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derm.acne-vulgaris.core.v1PRODUCTION
derm.acne-vulgaris.core.v1

Acne vulgaris (dermatology lens)

dermatologychronicadultpediatric
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12/12 authored

Canonical 12-phase frame with authored status for this dossier.

Current phase

Frame

Detailed

Frame as a CHRONIC pilosebaceous inflammatory disease driven by four pathogenic factors (follicular hyperkeratinisation, C. acnes, sebum/androgen, inflammation), managed on a stepwise multi-mechanism ladder — NOT a transient cosmetic rash. Scarring, dyspigmentation, and psychosocial burden are tracked as disease outcomes. Acneiform mimics + acne fulminans are recognised here and routed/escalated.

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chronic acne framing set; acneiform-mimic + fulminans escape routes noted

Patient inputs (16)

Hirsutism, irregular menses, virilisation, or sudden recalcitrant adult-female acne triggers an endocrine workup (total/free testosterone, DHEAS, 17-OHP, LH/FSH) for PCOS/CAH/tumour (AAD 2024 PMID 38300170)

Acne carries a major QoL/anxiety/depression/suicidality burden; psychosocial impact independently justifies systemic escalation incl. isotretinoin (AAD 2024 PMID 38300170; isotretinoin AE review Vallerand BJD 2017 PMID 28542914)

Systemic corticosteroid / EGFR-inhibitor / lithium / anabolic-androgen / iodide produces a monomorphic comedone-poor acneiform eruption — a key acne mimic (route derm.drug-eruption.core.v1)

True topical/oral failure (adequate agent × duration ≥8-12 wk × adherence) vs under-treatment determines whether to escalate or optimise before systemic step-up (AAD 2024 PMID 38300170)

Absence of comedones + centrofacial flushing/telangiectasia/persistent erythema argues rosacea, not acne (route derm.rosacea.core.v1) (AAD 2024 PMID 38300170 — acne is a comedone-bearing follicular disease)

Axillary/inguinal/inframammary recurrent nodules, abscesses, sinus tracts, double-ended comedones → hidradenitis suppurativa, not acne (route derm.hidradenitis-suppurativa.core.v1)

Comedonal vs inflammatory papulopustular vs nodulocystic morphology is the primary driver of where on the AAD 2024 ladder a patient enters (PMID 38300170)

Mild / moderate / severe (lesion count + extent + nodularity) gates topical-only vs +oral-antibiotic/hormonal vs isotretinoin (AAD 2024 PMID 38300170)

Active scarring (atrophic/keloidal) or post-inflammatory hyperpigmentation/erythema lowers the threshold to isotretinoin and drives aggressive early control (AAD 2024 PMID 38300170 — isotretinoin strongly recommended when scarring)

Isotretinoin/tetracyclines/spironolactone/COC are contraindicated in pregnancy; gates the entire systemic ladder and the iPLEDGE pathway (AAD 2024 PMID 38300170)

Tetracyclines contraindicated <8 y (dental staining); paediatric topical dosing; isotretinoin reproductive-age REMS gating (AAD 2024 PMID 38300170)

Total/free testosterone, DHEAS, 17-OHP, LH/FSH when hyperandrogenism signs present — PCOS / CAH / virilising tumour screen (AAD 2024 PMID 38300170)

Long/repeated oral-antibiotic courses raise resistance concern and the gram-negative-folliculitis differential — stewardship caps duration ~3-4 mo and mandates concomitant BPO (AAD 2024 PMID 38300170; Barbieri/Reynolds JAAD 2024 PMID 38925435)

Negative pregnancy test required before and during isotretinoin/hormonal/tetracycline therapy in patients of reproductive potential (AAD 2024 PMID 38300170)

Baseline + on-treatment lipids and transaminases for isotretinoin; AAD 2024 supports infrequent monitoring for most low-risk patients (PMID 38300170; Keow/Abu-Hilal Can Fam Physician 2025 PMID 40730431)

Isotretinoin REMS (iPLEDGE) mandates two contraception methods + monthly pregnancy testing in patients who can become pregnant — absolute teratogen gating (AAD 2024 PMID 38300170)

* = hard-required. Engine cannot meaningfully run until these are filled.

Severity triggers (7)

7 need judgement
  • informationalsevereacne_fulminans_emergency
    Acute onset of ulcerative/crusted nodular acne with fever, malaise, arthralgia/myalgia, ± osteolytic bone lesions or leukocytosis
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseveresevere_nodulocystic_or_scarring_acne_isotretinoin
    Severe nodulocystic acne, or any acne producing atrophic/keloidal scarring or failing standard oral + topical therapy
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereisotretinoin_pregnancy_risk_gating
    Isotretinoin candidate of reproductive potential — absolute teratogen, iPLEDGE REMS gating
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatesudden_recalcitrant_adult_female_acne_endocrine_workup
    Sudden, severe, or treatment-recalcitrant acne in an adult female ± hirsutism / irregular menses / virilisation
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderategram_negative_folliculitis_after_prolonged_antibiotics
    Sudden worsening with monomorphic pustules/nodules after prolonged oral-antibiotic therapy for acne
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderateacne_psychosocial_suicidality_screen
    Significant depression, anxiety, body-image distress, or suicidality attributable to acne (independent of isotretinoin use)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmildoral_antibiotic_overuse_stewardship
    Oral antibiotic continued beyond ~3–4 months, used as monotherapy, or combined with a topical antibiotic
    Trigger could not be auto-evaluated — needs clinician judgement.

Workflow calculators

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TREATMENToptionalDrives dose adjustment
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Recommended regimen

Acne vulgaris — stepwise multi-mechanism ladder (AAD 2024, Reynolds et al JAAD; PMID 38300170)
axis: acne_stepwise_aad_2024_ladderstep 1 - Step 1 — Mild / comedonal: topical retinoid + benzoyl peroxide
Selected step "Step 1 — Mild / comedonal: topical retinoid + benzoyl peroxide" — Mild predominantly comedonal acne; the foundation regimen retained at every higher step and as maintenance
  • tretinoin
    first line
    topical_retinoid
    0.025–0.05% cream/gel • topical • once nightly (max: per labeling; titrate for irritation)
    triggers: comedonal_acne, maintenance_after_oral_therapy
    AAD 2024 (PMID 38300170) STRONG — comedolytic + anti-inflammatory; the cornerstone of acne therapy and the key maintenance agent after oral therapy stops.
    rxcui 10753
  • adapalene
    first line
    topical_retinoid
    0.1% or 0.3% gel • topical • once daily (max: per labeling)
    triggers: comedonal_acne, tolerability_priority
    AAD 2024 (PMID 38300170) STRONG — third-generation retinoid; best tolerated, photostable, BPO-compatible (0.3%/2.5% fixed combo available).
    rxcui 60223
  • tazarotene
    second line
    topical_retinoid
    0.045% lotion / 0.1% cream • topical • once daily (max: per labeling)
    triggers: retinoid_responsive_but_inadequate, comedonal_recalcitrant
    AAD 2024 (PMID 38300170) STRONG (topical retinoid class) — most potent retinoid; teratogen — avoid in pregnancy.
    rxcui 83947
  • trifarotene
    second line
    topical_retinoid
    0.005% cream • topical • once daily (max: per labeling)
    triggers: truncal_acne, comedonal_inflammatory
    AAD 2024 (PMID 38300170) — selective RAR-γ retinoid studied for facial AND truncal acne.
    rxcui 2205637
  • benzoyl peroxide
    first line
    topical_antimicrobial_keratolytic
    2.5–5% wash/gel • topical • once–twice daily (max: per labeling)
    triggers: any_acne, paired_with_topical_or_oral_antibiotic
    AAD 2024 (PMID 38300170) STRONG — bactericidal against C. acnes with NO resistance; MUST accompany any topical or oral antibiotic to limit resistance (good-practice statement).
    rxcui 1418

outpatient playbook — drug actions (4)

  1. 1. topical retinoid (adapalene/tretinoin) + benzoyl peroxide
    rxcui 60223
    adapalene 0.1–0.3% + BPO 2.5–5% • topical • once daily
    trigger: Mild comedonal acne — the foundation regimen at every step (AAD 2024 PMID 38300170)
    Retinoid comedolytic + BPO bactericidal with no resistance — STRONG recs
  2. 2. topical clindamycin (ALWAYS with BPO) / clascoterone / azelaic acid
    rxcui 2582
    clindamycin 1% + BPO • topical • once–twice daily
    trigger: Mild–moderate inflammatory acne inadequately controlled by Step 1 (AAD 2024 PMID 38300170)
    Topical antibiotic never as monotherapy; clascoterone is topical androgen-receptor blockade (PMID 32320027)
  3. 3. oral doxycycline (time-limited, over topical retinoid+BPO) and/or spironolactone/COC (adult female)
    rxcui 3640
    doxycycline 100 mg BID ~3–4 mo; spironolactone 50–150 mg/day • PO • daily/BID
    trigger: Moderate–severe inflammatory acne, or hormonal-pattern adult-female acne (AAD 2024 PMID 38300170; SAFA PMID 39268864)
    Stewardship: no monotherapy, no oral+topical antibiotic, cap ~3–4 mo; hormonal therapy for adult females
  4. 4. oral isotretinoin (iPLEDGE) ± corticosteroid bridge if fulminans
    rxcui 6064
    0.5–1 mg/kg/day; cumulative ~120–150 mg/kg • PO • daily
    trigger: Severe nodulocystic / scarring / psychosocial-burden / recalcitrant acne; acne fulminans after steroid bridge (AAD 2024 PMID 38300170)
    Addresses all four pathogenic factors; absolute pregnancy contraindication; mood + lipid/LFT monitoring

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Chronic comedonal and/or inflammatory papulopustular eruption of the face/chest/back in an adolescent or adult (AAD 2024 acne guideline, Reynolds et al JAAD; PMID 38300170); Deep painful nodules/cysts or early atrophic/keloidal scarring → isotretinoin-candidate entry (AAD 2024 PMID 38300170 — isotretinoin strongly recommended for severe/scarring acne); Sudden, severe, or treatment-recalcitrant acne in an adult female ± hyperandrogenism signs → hormonal-workup entry (AAD 2024 PMID 38300170).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Acne vulgaris (dermatology lens)** (derm.acne-vulgaris.core.v1).
Phenotype framing: Terminal acneiform differential with named pivots: acne vulgaris (comedones + mixed lesions) vs rosacea (NO comedones + flushing/telangiectasia/persistent centrofacial erythema — route derm.rosacea.core.v1) vs folliculitis (gram-negative / Malassezia / pseudomonal — monomorphic follicular pustules) vs perioral dermatitis (perioral/periocular sparing vermilion, micropapules) vs hidradenitis suppurativa (intertriginous nodules/sinus tracts/double comedones — route derm.hidradenitis-suppurativa.core.v1) vs drug-induced acneiform (monomorphic, comedone-poor, drug timeline — route derm.drug-eruption.core.v1) vs acne fulminans / SAPHO vs endocrine hyperandrogenism (PCOS/CAH/tumour driver).
Scope: Frame as a CHRONIC pilosebaceous inflammatory disease driven by four pathogenic factors (follicular hyperkeratinisation, C. acnes, sebum/androgen, inflammation), managed on a stepwise multi-mechanism ladder — NOT a transient cosmetic rash. Scarring, dyspigmentation, and psychosocial burden are tracked as disease outcomes. Acneiform mimics + acne fulminans are recognised here and routed/escalated.

No severity triggers fired against current inputs.

Plan

Regimen axis: **Acne vulgaris — stepwise multi-mechanism ladder (AAD 2024, Reynolds et al JAAD; PMID 38300170)** — step "Step 1 — Mild / comedonal: topical retinoid + benzoyl peroxide".
1. tretinoin 0.025–0.05% cream/gel topical once nightly (topical_retinoid, first line) — AAD 2024 (PMID 38300170) STRONG — comedolytic + anti-inflammatory; the cornerstone of acne therapy and the key maintenance agent after oral therapy stops.
2. adapalene 0.1% or 0.3% gel topical once daily (topical_retinoid, first line) — AAD 2024 (PMID 38300170) STRONG — third-generation retinoid; best tolerated, photostable, BPO-compatible (0.3%/2.5% fixed combo available).
3. tazarotene 0.045% lotion / 0.1% cream topical once daily (topical_retinoid, second line) — AAD 2024 (PMID 38300170) STRONG (topical retinoid class) — most potent retinoid; teratogen — avoid in pregnancy.
4. trifarotene 0.005% cream topical once daily (topical_retinoid, second line) — AAD 2024 (PMID 38300170) — selective RAR-γ retinoid studied for facial AND truncal acne.
5. benzoyl peroxide 2.5–5% wash/gel topical once–twice daily (topical_antimicrobial_keratolytic, first line) — AAD 2024 (PMID 38300170) STRONG — bactericidal against C. acnes with NO resistance; MUST accompany any topical or oral antibiotic to limit resistance (good-practice statement).

Setting playbook (outpatient) — Classify lesion morphology + severity (incl. scarring + psychosocial burden), exclude acneiform mimics and an endocrine driver, escalate the AAD 2024 ladder to disease severity, and gate systemic-agent choice on pregnancy / age / contraception / antibiotic-stewardship (AAD 2024 PMID 38300170)
6. topical retinoid (adapalene/tretinoin) + benzoyl peroxide adapalene 0.1–0.3% + BPO 2.5–5% topical once daily — Mild comedonal acne — the foundation regimen at every step (AAD 2024 PMID 38300170) (Retinoid comedolytic + BPO bactericidal with no resistance — STRONG recs)
7. topical clindamycin (ALWAYS with BPO) / clascoterone / azelaic acid clindamycin 1% + BPO topical once–twice daily — Mild–moderate inflammatory acne inadequately controlled by Step 1 (AAD 2024 PMID 38300170) (Topical antibiotic never as monotherapy; clascoterone is topical androgen-receptor blockade (PMID 32320027))
8. oral doxycycline (time-limited, over topical retinoid+BPO) and/or spironolactone/COC (adult female) doxycycline 100 mg BID ~3–4 mo; spironolactone 50–150 mg/day PO daily/BID — Moderate–severe inflammatory acne, or hormonal-pattern adult-female acne (AAD 2024 PMID 38300170; SAFA PMID 39268864) (Stewardship: no monotherapy, no oral+topical antibiotic, cap ~3–4 mo; hormonal therapy for adult females)
9. oral isotretinoin (iPLEDGE) ± corticosteroid bridge if fulminans 0.5–1 mg/kg/day; cumulative ~120–150 mg/kg PO daily — Severe nodulocystic / scarring / psychosocial-burden / recalcitrant acne; acne fulminans after steroid bridge (AAD 2024 PMID 38300170) (Addresses all four pathogenic factors; absolute pregnancy contraindication; mood + lipid/LFT monitoring)

Non-pharmacologic actions:
- Adherence + expectation counselling (response takes 8–12 wk; no skin scrubbing/over-washing) (AAD 2024 PMID 38300170)
- Skin-of-colour PIH-directed regimen — minimise irritant retinoid/BPO concentration, add azelaic acid (AAD 2024 PMID 38300170)
- Intralesional triamcinolone for individual large painful nodules (AAD 2024 PMID 38300170 good-practice statement)
- Scar + dyspigmentation management referral once active acne controlled (AAD 2024 PMID 38300170)
- iPLEDGE enrolment + two-method contraception counselling before isotretinoin in patients who can become pregnant (AAD 2024 PMID 38300170)

AVOID / contraindication checks:
- Isotretinoin absolute pregnancy contraindication iPLEDGE REMS (AAD 2024 PMID 38300170 — teratogen; two contraception methods + monthly pregnancy testing in patients who can become pregnant)
- Tetracyclines contraindicated in pregnancy and age under 8y (AAD 2024 PMID 38300170 — dental staining / skeletal effects)
- Spironolactone and combined oral contraceptive avoided in pregnancy (AAD 2024 PMID 38300170)
- Isotretinoin plus tetracycline avoid pseudotumor cerebri (AAD 2024 PMID 38300170 — concurrent use raises idiopathic intracranial hypertension risk)
- Oral antibiotic stewardship cap 3 4 months and mandatory concomitant bpo (AAD 2024 PMID 38300170; Barbieri/Reynolds JAAD 2024 PMID 38925435)
- No oral antibiotic monotherapy and no oral plus topical antibiotic (AAD 2024 PMID 38300170 good practice statements)
- Acne fulminans needs corticosteroid bridge then low dose isotretinoin not abrupt high dose (AAD 2024 PMID 38300170)
- Isotretinoin mood and suicidality counselling and monitoring (AAD 2024 PMID 38300170; Vallerand BJD 2017 PMID 28542914)

Monitoring

Regimen monitoring:
- response reassessed at 8-12wk per step lesion count plus IGA (AAD 2024 PMID 38300170 — set adherence/expectation: meaningful response takes 8–12 wk)
- isotretinoin: monthly pregnancy test (iPLEDGE) in patients who can become pregnant + lipids/LFT (infrequent monitoring sufficient for most low-risk; AAD 2024 PMID 38300170; Keow/Abu-Hilal Can Fam Physician 2025 PMID 40730431) + mood/depression screen each visit
- spironolactone: routine serum-potassium monitoring NOT required in healthy young women; check K only with renal impairment / cardiac disease / RAAS-blocker co-therapy / older age (AAD 2024 PMID 38300170)
- oral antibiotic: cap course ~3–4 mo, reassess for step-down, ensure concomitant BPO (AAD 2024 PMID 38300170; Barbieri/Reynolds JAAD 2024 PMID 38925435)
- topical retinoid irritation and photosensitivity counselling and titration (AAD 2024 PMID 38300170)
- reassess diagnosis if no response (endocrine hyperandrogenism / gram-negative folliculitis / acneiform mimic) (AAD 2024 PMID 38300170)

Setting (outpatient) monitoring:
- Reassess lesion count + IGA at 8–12 wk per step (AAD 2024 PMID 38300170)
- Isotretinoin: monthly pregnancy test (iPLEDGE) + lipids/LFT (infrequent for most low-risk) + mood screen (AAD 2024 PMID 38300170; PMID 40730431)
- Spironolactone: routine K monitoring NOT required in healthy young women (AAD 2024 PMID 38300170)
- Oral antibiotic: cap ~3–4 mo, ensure concomitant BPO, then step down (Barbieri/Reynolds JAAD 2024 PMID 38925435)

Follow-up plan: Chronic-disease maintenance: topical-retinoid maintenance after oral therapy stops (relapse prevention, the single most effective maintenance strategy), adherence/expectation counselling (response takes 8-12 wk; no antibiotic monotherapy/long courses), scar + dyspigmentation management and referral, mental-health surveillance, hormonal-therapy continuity for adult females, and isotretinoin post-course relapse monitoring (a second course may be needed). Skin-of-colour: PIH-directed gentle regimens minimising irritation.
- Close-out criterion: maintenance retinoid + adherence/expectation + scar/dyspigmentation + MH surveillance documented

Monitoring phase: Disease: reassess response at 8-12 wk per step (topicals/oral antibiotics: lesion-count + IGA; isotretinoin: cumulative dose progress to target). Drug safety: isotretinoin → pregnancy test monthly (iPLEDGE) + lipids/LFT (AAD 2024 supports infrequent monitoring for most low-risk patients) + mood/depression screen at each visit; spironolactone → routine serum-potassium monitoring NOT required in healthy young women (encode this nuance — reserve K for renal/cardiac/RAAS-drug/older patients); oral antibiotics → cap duration ~3-4 mo, reassess, ensure concomitant BPO. Re-evaluate diagnosis (endocrine, gram-negative folliculitis, mimic) if no response.

Disposition

Current setting: outpatient — Classify lesion morphology + severity (incl. scarring + psychosocial burden), exclude acneiform mimics and an endocrine driver, escalate the AAD 2024 ladder to disease severity, and gate systemic-agent choice on pregnancy / age / contraception / antibiotic-stewardship (AAD 2024 PMID 38300170)

Disposition criteria:
- Continue ladder + topical-retinoid maintenance + derm follow-up if responding (AAD 2024 PMID 38300170)
- Step up the ladder if an adequate trial fails after adherence/expectation optimisation
- Route OUT by engine_id if a mimic (rosacea / hidradenitis / drug-acneiform) or endocrine driver is the diagnosis

Escalation triggers (move to higher acuity):
- Acne fulminans (acute ulcerative/crusted nodular acne + fever/arthralgia) → corticosteroid bridge then low-dose isotretinoin, urgent dermatology (AAD 2024 PMID 38300170)
- Suicidality / severe psychosocial crisis → mental-health pathway + close follow-up (AAD 2024 PMID 38300170; Vallerand BJD 2017 PMID 28542914)
- Rapid virilisation / markedly elevated androgens → urgent endocrine + tumour evaluation (AAD 2024 PMID 38300170)

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [SEVERE] Acute onset of ulcerative/crusted nodular acne with fever, malaise, arthralgia/myalgia, ± osteolytic bone lesions or leukocytosis
- [SEVERE] Severe nodulocystic acne, or any acne producing atrophic/keloidal scarring or failing standard oral + topical therapy
- [SEVERE] Isotretinoin candidate of reproductive potential — absolute teratogen, iPLEDGE REMS gating

Citations

- AAD 2024 Guidelines of care for the management of acne vulgaris (Reynolds RV, Yeung H, ... Barbieri JS; J Am Acad Dermatol 2024;90(5):1006.e1-1006.e30; PMID 38300170, DOI 10.1016/j.jaad.2023.12.017) — 18 evidence-based recommendations + 5 good-practice statements; STRONG: benzoyl peroxide, topical retinoids, topical antibiotics, oral doxycycline, oral isotretinoin (severe/psychosocial/scarring/refractory); CONDITIONAL: clascoterone, salicylic/azelaic acid, minocycline, sarecycline, combined oral contraceptives, spironolactone. Applied via Keow/Abu-Hilal Can Fam Physician 2025 (PMID 40730431) + antibiotic-stewardship commentary Barbieri/Reynolds JAAD 2024 (PMID 38925435); supporting pivotal RCTs: clascoterone (Hebert JAMA Dermatol 2020 PMID 32320027; long-term Eichenfield JDD 2023 PMID 37556524), sarecycline SC1401/SC1402 (Moore JDD 2018 PMID 30235387; pooled PMID 36671290), spironolactone SAFA RCT (Santer HTA 2024 PMID 39268864), isotretinoin AE systematic review (Vallerand BJD 2017 PMID 28542914) + cumulative-dose RCT (PMID 33185932) [PMID:38300170](https://pubmed.ncbi.nlm.nih.gov/38300170/)
- Cited evidence (PMID 40730431) [PMID:40730431](https://pubmed.ncbi.nlm.nih.gov/40730431/)
- Cited evidence (PMID 38925435) [PMID:38925435](https://pubmed.ncbi.nlm.nih.gov/38925435/)
- Cited evidence (PMID 32320027) [PMID:32320027](https://pubmed.ncbi.nlm.nih.gov/32320027/)
- Cited evidence (PMID 37556524) [PMID:37556524](https://pubmed.ncbi.nlm.nih.gov/37556524/)

Last reconciled with current guidelines: 2026-05-22.
References
  • AAD 2024 Guidelines of care for the management of acne vulgaris (Reynolds RV, Yeung H, ... Barbieri JS; J Am Acad Dermatol 2024;90(5):1006.e1-1006.e30; PMID 38300170, DOI 10.1016/j.jaad.2023.12.017) — 18 evidence-based recommendations + 5 good-practice statements; STRONG: benzoyl peroxide, topical retinoids, topical antibiotics, oral doxycycline, oral isotretinoin (severe/psychosocial/scarring/refractory); CONDITIONAL: clascoterone, salicylic/azelaic acid, minocycline, sarecycline, combined oral contraceptives, spironolactone. Applied via Keow/Abu-Hilal Can Fam Physician 2025 (PMID 40730431) + antibiotic-stewardship commentary Barbieri/Reynolds JAAD 2024 (PMID 38925435); supporting pivotal RCTs: clascoterone (Hebert JAMA Dermatol 2020 PMID 32320027; long-term Eichenfield JDD 2023 PMID 37556524), sarecycline SC1401/SC1402 (Moore JDD 2018 PMID 30235387; pooled PMID 36671290), spironolactone SAFA RCT (Santer HTA 2024 PMID 39268864), isotretinoin AE systematic review (Vallerand BJD 2017 PMID 28542914) + cumulative-dose RCT (PMID 33185932) — PMID:38300170
  • Cited evidence (PMID 40730431) — PMID:40730431
  • Cited evidence (PMID 38925435) — PMID:38925435
  • Cited evidence (PMID 32320027) — PMID:32320027
  • Cited evidence (PMID 37556524) — PMID:37556524