A patient presented with multiple nodulocystic lesions on the face. The drug of choice is –
**Core Concept**
Isotretinoin is a derivative of vitamin A used in the treatment of severe acne, particularly nodulocystic acne, due to its ability to reduce sebum production and inhibit inflammation.
**Why the Correct Answer is Right**
Isotretinoin works by inhibiting the enzyme 5-alpha-reductase, which is responsible for converting testosterone to dihydrotestosterone (DHT), a potent androgen that stimulates sebaceous gland activity. By reducing DHT levels, isotretinoin decreases sebum production, thereby reducing the formation of comedones and inflammation in the skin. Additionally, isotretinoin has anti-inflammatory properties, which help to reduce the size and number of acne lesions.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because antibiotics, such as doxycycline or minocycline, are effective in treating acne but are typically reserved for mild to moderate cases. They work by reducing bacterial loads and inflammation but are not as effective as isotretinoin in severe cases.
**Option B:** This option is incorrect because hormonal treatments, such as spironolactone, may be useful in treating acne in women with polycystic ovary syndrome (PCOS) but are not the first-line treatment for nodulocystic acne.
**Option C:** This option is incorrect because retinoids, such as adapalene or tretinoin, are topical treatments that can be used to treat mild to moderate acne but are not as effective as isotretinoin in severe cases.
**Clinical Pearl / High-Yield Fact**
Isotretinoin can cause teratogenic effects and should be avoided in women of childbearing age. Female patients must use two forms of contraception while taking isotretinoin and for one month after stopping treatment.
**Correct Answer: C. Isotretinoin**