Oral isotretinoin: the most promising dermatological off-label uses

Oral isotretinoin, or 13-cis retinoic acid, has been the gold-standard therapy for acne during the last 30 years. It possesses many properties and may influence skin cellular process by modifying gene expression. Oral isotretinoin represents a great opportunity in the field of dermatology, although it is not bound by cytoplasmic retinoic acid binding proteins and has a weak affinity for retinoid nuclear receptors. Teratogenicity is its main limitation. Despite its common side effects, many off-label uses have been reported. The most promising off-label indications are: seborrhea, seborrheic dermatitis, severe rosacea, non-melanoma skin cancer chemoprevention for at-risk patients, and advanced photoaging with multiple actinic keratoses.