Acne Treatment with Isotretinoin (Accutane)
Isotretinoin is a drug, which is used in the treatment of severe cystic acne. Cystic acne typically is unresponsive to systemic or oral antibiotics such as Doxycycline and Minocycline. Isotretinoin has proven to be very effective in significantly clearing acne in most of the patients who take it. It has been shown to cure up to 80% of patients who complete a full course (1mg/kg/day for 4-5 months). Isotretinoin has a great advantage over antibiotics, in that four to five months of treatment usually leads to marked clearing of the acne and acne scarring. These improvements in the skin continue to occur, even after the Isotretinoin is stopped.
There are however more side effects to manage with Isotretinoin, compared to antibiotics. With proper medical supervision, these side effects can be controlled and sometimes, eliminated. The most common side effects usually do not present a problem during treatment with Isotretinoin. The major side effect with Isotretinoin is that taking Isotretinoin can cause severe birth defects in children who are born to pregnant women, or when a female becomes pregnant while taking Isotretinoin. However, there is no problem with children born to women who have become pregnant after stopping the Isotretinoin.
How Isotretinoin Works
Isotretinoin is a synthetic form or derivative of Vitamin A. It improves acne by reducing oil production and shrinking oil glands, and by decreasing inflammation. The oil production is reduced while the patient is on the Isotretinoin, but returns to normal after the Isotretinoin is stopped. Surprisingly, the improvement in the acne persists even after oil production returns to normal and the Isotretinoin is stopped.
The usual treatment course is FOUR – FIVE MONTHS. Because pregnancy is the TOP risk associated with taking Accutane female patients must wait 30 days to start the medication once they are enrolled in the system. In Portland, the first office visit confirmation of a negative pregnancy screen is performed. Isotretinoin and IPLEDGE consent is obtained at this point. The patient goes on line and enrolls in the IPLEDGE program. The patient will follow up in 30 days to begin the treatment. Each patient is seen monthly for a total of 6 visits. Male patients can start the medication at the first visit.
Effects of Isotretinoin
- The SIDE EFFECTS OF ISOTRETINOIN are primarily due to the reduction in oil gland secretion. This leads to dry skin and especially dryness of the lips. The main problem all patients have is dryness of the lips, which can be controlled by the application of a lubricant to the lips such as Vaseline or Aquaphor. Some patients will get dryness of the lining of the nose and occasionally one can get nosebleeds. Nosebleeds should not alarm the patient as long as they can be controlled easily by applying a little Vaseline on the skin in the nose. The eyes may also dry out a bit and we recommend applying an eye drops to prevent excessive dryness in the eyes. Contact lens wearers may require an eye solution but is rarely a problem. The dryness of the skin is usually not a problem for most patients, as most patients with acne have oily skin anyway. However, some patients will experience dryness and peeling of the skin on the face. You can try regular moisturizers to combat this dryness. This dryness will disappear once the Isotretinoin is stopped.
- Occasionally the patient may get mild peeling of the top of the hands or forearms or scaling of the arms and lubricant lotions or cortisone creams will help improve this problem
- Isotretinoin takes a few months to work; so many patients will not experience any improvement in their acne until the third or fourth month that they are taking the pills. Some patients may not notice significant improvement until after the Isotretinoin has been stopped, and in fact, the greatest improvement in the acne is noted after the Isotretinoin is stopped.
- There have been a very few reported cases of patients on Isotretinoin having an increase in the fat levels in the blood (Triglyceride level). Triglycerides return to normal when the Isotretinoin is stopped. However, Triglyceride levels of the blood are checked regularly during treatment. Blood tests are performed fasting typically after breakfast, having had nothing to eat since dinner the night before.
- About 65% of patients have very significant improvement after one course of therapy and do not require a second course. Approximately 35% of patients will improve with the first course of Isotretinoin, but require another course of therapy in order to get the clearing that they desire. The second course of therapy is often shorter in duration and is never begun before a few months after the previous treatment course. A two-month rest period off the Isotretinoin is always taken, as the acne will continue to improve during this time).
- Isotretinoin is metabolized by the liver like many medications are. Minimizing alcohol and medications like Tylenol while taking Isotretinoin is essential.
- There have been a few isolated reports of patients in Portland on Isotretinoin getting depressed. There is no conclusive evidence that depression is caused by Isotretinoin. Should you feel depressed while on Isotretinoin, contact your dermatologist immediately.
- There have been reports of Isotretinoin being linked to Inflammatory Bowel Disease. However, current scientific evidence is insufficient to prove that a definite relationship between Isotretinoin and inflammatory Bowel Disease actually exists.
- Patients on Isotretinoin should wash their face much less so as not to increase the dryness that the Isotretinoin causes. Wash your face only once a day with no soap at all unless otherwise advised
- Stop all other acne creams as they increase the dryness that Isotretinoin can cause. Do not take any antibiotics while on Isotretinoin as they can interfere with the treatment and cause severe headaches and side effects. Should you require antibiotics for an infection, contact your dermatologist for advises how to use the Isotretinoin during this time.
- You should avoid Vitamins that contain Vitamin A. This is because the Vitamin A in these products may add to the unwanted effects of Isotretinoin.
- Please be sure to return to me in the scheduled appointments. Because of the well-structured way in which Isotretinoin is given, prescriptions cannot be renewed over the telephone.
- Report any unusual or severe symptoms that appear during treatment with isotretinoin. Isotretinoin usually is very well tolerated, but unwanted side effects may occur with this drug as with other medicines. Please tell me, especially if there is severe or persistent headache, blurred vision or other visual disturbances, nausea and vomiting, severe abdominal pain, diarrhea, etc.
Avoid waxing while on Isotretinoin and for one month afterwards, as the skin is very fragile and may tear easily.