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To the Editor.—
The frequent use of isotretinoin (Accutane) reminds me of the adage when penicillin was first introduced: "If an injection of penicillin doesn't cure the condition it's advisable to examine the patient."The following anecdotal reports are limited and uncontrolled, but I wonder what a controlled objective report of isotretinoin failures would reveal. This is no way intended to refute the excellent results from the use of isotretinoin after simpler modalities have failed.A 40-year-old woman had acne vermicularis on the face and back. She complained that the isotretinoin prescribed to her had not helped her. Her physician had used benzoyl peroxide treatment unsuccessfully and then switched to treatment with isotretinoin. He had not tried therapy with antibiotics and had never cautioned her about reducing her intake of ten cups of coffee or her 1½ packages of cigarettes per day. He had not mentioned that the condition, at
Savitt LE. Perspective on Isotretinoin. Arch Dermatol. 1984;120(10):1281. doi:10.1001/archderm.1984.01650460021009