Family doctor

Brands:

• Roaccutane
• Oratane

Use: Severe acne

Isotretinoin (ice-oh-tret-in-oh-in) is a form of Vitamin A that is prescribed by dermatologists (skin specialists) for severe acne that has not improved with other milder therapy. It is especially recommended if cysts are present and when the body (e.g. chest and back) is affected rather than only the face.

Isotretinoin makes the sebaceous (sea-bay-shis) glands less productive, reduces the size of the sebaceous glands and reduces the inflammation (redness and swelling) of the skin in acne. It affects the development of pimples and blackheads and reduces the amount of the bacteria "Propionibacterium acnes".

Dose:

The dose is tailored to each patient depending on patient weight, response to the medicine and side effects. Usually it is started at a dose of 0.5 mg/kg each day and after 2 to 4 weeks the dose may be adjusted. Most patients are treated from 0.5 mg - 1.0 mg/kg each day, although lower doses may be used if side effects are problematic.

When settled on the dose, the medicine is usually given for 12 weeks then stopped. Even after stopping the acne will usually improve further. While most patients will only require one course, some patients will need a second course; this should not be given until at least 8 weeks after finishing the first course.

Cautions:

Isotretinoin must not be used in people with a bad liver or kidneys, people with very high blood lipids or allergy to isotretinoin or other ingredients of the capsule.

It is extremely important that women taking isotretinoin do not become pregnant while on isotretinoin or for 1 month after stopping the medicine. Isotretinoin is teratogenic, which means that it is extremely damaging to an unborn child.

Special care is required if patients have a history of depression as there have been reports of depression and other similar problems in patients on isotretinoin, although it has not be confirmed if isotretinoin was the cause.

The manufacturers recommend that liver function and lipids should be checked prior to starting treatment, one month after the start of treatment and in the case of lipids, after the treatment has finished, and in the case of liver function, every three months. Overweight people, diabetics or people with alcoholism or lipid metabolism disorders will need to have blood tests more often.

Side effects:

The side effects of isotretinoin are generally those of too much vitamin A. Many patients will have dry:

• Skin
• Lips
• Inside the nose
• Eyes
• Mouth
• Throat (can temporarily affect the voice)

Some other possible side effects are:

• Itchy skin, nail problems, hair thinning or loss, increased sensitivity to sunlight.
• Muscle and joint pain (quite common)
• Headache
• Changes in blood tests e.g. liver tests, cholesterol
• Infections including skin infections

There are a number of other side effects that can occur, so check with your doctor or pharmacist if you think you may have a side effect of the medicine.

Interactions:

• Vitamin A must not be taken in addition to isotretinoin
• Tetracyclines e.g. minomycin and doxycycline should not be taken with isotretinoin
• The "mini pill" may not work with isotretinoin so should not be used

Patient information:

• Follow the instructions on the label of the medicine or as directed by your doctor.
• Women using isotretinoin must ensure they do not become pregnant just prior to starting treatment, while using the medicine and for one month after finishing the course. It is recommended that two forms of contraception are used at the same time (e.g. condoms and the pill) to be safe.
• It is very important not to take any other Vitamin A when you are using this medicine.
• Initially the acne may worsen a little, however during and even after treatment there is usually further improvement.
• Take with food either once or twice daily according to the doctor's directions.
• Do not donate blood while taking isotretinoin or within 1 month of finishing the course.
• Avoid waxing to remove hair, or dermabrasion while taking isotretinoin and for 5 or 6 months after treatment.
• If the eyes are dry it may be best to avoid wearing contact lenses.
• It is wise to avoid sunlight where possible while taking isotretinoin. Do not use a sunbed and always use a sunblock when outside - remember to reapply regularly.
• If taken with food more medicine will be available to the body than taken without food.
• Use a good skin moisturiser (emollient) regularly to keep the skin in good condition.
• Eye drops can help with dry eyes (ask your pharmacist or see the article on dry eye products).
• There are a variety of moisturisers for lips and inside the nose - a very good one is Elizabeth Arden's Eight Hour Cream.
• See a doctor if you think you may have a skin or eye infection.

Common Question:

Can I just take a lot of Vitamin A from health products to help my skin instead of taking isotretinoin?

Answer: No, this will not be very effective on the acne and is very dangerous. Isotretinoin has been specially developed to treat acne with the least possible side effects. This therapy must only be used under the guidance of a skin specialist because of the possible risks. It is very important not to take more Vitamin A than is recommended.