Structured digital care pathway for systemic acne treatment using isotretinoin

© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Acne is a condition that affects a large portion of the population, especially younger people. The condition is well documented as being a formidable burden on the patient, psychologically and socially. Moreover, the severe forms of acne can leave permanent scars on the skin, if not properly treated. Treatments of acne consist of a range of various topical treatments sometimes combined with antibiotics administered orally. Among the most potent systemic treatment options, there is isotretinoin, which is a vitamin Aderivative. In treating acne, isotretinoin works by ► Reducing sebum production. ► Shrinking the sebaceous glands. ► Reducing follicular occlusion. ► Inhibiting the growth of bacteria. ► Having antiinflammatory effects. Isotretinoin is administered orally in the form of capsules that are ingested daily over a longer period of time, typically over a course of 6–12 months. In most cases, the effect of the treatment is prolonged and sometimes permanent. The treatment of acne using isotretinoin includes regular followups and blood tests. Female patients need to be strongly advised against pregnancy due to the severe teratogenic effect. Among other known side effects are liver toxicity and elevated blood lipids. (Depression and other psychological problems are possible, although much debated side effects). 4 Hence, liver enzymes and lipid panels should be monitored. A safe treatment plan will include checkups with the doctor for blood work, patient– doctor conversation and guidance during the treatment. Though the frequency of blood tests need not be monthly for standard doses. In our service design research phase, we identified some key challenges that acne patients meet, when being considered for isotretinoin treatment. ► General practitioners (GPs) sometimes lack the knowledge of isotretinoin for acne treatment. It is a specialised task better left WHAT ARE THE NEW FINDINGS ⇒ Digital care pathway for treatment of acne using isotretinoin aims to streamline both patient and dermatologist user experience. ⇒ The digital service is built with care for medical soundness and treatment safety. ⇒ Communication between patient and doctor is facilitated through frequent message exchanges. ⇒ Knowledge transfer to patient is addressed. ⇒ The digital care pathway aims to make the treatment more accessible, and the digital experience more user friendly and efficient. ⇒ Provides a working example of a modern, teledermatological, digital care pathway for systemic treatment of acne using isotretinoin.