1. Introduction
2. Circadian Rhythm
3. The hypothalamus
4. The Hypothalamus and Beta-Catenin
5. Melatonin: The Anti-Accutane?
6. Conclusion
7. Article Summary
8. References

Introduction

Despite its now long history of use in treating severe acne, the mechanism underlying Accutane’s efficacy still hasn’t been agreed by practitioners. There are only two known pathways that influence sebum production, PPAR (Peroxisome proliferator-activated receptors) and Androgens. The primary metabolite of Accutane, All-Trans-Retinoic Acid, isn’t usually thought of as having a direct influence on either of these pathways. Nonetheless, there’s increasing evidence to show that Accutane does indeed possesses anti-androgenic, and PPAR repressive activity. [1][2] Furthermore, its sweeping hormonal impact may even extend to the vital sleep hormone Melatonin.

The evidence for Accutane’s anti-androgenic effects is steadily accumulating and appears to be a significant factor in its mechanism of action. There’s even evidence that patients with increased Androgen Receptor sensitivity experience higher rates of relapse following treatment with Isotretinoin. [3] It’s also been determined that Isotretinoin inhibits a number of enzymes involved in Retinoic Acid synthesis that also share a role in androgen metabolism. One such enzyme is Retinol-Dehydrogenase 4 (RoDH4). [4] This enzyme not only metabolises Retinol (a precursor to Retinoic Acid) but also converts relatively weak 3-alpha-Androstanediol into the potent Dihydrotestosterone (DHT).