Oral Isotretinoin for Acne in the US Military: How Accelerated Courses and Teledermatology Can Minimize the Duty-Limiting Impacts of Treatment
Acne vulgaris is a common dermatologic disease affecting 40 to 50 million individuals in the United States each year. It has a peak incidence in adolescents and young adults; however, for some patients, the disease may persist well into adulthood. These incidence peaks coincide with the age demographic of a large proportion of military service members. Although there are many approaches to treating acne, active-duty service members and military dermatologists must weigh multiple additional challenging factors when selecting a therapy. Untreated acne itself may hinder a military service member’s ability to perform, and many of the available therapies also can limit their medical readiness or fitness for full duty. Herein, we review operational restrictions to acne-specific therapeutics and discuss an accelerated course of oral isotretinoin as a safe and effective option for military service members bound by duty restrictions and operational timelines. In addition, we explore the role of teledermatology for the treatment of acne in military service members.
Practice Points
- Acne is a common skin disease with a high prevalence in the active-duty US Military population.
- Oral isotretinoin is a commonly utilized acne medication that can limit the ability for military service members to deploy and is considered disqualifying for some special duty assignments.
- High daily- and cumulative-dose oral isotretinoin therapy as well as teledermatology can minimize the duty-limiting impact of isotretinoin therapy for military service members.
The use of teledermatology for uncomplicated oral isotretinoin management has the potential to increase medication compliance and decrease the amount of travel time for active-duty service members; for example, consider a military dermatology practice based in San Diego, California, that accepts referrals from military bases 3 hours away by car. After an initial consultation for consideration and initiation of oral isotretinoin, teledermatology appointments can save the active-duty service member 3 hours of travel time for each follow-up visit per month. This ultimately increases operational productivity, reduces barriers to accessing care, and improves patient satisfaction.23
Although military personnel usually are located at duty stations for 2 to 4 years, training exercises and military vocational schools often temporarily take personnel away from their home station. These temporary-duty assignments have the potential to interrupt medical follow-up appointments and may cause delays in treatment for individuals who miss monthly isotretinoin visits. When deemed appropriate by the prescribing dermatologist, teledermatology allows for increased continuity of care for active-duty service members and maintenance of a therapeutic isotretinoin course despite temporary geographic displacement.
By facilitating regular follow-up appointments, teledermatology can minimize the amount of time an active-duty service member is on a course of oral isotretinoin, thereby reducing the operational and duty-limiting implications of the medication.
Final Thoughts
Acne is a common dermatologic concern within the active-duty military population. Oral isotretinoin is indicated for treatment-resistant moderate or severe acne; however, it limits the ability of service members to deploy and is disqualifying for special military assignments. High daily- and cumulative-dose isotretinoin treatment strategies can reduce the duration of therapy and may be associated with a decrease in acne relapse and the need for retrial. Teledermatology can increase access to care and facilitate the completion of oral isotretinoin courses in a timely manner. These treatment strategies may help mitigate the duty-limiting impact of oral isotretinoin therapy in military service members.
