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As a last resort in refractory disease, sebosuppressive agents such as isotretinoin accutane may be used to reduce sebaceous gland activity.

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54 55 isotretinoin has a low affinity for retinoic acid receptors rar and retinoid x receptors rxr , but may be converted intracellularly to metabolites that act as agonists of rar and rxr nuclear receptors.

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