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Isotretinoin
What is isotretinoin?
Isotretinoin is a vitamin A derivative. It has been used as a therapeutic agent since the mid-1970s.
Uses
Isotretinoin is a very effective drug. It’s often used to treat severe cases of acne.
In addition, isotretinoin can also be used for other hair follicle diseases, such as:
- Rosacea;
- Hyperseborrhea;
- Hidradenitis suppurativa;
- Scalp folliculitis.
Why Isotretinoin Can Treat Acne Effectively
Isotretinoin can:
- Reduce sebum production;
- Shrink the sebaceous glands;
- Reduce follicular occlusion;
- Inhibit the growth of bacteria;
- Bring down inflammation at the tissue level.
Contraindications
Isotretinoin must not be taken during pregnancy.
You should not donate blood while taking isotretinoin.
Precautions
Isotretinoin should not be used during breastfeeding.
If pilots take isotretinoin, their performance may be affected.
If young children take medium to high doses of isotretinoin, it may cause premature epiphyseal closure, which may affect their final height. But this is not seen when isotretinoin is given at low doses.
The individual dosage prescribed by a dermatologist depends on...
- Severity of illness;
- The effects that can be produced after taking it;
- Side effect;
- Past medical history.
Dosing Schedule
Isotretinoin is best taken with water after meals, as this can increase drug absorption and achieve better results.
Treatment Duration
Most patients should continue treatment until their skin condition improves. Adequate treatment reduces the chance of recurrence.
Drug interactions with isotretinoin
- Vitamin-A (retinoic acid);
- Tetracyclines (including doxycycline, minocycline): these could increase the risk of headaches and blurred vision due to raised intracranial pressure;
- Warfarin: monitoring of INR mandatory.
Side Effects and Risks
The side effects of isotretinoin are dose-dependent. The range and severity of side effects also depend on personal factors and the severity of the disease.
It is recommended that patients with severe liver or kidney disease, hyperlipidemia, diabetes, and depression should not take isotretinoin.
Most of the side effects caused by isotretinoin affect the skin or mucous membrane, which is related to the pharmacological actions of the drug. When side effects are severe, the dose may need to be reduced.
The most common side effects
- Initial acne (acne) outbreak (outbreak period) during the period of taking (if the starting dose is high).
- Dry lips and cheilitis (common).
- Dry skin, eczema/dermatitis (itching, erythema).
- Increased sweating.
- Dry nostrils and nosebleeds.
- Dry eyes.
- Erythema on face.
- An increased chance of sunburn upon an exposure to strong sunlight.
Rare side effects
(The cause and effect of the side effects listed may not have been proven.)
- Mood changes and depression.
Note: Depression is often related to skin conditions, health or other psychological problems. - Abnormal liver function tests.
Dose-related side effects
- Headache.
- Muscle and joint pain;
- Tiredness.
- Night vision impairment and slow adaptation to darkness.
- Triglyceride levels in the blood may be elevated, but usually does not affect health.
- Delayed menstrual cycle or heavy menstrual bleeding.
Treatment methods for side effects
- Avoid alcohol.
- Take acetaminophen for headaches and minor muscle and joint pain.
- If you feel unwell, please seek medical advice as soon as possible.
Treatment methods for skin and mucosal side effects
- Emollients, lip balm, petroleum jelly, sunscreen, eye drops as needed.
- Topical steroid ointments can be used for dermatitis.
- No hot shower or hot water bathing. It will wash away the natural lipid stored in your skin.
- Do not have elective eye surgery while taking isotretinoin or within 6 months of consumption.
- Do not undergo mechanical dermabrasion or laser treatments (such as CO2 laser resurfacing) while taking isotretinoin or within 6 months after treatment cessation.
Relevance between isotretinoin and mood effects
The effect of isotretinoin on mood is a very controversial issue. Most acne patients’ mood improves together with their acne. Isotretinoin rarely causes depression or low mood. If the emotional problems are caused by isotretinoin, the depression will be relieved after stopping the medication, but it will reappear as long as the medication is resumed. Oftentimes, acne itself can be a source of pain, anxiety and depression. In rare cases, suicidal ideation may occur during isotretinoin treatment, but it is difficult to determine whether these mood changes are caused by acne, scars, medications, or something else.
The largest meta-analysis examining data 1.6 million people found that the 1-year absolute risks of suicide, suicidal ideation, completed suicide, and self-harm were all less than 0.5%, and that of depression was 3.8%, all lower than the general adolescent population. It showed that the relative risk of psychiatric disorders was not increased in users of isotretinoin. Within 2-4 years of taking isotretinoin, the incidence of psychiatric disorders was lower than in people who did not take the drug. People who take isotretinoin and have a history of depression have a slightly increased risk of developing depression. Despite all these, patients and their families should keep an eye on these issues.
Treatment Follow-up
Isotretinoin should not be taken during pregnancy because the risk of serious congenital malformations in the baby is very high. Caution is needed during breastfeeding as isotretinoin passes into breast milk and may affect the baby in an undesirable way.
Effects of taking isotretinoin on pregnant women
If the fetus is exposed to isotretinoin in the first half of pregnancy, it may cause spontaneous miscarriage or organ malformation.
Men do not need to take contraceptive measures
Isotretinoin has no effect on sperm or male fertility. There is no scientific evidence that the child born from father taking isotretinoin will have birth defects.
Can I use isotretinoin again if acne recurs?
At least 50% of acne patients will achieve lasting relief after taking a sufficient course of isotretinoin. Some patients may experience a recurrence within months or years after stopping the medication. These patients are advised to start a new round of isotretinoin treatment.
