Treatment with Isotretinoin:
Most people with acne respond well to prescription creams and/or pills together with supportive care such as facials, chemical peels and home care regimens. Some people, however, have very severe acne or acne that does not respond to these treatments and may need more aggressive intervention. This is especially important in people who develop scars as a result of continual breakouts.
The FDA approved isotretinoin (the generic name for Accutane®, Sotret®, Amnesteem® and Claravis®) in 1982 for the treatment of severe nodulocystic acne. It is the most effective treatment for this form of acne. Isotretinoin works by targeting the sebaceous or oil glands where acne breakouts form (Understanding Acne). By decreasing the activity of the sebaceous glands, isotretinoin blocks this sequence of events at the very start. This is why it is such a powerful tool in treating severe and resistant cases of acne.
As part of your medical treatment plan, the use of isotretinoin may become appropriate. Although isotretinoin is a very effective treatment for even the most severe cases of acne, certain serious side effects limit and restrict its use. Because isotretinoin can cause severe birth defects if taken during pregnancy, it should never be taken by any woman who is pregnant or planning pregnancy. This dangerous side effect is so important that all female patients who are able to become pregnant are required to use two forms of birth control during treatment with isotretinoin and for one month following conclusion of treatment. The FDA has implemented a very strict registration program called iPledge to further prevent a female patient from becoming pregnant while taking isotretinoin. Other serious side effects are also possible with isotretinoin therapy and should be addressed during your medical consultation. An understanding of all of the risks and benefits of isotretinoin therapy is important when considering if this treatment is right for you.
Although isotretinoin is a very effective treatment for even the most severe cases of acne, potential side effects limit and restrict its use. Isotretinoin is a derivative of Vitamin A and can have some of the same side effects as taking too much Vitamin A. Problems with night vision, for example, can occur in some patients taking isotretinoin. Patients who take isotretinoin may develop dry lips and may need to apply moisturizing lip balms frequently. Patients also can experience dryness of the eyes, skin and hair. The nasal passages can also become dry, sometimes resulting in nosebleeds. Headaches may occur which do not usually interfere with treatment. However, a condition known as pseudo tumor cerebri, an uncommon cause of increased pressure around the brain may be a cause of severe headaches requiring discontinuation of isotretinoin and further medical treatment. Abnormal bone development can be a side effect in children who have not yet reached the end of their growth period. Other effects on muscles and bones can also occur, including pain and discomfort. Gastrointestinal side effects can occur, including bleeding as well as the possible development of inflammatory bowel disease (IBD). IBD is a chronic inflammation of the gastrointestinal tract that can have serious and irreversible consequences, sometimes needing surgery and medical therapy.
Other possible associations with isotretinoin may include mood changes, depression…and even suicide. All patients under treatment with isotretinoin are required to have blood tests before and every month during treatment to check for any treatment related effects on the liver, blood count, blood sugar, cholesterol and triglycerides. All female patients of child bearing potential must have monthly pregnancy tests. Male patients taking isotretinoin should not have unprotected sex with female patients who are able to become pregnant.
Additional instructions for all patients taking isotretinoin include:
- Do not take Tylenol or any other medicine that may interact with your liver unless approved by your doctor.
- Do not donate blood during treatment and for one month after completing treatment.
- Do not have waxing treatments to remove face or body hair.
- Do not drink alcoholic beverages.
- Do not take Vitamin A supplements.
- Do not undergo elective surgery or laser treatments during treatment and for 6 months after completing isotretinoin therapy.
- Avoid intense sun exposure and always use a sun block.
An understanding of all of the risks and benefits of isotretinoin therapy is important when considering if this treatment is right for you. Make sure that you ask your doctor any questions that you may have before you decide to begin treatment.