Depletion of glutathione (GSH) is one of the initiating steps in APAP-induced hepatotoxicity therefore, one strategy for restricting organ damage is to restore GSH levels by using GSH prodrugs. It is safe at therapeutic doses, but its overdose can result in severe hepatotoxicity, a leading cause of drug-induced acute liver failure in the USA. This review explores the various uses of n-acetylcysteine in the field of dermatology, the evidence supporting the same, the possible mechanisms of action and the adverse effects of the drug.Īntioxidant drug reaction n-acetylcysteine trichotillomania.Acetaminophen (N-acetyl-p-aminophenol, APAP) is one of the most widely used over the counter antipyretic and analgesic medications. Thus a greater role is possible for use of n-acetylcysteine in various skin conditions.
The drug is cheap and is generally safe with few adverse effects. Higher quality of evidence is needed for its wider use. Most indications in dermatology are supported by case reports, small case series and small trials. It also has a role in protection from radiation-induced skin damage including photo-ageing, photocarcinogenesis and radiation dermatitis. The drug has been used as an adjuvant in the management of conditions such as toxic epidermal necrolysis, drug hypersensitivity syndrome, trichotillomania, skin picking disorders and onychotillomania, ichthyoses, contact dermatitis, atopic dermatitis, melasma, pseudoporphyria, connective tissue diseases, wound healing and alopecia. Due to these actions, n-acetylcysteine has found use in several dermatologic conditions in systemic and topical form. It also has anti-inflammatory effects, alters the levels of neurotransmitters, inhibits proliferation of fibroblasts and keratinocytes and causes vasodilatation. It is a thiol compound, which acts as a donor of cysteine, leading to replenishment of glutathione and thus acts as an antioxidant.
N-acetylcysteine is a mucolytic drug which is commonly used as an antidote for acetaminophen toxicity.
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