Revolutionizing Acne Treatment: The Promise of Oral Isotretinoin for PCOS Patients

Greetings, dear friends!

Lets embark on an exploration into the dynamic intersection of skincare and health.

In this newsletter edition we will decode the intriguing study exploring the intersection of acne and PCOS. We will explore the significant influence of isotretinoin, elucidating its pivotal role in effectively managing both PCOS and acne

This research paper was published in January 2024 in Journal of Ovarian Research.

Title- “The impact of oral isotretinoin on ovarian functions of acne patients complaining of polycystic ovarian syndrome: a prospective study”

Heba I. Elnagar1, Osama A. Hashem1, Hany O. Aboelwafa2, Ehab Elhelw2 and Mohamed L. Elsaie3

First Published- 20 January 2024

DOI:10.1186/s13048-024-01347-x

Introduction: Polycystic ovarian syndrome (PCOS) affects millions of women worldwide, and its symptoms can be distressing. Among these symptoms, acne often takes centre stage, impacting both physical appearance and emotional well-being. However, what if a transformative solution lies within our reach? Enter isotretinoin, a powerful medication that has long been associated with acne treatment. Recent research is shedding light on its potential benefits for PCOS patients. Let’s dive into the science and explore how isotretinoin might revolutionize our approach to managing PCOS-related acne. 

The Study: In a prospective clinical trial, researchers evaluated the impact of oral isotretinoin on ovarian functions in women suffering from both acne and PCOS. Here are the key findings:

1. Acne Severity Reduction: Participants experienced a significant reduction in global acne scores after isotretinoin treatment. From pre-treatment levels to post-treatment, the improvement was remarkable. (11.58 ± 5.857 vs. 1.65 ± 1.369).
2. Ovarian Volume: Isotretinoin led to a decrease in ovarian volume on both sides. The right ovary volume decreased from (10.26 ± 1.539 to 8.74 ± 1.436), and the left ovary volume decreased from (11.08 ± 1.564 to 9.36 ± 1.479).
3. Hormonal Changes: Free testosterone levels and hirsutism scores also showed significant reductions after treatment.

The Mechanism: Why does isotretinoin work? It’s not just about drying up pimples. This wonder drug:

• Normalizes Sebaceous Glands: By reducing sebaceous gland secretion, isotretinoin tackles the root cause of acne.
• Cellular Apoptosis: It induces apoptosis (cell death) in bacterial cells and sebocytes, preventing comedone formation.
• Anti-Inflammatory Properties: Isotretinoin fights inflammation, reducing  breakouts.
• Insulin growth factor (IGF-1) - Isotretinoin has been shown to reduce insulin growth factor (IGF-1) that induces the expression of 5-α reductase and converts testosterone to dihydrotestosterone (DHT). DHT is a potent androgen that contributes to the symptoms of PCOS. 

Effects on Ovarian Morphology and Function:

Isotretinoin exhibits dual actions on ovarian health:

1. Enhancement of granulosa cell apoptosis: Recent research suggests that isotretinoin can promote apoptosis (cell death) of granulosa cells, potentially diminishing the follicular reserve within the ovaries.
2. Inhibition of p53 expression and antiproliferative effect: Isotretinoin inhibits the expression of the tumour suppressor protein p53 and exerts an antiproliferative effect on ovarian stromal cells. 

This dual mechanism leads to a reduction in ovarian volume, indicating a potential impact on ovarian function and reproductive health. 

Implications and Future Directions: The study’s implications are promising:

• Hyperandrogenic Women: Isotretinoin may benefit women with PCOS who experience hyperandrogenism.
• Multicentre Trials Needed: Larger controlled trials are essential to validate these findings and explore isotretinoin’s full potential.