A 22-year-old woman presents with comedones, inflammatory papules, pustules, and nodules on her face and upper back. She has a history of regular menstrual irregularities and mild hirsutism. Hormonal work-up shows elevated free testosterone. Which oral agent targets the sebaceous gland most directly by reducing sebum production and is the ONLY drug that addresses all four pathogenic factors of acne?
- A Doxycycline
- B Isotretinoin (13-cis retinoic acid) ✓
- C Spironolactone
- D Combined oral contraceptive pill
Explanation
Acne vulgaris has four pathogenic factors: (1) sebaceous gland hyperactivity with excess sebum, (2) follicular hyperkeratinisation/comedogenesis, (3) Cutibacterium acnes (formerly Propionibacterium acnes) proliferation, and (4) inflammation. Oral isotretinoin (13-cis retinoic acid) is unique in targeting all four simultaneously: it dramatically reduces sebum production (>70% reduction in sebaceous gland size), normalises follicular keratinisation, reduces C. acnes load, and has direct anti-inflammatory effects. No other acne drug addresses all four mechanisms. Spironolactone and OCPs target only sebum via androgen blockade.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.