Cook Madison K, Perche Patrick O, Feldman Steven R
Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Dermatol Online J. 2022 Oct 15;28(5). doi: 10.5070/D328559239.
Changes to the iPLEDGE platform on December 13, 2021 made isotretinoin virtually inaccessible for many patients. Prior to the FDA approval of isotretinoin, a derivative of vitamin A, in 1982, vitamin A was used for severe acne.
To review the efficacy, safety, affordability, and practicality of vitamin A as a substitute for isotretinoin when the latter is inaccessible.
A literature review of PubMed was conducted using the key words: oral vitamin A, retinol, isotretinoin, Accutane, acne, iPLEDGE, hypervitaminosis A, and side effects.
We identified 9 studies (8 clinical trials and one case report); acne improved in 8 studies. Dosages ranged from 36,000IU daily to 500,000IU with 100,000IU as the most common. Mean duration until clinical improvement was 7 weeks to four months after initiation of therapy. Mucocutaneous side effects were most common, along with headaches, which resolved with either continued treatment or cessation.
Oral vitamin A is efficacious for the treatment of acne vulgaris, although the available studies have limited controls and outcomes. Side effects are qualitatively similar to those of isotretinoin and avoiding pregnancy for at least three months after stopping treatment is critical; like isotretinoin, vitamin A is a teratogen.
2021年12月13日iPLEDGE平台的变更使得许多患者几乎无法获得异维A酸。在1982年美国食品药品监督管理局（FDA）批准维生素A的衍生物异维A酸之前，维生素A被用于治疗重度痤疮。
探讨在无法获得异维A酸时，维生素A替代异维A酸的疗效、安全性、可负担性和实用性。
使用关键词“口服维生素A”“视黄醇”“异维A酸”“异维甲酸”“痤疮”“iPLEDGE”“维生素A过多症”和“副作用”对PubMed进行文献综述。
我们纳入了9项研究（8项临床试验和1例病例报告）；8项研究中痤疮有所改善。剂量范围从每日36,000国际单位到500,000国际单位，最常用的是100,000国际单位。开始治疗后至临床改善的平均持续时间为7周至4个月。皮肤黏膜副作用最为常见，还有头痛，持续治疗或停药后症状会缓解。
口服维生素A对寻常痤疮有效，尽管现有研究的对照和结果有限。其副作用在性质上与异维A酸相似，停药后至少三个月内避免怀孕至关重要；与异维A酸一样，维生素A也是一种致畸剂。
