Very severe nodular acne is extremely difficult to treat. As a last resort, your dermatologist could prescribe isotretinoin (chemical name) – with the original brand name of Accutane. Other brand names for isotretinoin are Roaccutane, Amnesteem, Claravis and Sotret. Isotretinoin for acne is the only known treatment that helps to induce drug-free and long-term remission of severe nodular acne. Isotretinoin is considered a retinoid for it is related to vitamin A (retinol) and tretinoin (retinoic acid). In some countries like Canada, Australia, UK and Europe, isotretinoin is available both as an oral and topical preparation.
A dramatic improvement can be seen in patients often after a single course of 15-20 weeks. Isotretinoin is so effective because it attacks the root cause of acne. It can stop excess oil production by shrinking the size of sebaceous glands. This limits sebum production, therefore cutting off the sustenance for the P.acnes bacteria. The other effect it has is that of stabilizing keratinization. This process is the creation of the keratin protein by keratinocytes. When dead skin cells are shed abnormally and frequently, it causes the clogging of hair follicles and results in acne outbreaks. Isotretinoin stops this abnormal shedding of dead skin cells. Hence, hair follicles do not get clogged.
Due to its very severe side effects, isotretinoin can only be prescribed by a qualified dermatologist and only after all other treatment options have failed. Many important precautions need to be followed when using isotretinoin. This medication is prescribed for the following types of acne:
- Severe nodular acne
- Inflammatory acne that produces scarring
- Moderate-to-severe acne that relapses frequently
- Acne that causes serious psychological distress
Severe nodules must at least be 5mm or more in diameter to qualify as ‘severe’ and requiring the use of isotretinoin.
How should isotretinoin be used?
Isotretinoin for acne is available as a capsule that has to be swallowed. It cannot be sucked or chewed. The normal dosage is two capsules a day to be taken with meals. Your doctor will provide precise instructions on how to take this medication and you must follow these instructions very carefully. Usually a medium strength dose will be given and your doctor will monitor your response to isotretinoin. The dose will then be increased or decreased depending on the patient’s response to the initial dosage, side effects and such. Acne outbreaks can get worse before it gets better. So, do not worry and think that the medication is not working.
Benefits of isotretinoin
Isotretinoin for acne is a potent drug that is the only known cure for severe cysts that do not respond to other medications. It treats all four causes of acne – clogged pores, excess sebum production, inflammation and P.acnes. Patients report remissions from acne for many months or years. Often one course of isotretinoin is sufficient to treat severe acne.
Limitations and Side Effects of isotretinoin
Isotretinoin produces many side effects – from mild to extremely serious. In fact it is called a teratogen – this means a substance that causes fetal birth deformities. Anyone who demonstrates an allergic reaction to isotretinoin must not use it. Its uses are limited only to severe acne and not for milder forms.
Isotretinoin Side effects
Various side effects can be experienced when using isotretinoin. All side effects must be routinely reported to your doctor.
- Immediate side effects of isotretinoin can be:
- Cracked and sore lips
- Dry skin, mouth, eyes or nose
- Peeling of skin on the soles or palms
- Changes in color of nails and skin
- Slow healing of wounds
- Swollen or bleeding gums
- Unwanted hair growth
- Voice changes
- Cold symptoms
Some serious side effects:
- Pain in the bone and joints
- Pain when swallowing
- Chest pain
- Vomiting and nausea
- Severe headache
- Blurred vision
- Night vision impairment
- Severe abdominal
- Rectal bleeding
- Dark urine
- Yellowing of eyes and skin
- Numbness on one part of the body
- Severe heartburn
- Unusual thirst
- Bruising or red patches on the legs
- Frequent urination
- Ringing in the ears
Other serious side effects:
- Serious fetal abnormalities
- Changes in mood
- Increased triglyceride levels
- Liver damage
All these side effects must be reported and doctors will perform blood tests to check triglyceride levels, if a patient is pregnant or for liver damage. Children on isotretinoin must be monitored carefully for mood swings and signs of depression.
Isotretinoin for acne will not be given to pregnant women. All women in the reproductive age will be advised to use 2 types of birth control a month before and after the last dose and during the entire period when on isotretinoin. Apart from this, your doctor could advise a pregnancy test every month you are on the medication, for some birth control methods are not 100% safe.
Inform your doctor if you are breastfeeding, have hepatitis or other liver diseases, digestive or bowel problems like diarrhea, bleeding, or pain. You must also inform them about other health conditions like diabetes, heart problems, problems with pancreas, eyes, ears, high cholesterol and even any minor health issues. If there is a family history of depression, mental illnesses, eating disorders, aggressive behavior or osteoporosis, your doctor must be told.
Any changes in mood or behavior must be reported at once for this medication can cause people to go into severe depression and even become suicidal. Patients must not play rough sports when on isotretinoin for they can get easily injured. Blood must not be donated at this time. Vision could get affected, so avoid driving or operating machinery at night. Skin can get sensitive to strong lights. So, use a sunscreen when going out and avoid artificial tanning beds and sunlamps for this duration. Patients can get infected more easily for blood cell count can drop when on isotretinoin. So, avoid being around people who are sick and follow proper hygiene.
Due to the serious nature of the side effects that isotretinoin can cause, patients will be asked to sigh a consent form before taking this medication. This will list the risks of isotretinoin and guidelines for safe usage. Patients must ensure they read through this form carefully before signing it.
Inform your doctor about all medications you are taking when he prescribes isotretinoin. Certain medications can make birth control pills ineffective. All cosmetics, wax hair removal and other skin treatments must be avoided during and at least 6 months after stopping isotretinoin. Do not consume alcohol when on isotretinoin.
Isotretinoin must be kept in a tight container at room temperature. It must not be exposed to moisture and heat and must be kept away from children. All unused medication must be disposed off in the right way.
Isotretinoin for acne is an extremely effective medication. However, it is important to follow all safety precautions when using this drug to avoid dangerous side effects. Make sure you keep all doctor’s appointments when on isotretinoin.