Management of Isotretinoin-induced dermal toxicity through Ayurveda: A clinical experience

Abstract: Isotretinoin, a Vitamin A derivative, is effective for severe acne but often causes mucocutaneous side effects such as dryness, scaling, and inflammation over the lips, skin, or mucous lining of the eye, nose, etc., impacting the quality of life. This case describes a 24-year-old female who developed severe perioral dryness, erythema, and exfoliation after 22 days of intake of oral Isotretinoin (10 mg per day) for acne vulgaris. Despite cessation of the drug and undergoing symptomatic treatment, the condition of the patient worsened over the past eight months with development of significant dryness, inflammation, and cracking of the lips along with intense discomfort. Ayurvedic management was initiated, interpreting the condition as Garavishajanya twak vikara (~artificial poison-induced skin disorder). A combination of internal medicines including Punarnavadi kashaya, Vilwadi gulika, Dushivishari gulika and topical application including cold sponging with Triphala decoction and application of Shatadhauta ghrita , aimed at reducing inflammation, balancing Dosha (~regulatory functional factors of the body), and supporting tissue healing, was employed. The patient showed marked improvement with complete symptom resolution within two weeks, along with substantial reduction in severity assessed using the Isotretinoin cheilitis grading scale. There was no recurrence on one-week follow-up after completion of treatment. This case highlights the importance of patient education before Isotretinoin use and supports the role of Ayurvedic approaches in managing persistent drug-induced side effects wherein conventional treatment provided limited benefit.