Systemic isotretinoin has been successfully used in Russia for acne therapy for more than 30 years, and if at the beginning of this period the use of this molecule in practice was limited, then the appearance on the pharmaceutical market of new isotretinoin preparations, including those with improved pharmacokinetic properties, allowed an increasing number of dermatologists, and now cosmetologists, to master and to understand the specifics of the use of this class of medicines, which is certainly important for specialists. The widespread use of preparations is reflected in the more frequent occurrence in practice of a certain number of non-standard comorbid situations in patients with acne, which can potentially affect the choice of dose regime, frequency of adverse events and laboratory methods of their control. Recently, there has been a significant amount of interest in the use of systemic isotretinoin on an extended list of indications, taking into account the experience of its application from available world data of experimental studies, the number of which increases every year. However, non-routine situations can make it difficult to make a particular decision for clinicians. Therefore, sharing experience with experts and discussion of similar data from other publications will be very useful for specialists in our opinion. The first steps of our experience generalization, which were made 10 years ago, had already become requested, and we hope that the continuation of this topic is interesting at the current moment.