Systemic retinoids for treating acne
About isotretinoin for acne
For severe acne that is resistant to other acne treatments, oral isotretinoin is sometimes used with excellent outcomes. Commonly called Accutane, the generic name isotretinoin is preferred. Other brand names are Amnesteem, Claravis and Sotret. Isotretinoin has many effects on the skin including decreasing sebum production, follicular keratin formation, and bacterial counts. The downside of isotretinoin is that side-effect such as chapped lips and dry skin invariably occur. Systemic side-effects include elevation in liver enzymes and abnormalities of lipid metabolism, among many others. Frequent laboratory monitoring is required. Most significantly, isotretinoin is teratogenic (causes birth defects) and cannot be used in pregnant women or in women that might become pregnant. Birth control measures and rigorous monitoring are necessary to ensure compliance. Patients must be registered in a special monitoring program termed iPLedge. The risks and benefits must be discussed fully with an experienced physician. Despite the need for monitoring and the risk of side-effects, isotretinoin can often achieve long-term control of acne when all else has failed.
How do I start using isotretinoin for acne?
Before using isotretinoin, your dermatologist will usually try other acne treatments, such as topical and oral antibiotics, and topical treatments such as benzoyl peroxide and topical retinoids. If results are not sufficient then your doctor will review with you the pros and cons and side-effect considerations of starting isotretinoin. In female patients two negative pregnancy tests, one month apart, are required to start the medication. Both female and male patients will have baseline lab tests performed. you will usually stop all other acne medications before starting isotretinoin. Before starting isotretinoin for acne, you will be enrolled in the iPledge program. Female patients will need to confirm each month that they are not pregnant and which method of contraception is being used.
How long will I take isotretinoin?
A course of isotretinoin is typically 5 to 12 months. The longer the course, and the higher the accumulated dose, the better the chances of staying free of acne after the course of treatment. There are several methods of dosing isotretinoin, but typically your dermatologist will start with a low dose and increase the dose monthly until a dose of approximately 1 mg per kilogram of weight is achieved.
Do I need lab tests every month while on isotretinoin?
Pregnancy tests are required monthly for all female patients of child-bearing age. Your doctor will determine at what frequency routine lab tests are required. Lab test are usually checked when the dosage is increased, and every few months while on a stable dose, and more often if anything specific is being monitored.
What are the side-effects of isotretinoin?
Chapped lips and dry skin are universally noted. Increases sun sensitivity is common. Muscle and joint pain is sometimes observed. As with any medication there is a long list of other potential side effects. You should review the label and the isotretinoin information that your doctor will give you. Most side-effects are rare.
Will isotretinoin cure acne?
Although not a cure, isotretinoin is the only medication that can modify the long-term course of acne. Many patients will get clear and stay clear after one course of isotretinoin, but some patients require a second or third course.
Can I have laser procedures while on isotretinoin?
The latest studies indicate that most laser procedures are safe immediately following or during isotretinoin treatment. Discuss your specific laser procedure with an experienced dermatologist.
