Oral Vitamin A for Acne Management: A Possible Substitute for Isotretinoin.

Background: Recent changes to the iPLEDGE platform left providers without the ability to prescribe isotretinoin to their patients. A potential substitute for isotretinoin could be beneficial when the drug is unavailable. Prior to the FDA approval of isotretinoin, a vitamin A derivative, vitamin A was studied for its use in acne management.

Objective: To review the potential of vitamin A to serve as a substitute for isotretinoin when the latter drug is inaccessible.

Methods: We conducted a review of published literature from 1931 to 2021, regarding the use of vitamin A in acne treatment, using PubMed and Google Scholar databases. Nine studies were selected after reviewing articles for relevancy to our topic.

Results: Eight out of the 9 studies noted improvement in patients’ acne with vitamin A use. Ranges of doses used were 36,000 I/U daily to 500,000 I/U daily, with 100,000 I/U daily being the most common. Side effects were mainly mucocutaneous in nature.

Limitations: Many of the trials included in our review were published over 50 years prior and lack standardized components of clinical trials today.

Conclusion: Oral vitamin A could potentially serve as a substitute for isotretinoin in acne management for select patients. However, due to its teratogenicity, potential for toxicity, and long half-life, strict monitoring under the care of a medical provider is prudent. Since vitamin A is available without a prescription, strict monitoring cannot be assured, and especially careful patient selection and education would be essential. J Drugs Dermatol. 2022;21(6):683-686. doi:10.36849/JDD.6781.