ARTICLE: Advances in Oral Isotretinoin Therapy

May 2021 | Volume 20 | Issue 5 | Supplement Individual Articles | s5 | Copyright © May 2021

Published online April 23, 2021

Madison Jones BA,a April W. Armstrong MD MPH,a Hilary Baldwin MD,b Linda Stein Gold MD,c Leon H. Kircik MDd

aDepartment of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA
bDepartment of Dermatology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, NJ; The Acne Treatment and Research Center, Brooklyn, NY
cDepartment of Dermatology, Detroit, MI; Division of Dermatology, West Bloomfield, MI
dIcahn School of Medicine at Mount Sinai, New York, NY; Indiana University Medical Center, Indianapolis, IN; Physicians Skin Care, PLLC; DermResearch, PLLC; Skin Sciences, PLLC, Louisville, KY

be reserved for patients with severe nodular acne who are unresponsive to conventional therapy, including systemic antibiotics.15 Like other forms of isotretinoin, Absorica LD is limited by the timing of a potential second course; if a second course of Absorica LD is needed, it is not recommended before a two-month waiting period because the patient’s acne may continue to improve following a 15- to 20-week course of therapy.15

Absorica LD has two contraindications. First, as with all oral isotretinoin, Absorica LD is a teratogen and must not be used by female patients who are or may become pregnant.15 Major congenital malformations, spontaneous abortions, and premature births have been documented following pregnancy exposure to isotretinoin. Because of the risk of teratogenicity and to minimize fetal exposure, Absorica LD is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called iPLEDGE.15 In addition to its pregnancy contraindication, Absorica LD is also contraindicated in patients with hypersensitivity to isotretinoin (or Vitamin A, given the chemical similarity to isotretinoin) or any of its components.15

Several other important considerations exist with Absorica LD administration. Notably, Absorica LD and Absorica are not legally substitutable by each other or by any traditional oral isotretinoin product.15 As previously discussed, the bioavailability and recommended dosage are different (Table 3). In addition, checking laboratories during treatment is important to monitor for possible side effects. Routine monitoring of liver function tests, serum cholesterol, and triglycerides at baseline and again until response to treatment is established, is recommended.15 Routine monitoring of complete blood count is not recommended.15 The iPLEDGE program mandates monthly office visits for all patients with Absorica LD and all other isotretinoin products.


While traditional oral isotretinoin has revolutionized acne management, its food-dependent nature and varying bioavailability represent critical challenges of its administration. Absorica LD, with its unique micronized technology, exhibits enhanced gastrointestinal absorption and bioavailability compared to Absorica and previous forms of oral isotretinoin.18 Absorica LD produces consistent serum levels irrespective of gastrointestinal contents.18 By removing the “food effect” of previous formulations of oral isotretinoin, Absorica LD relieves patients from the requirement to ingest oral isotretinoin with a high-fat meal. Patients are able to administer Absorica LD on an empty stomach or with healthier meals (ie, low-fat, high-protein) without experiencing negative therapeutic consequences. With Absorica LD, we anticipate improved patient adherence and therefore improved longterm therapeutic outcomes.


Dr. Armstrong has served as a research investigator and/or scientific advisor to AbbVie, BMS, Incyte, Leo, UCB, Janssen, Lilly, Novartis, Ortho Dermatologics, Sun, Dermavant, Dermira, Sanofi, Regeneron, Pfizer, and Modmed.

Madison Jones has nothing to disclose.

Dr. Kircik has received compensation from JDD for his editorial support and serves as either a speaker, investigator, consultant, or advisory board member for Sun Pharma.

Dr. Baldwin has served as a speaker, investigator, consultant or advisory board member for Almirall, Cassiopea, EPI, Galderma, Johnson and Johnson, La Roche-Posay, Ortho Dermatologics, Sol-Gel, Sun, and Vyne.

Dr. Stein Gold has served as investigator, advisor, and/or speaker for Sun, Almirall, Ortho Derm, Galderma, and Cutera.


1. Brelsford M, Beute TC. Preventing and managing the side effects of isotretinoin. Semin Cutan Med Surg. Sep 2008;27(3):197-206. doi:10.1016/j. sder.2008.07.002
2. Williams HC, Dellavalle RP, Garner S. Acne vulgaris. Lancet. 2012;379(9813):361-372.
3. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-973.
4. Layton AM, Knaggs H, Taylor J, Cunliffe WJ. Isotretinoin for acne vulgaris— 10 years later; a safe and successful treatment. Br J Dermatol. 1993;129(3):292-296.
5. Del Rosso JQ. Face to face with oral isotretinoin: a closer look at the spectrum of therapeutic outcomes and why some patients need repeated courses. J Clin Aesthet Dermatol. 2012;5(11):17.
6. Colburn WA, Gibson DM, Wiens RE, Hanigan JJ. Food increases the bioavailability of isotretinoin. J Clin Pharmacol. 1983;23(11):534-539.
7. Taylor PW, Keenan MHJ. Pharmaceutical quality of generic isotretinoin products, compared with Roaccutane. Curr Med Res Opin. 2006;22(3):603-615.
8. Leyden JJ, Del Rosso JQ, Baum EW. The use of isotretinoin in the treatment of acne vulgaris: clinical considerations and future directions. J Clin Aesthet Dermatol. 2014;7(2 Suppl):S3.
9. Services USDoHaH. Guidance for industry: food-effect bioavailability and fed bioequivalence studies. FDA, Center for Drug Evaluation and Research (CDER). 2002;
10. Strauss JS, Rapini RP, Shalita AR, et al. Isotretinoin therapy for acne: results of a multicenter dose-response study. J Am Acad Dermatol. 1984;10(3):490-496.