Isotretinoin, has proven to be very effective in significantly clearing acne in most of the patients who take it. It has a great advantage over antibiotics, such as Tetracycline, in that four to six months of treatment usually leads to marked improved of the acne, and the improvement continues after the Isotretinoin is stopped. There are however more side effects with Isotretinoin than with antibiotics, but with proper medical supervision these side effects can be controlled and eliminated and usually do not present much of a problem. The major side effect with Isotretinoin is that it causes severe abnormalities in children born to pregnant women who are or become pregnant while taking Isotretinoin. However, there is no problem with children born to women who have become pregnant after stopping the Isotretinoin. Isotretinoin is very expensive (costing about $150 per month) for average dosage.
How Isotretinoin Works
Isotretinoin is a derivative of Vitamin A. It improves acne by reducing oil production, by helping unclog pores and also 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 TO SIX MONTHS. Isotretinoin is given as tablets which should be taken with food. If you forget a dose, it may be taken later the same day, but do not take more Isotretinoin in one day than is prescribed.
Effects of Isotretinoin
- The SIDE EFFECTS OF ISOTRETINOIN mainly result from the fact that Isotretinoin reduces oil production. This leads to dryness of the 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, Ceralip, Burt`s Bees Wax etc. Some patients will get dryness of the lining of the nose and occasionally one can get nose bleeds. Nose bleeds should not alarm the patient as long as they can be controlled easily. The eyes may also dry out a bit, but this is usually not noticed by patients except those wearing contacts lenses. Contact lens wearers may require an eye solution. 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, but if this is not helpful, a cortisone cream can be prescribed. This dryness will disappear once the Isotretinoin is stopped.
- Occasionally the patient may get mild peeling of the top of the hands or feet 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). This level returns 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 (ie. A two month rest period off the Isotretinoin is always taken, as the acne will continue to improve during this time).
- Again, it is important to note that once the Isotretinoin is stopped your acne will continue to improve for at least the next two or three months and in face the greatest improvement is noted two months after stopping the Isotretinoin.
- Acne of the back and chest responds slower than acne of the face.
- There have been a few isolated reports of patients 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 advice oh 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 your dermatologist 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 immediately to your dermatologist. Isotretinoin usually is very well tolerated, but unwanted side effects may occur with this drug as with other medicines. Please tell your dermatologist, 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.
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