Isotretinoin, or 13-cis-Retinoic Acid (Accutane in the USA), is a retinoid used in severe acne and rosacea as well as in cancer chemotherapy. It may have the same effects on the vitamin D receptor as other retinols. It certainly interferes with vitamin D metabolism. For those taking Isotretinoin for cancer, continue doing what your oncologist says to do, but also get your 25(OH)D to at least 100 ng/mL. If you are taking Isotretinoin for acne, my advice is to stop the Isotretinoin and take adequate doses of vitamin D.In 1938, Dr. Merlin Maynard showed vitamin D helped acne more than one of the most effective treatments of all time, x-ray treatment. You can download his entire paper for free (PDF format).Dr. Maynard wrote beautifully:There is probably no skin disease of greater importance to the human race than acne. It is undoubtedly our commonest skin disease, and it is rare that any individual reaches maturity without having had it in one of its phases. It is a disease of considerable econo
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mic importance, as the disfiguring scars of a severe case are never completely obliterated. It is also a disease of youth. It attains its most noxious form at the time the individual first has to earn his own living. It is undoubtedly responsible for many failures in getting business positions. It is also the basis for inferiority complexes and discouragement in young people.Dr. Maynard published a long case series. In his earlier days, he used x-ray treatment for acne, but when he started using viosterol (vitamin D2) he stopped using x-ray treatment. In reviewing his cases, he found x-ray treatment led to favorable results 48% of the time but vitamin D did so 76% of the time; he used between 5,000 and 14,000 IU per day. Vitamin D3 may work even better than D2, if acne patients take adequate doses, like 10,000 IU/day with frequent 25(OH)D levels.In summary, Dr. Maynard said:I believe I may say that at no time in my dermatological experience have I felt such complete satisfaction with a treatment as I have with the cases of this series. I know that vitamin D is an imperfect weapon to slay this disfiguring disease, but it undoubtedly gives one a feeling of being well defended. From the patients' viewpoint, it has left little to be desired, as they find themselves improving, both in appearance and in general well-being. Many have expressed the sentiment, 'Never felt better.'In 2008, the mechanism of action of vitamin D in the skin was the subject of a lengthy review (PDF format).Theoretically, rosacea should not respond to vitamin D, just the opposite, but readers have told me it does. However, if you have been on Isotretinoin, it may take months or years for the excessive vitamin A to get out of your system. The excess vitamin A may continue to compete for the vitamin D's receptors attention and, until the vitamin A is gone, one may not see the full effects of vitamin D. By the way, just ask any acne patient if their acne gets better after a week of sunning at the beach.
02 Mar 2011, 7:31 am
