomodülatör, antiinflamatuar, anti-tümör, anti-anjiyogenik etkileri ile akne vulgaris dışındaki birçok dermatolojik hastalıkta da kullanılabilmektedir. İzotretinoin; immünomodülatör etkisi ile T ve B lenfositler üzerine, antiinflamatuar etkisi ile polimorfonükleer lökositler üzerine, anti-tümör etkisi ile gen ekspresyonu üzerine, anti-anjiyogenik etkisi ile de endotelyal hücreler ve keratinositler üzerine etki etmektedir. Sistemik izotretinoinin son yıllarda akne dışındaki dermatolojik hastalıklarda kullanımı giderek artmaktadır. İzotretinoinin akne dışındaki temel kullanım alanları; inflamatuar dermatozlar (rozase, psöriyazis, hidradenitis süpürativa, pityriazis rubra pilaris), enfeksiyöz hastalıklar (yassı siğiller, kondiloma akuminata), sebase bez patolojileri (sebore, seboreik dermatit, sebase hiperplazi, sebase adenom), skatrisyel alopesiler (dissekan selülit, folikülitis dekalvans, frontal fibrozan alopesi), non-melanom deri kanserleri (aktinik keratoz, skuamöz hücreli karsinom, bazal hücreli karsinom, kutanöz T hücreli lenfoma, kseroderma pigmentozum, Gorlin Goltz sendromu, epidermodisplazya verrüsiformis), kozmetik dermatoloji (fotoyaşlanma, rinoplasti operasyonu sonrası) ve keratinizasyon bozukluklarıdır (iktiyozlar, eritrokeratodermalar, palmoplantar keratodermalar, Darier hastalığı, Hailey-Hailey hastalığı). Bunlar dışında da birçok dermatolojik hastalıkta izotretinoinin faydalı olduğunu belirten vaka raporları ve serileri mevcuttur. Ancak izotretinoinin bu dermatolojik hastalıkların çoğunda tam olarak nasıl ve ne zaman kullanılabileceğini netleştirmek için daha fazla çalışmaya ihtiyaç vardır.
Anahtar Kelimeler: İzotretinoin; tedavi
Isotretinoin is a synthetic retinoid derived from retinol. Systemic isotretinoin has been used for years in the treatment of severe acne vulgaris. Isotretinoin is the only drug that acts alone on the 4 etiopathogenic factors of acne vulgaris. In addition, systemic isotretinoin can be used in many dermatological diseases other than acne vulgaris with its immunomodulatory, anti-inflammatory, antitumor, anti-angiogenic effects. It acts on T and B lymphocytes with its immunomodulatory effect, on polymorphonuclear leukocytes with its anti-inflammatory effect, on gene expression with its anti-tumor effect and on endothelial cells and keratinocytes with its anti-angiogenic effect. The use of systemic isotretinoin in dermatological diseases other than acne has been increasing in recent years. The main uses of isotretinoin other than acne; inflammatory dermatoses (rosacea, psoriasis, hidradenitis suppurativa, pityriasis rubra pilaris), infectious diseases (flat warts, condyloma acuminata), sebaceous gland pathologies (seborrhea, seborrheic dermatitis, sebaceous hyperplasia, sebaceous adenoma), cicatricial alopecias (dissecting cellulitis, folliculitis decalvans, frontal fibrosing alopecia), non-melanoma skin cancers (actinic keratosis, squamous cell carcinoma, basal cell carcinoma, cutaneous Tcell lymphoma, xeroderma pigmentosum, Gorlin Goltz syndrome, epidermodysplasia verrusiformis), cosmetic dermatology (photoaging, after rhinoplasty operation) and keratinization disorders (ichthyoses, erythrokeratodermas, palmoplantar keratodermas, Darier's disease, Hailey-Hailey disease). Apart from these, there are case reports and series indicating that isotretinoin is beneficial in many dermatological diseases. However, more studies are needed to clarify exactly how and when isotretinoin can be used in most of these dermatological conditions.
Keywords: İsotretinoin; therapy
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