Isotretinoin in the Treatment of Acne

Oral Retinoids Best Treatment for Severe Pimples

Nov 9, 2009 Hanish Babu

Isotretinoin, the oral retinoid, is the treatment of choice for severe pustular and very severe nodulo-cystic types of acne.

Isotretinoin, a vitamin A derivative, is considered a miracle drug, and, like many miracles, has its own risks. It is a fact that the not-so-uncommon side effects of isotretinoin, especially that of fetal deformities, limits its usefulness in females in the child-bearing age group.

In Which Types of Acne is Isotretinoin Indicated?

Isotretinoin is the best treatment available for the severe and very severe types of acne, where pus-filled bumps, deep nodules and cysts are present. Early institution of isotretinoin will prevent scarring and disfiguration in the treated.

There are two schools of thought regarding the initiation of therapy with isotretinoin. One group advocates using isotretinoin as the first line of therapy. The other school, though, prefers to try the combination treatment with oral antibiotics and topical retinoids for a few weeks and, only in the case of treatment failure, opt for the systemic isotretinoin later on.

Can Isotretinoin be Used to Treat Mild and Moderate Types of Acne?

Many studies do point towards the advantage of using isotretinoin even in cases of mild and moderate acne, albeit in a smaller dosage than that used for severe acne treatment. But considering the side effects of isotretinoin, it is advisable to use isotretinoin only with severe pimples where there is a potential of permanent scar formation.

Does Isotretinoin Cure Acne?

Isotretinoin does not cure acne, though it comes close to getting rid of acne forming sebaceous glands permanently in most treated cases. Recurrences cannot be ruled out in all the retinoid treated patients.

How Does Isotretinoin Help Clear Acne?

Isotretinoin dramatically reduces the sebaceous gland activity; both sebum production and the size of the glands are reduced. It normalizes the thickening of the duct walls, reduces the accumulation of the bacteria within the sebaceous gland and hair follicle and also has an inhibitory effect on the inflammatory process in acne. The last two may well be a natural fallout of the reduction of sebum production within the gland.

The oiliness of the skin reduces, the acne bumps and cysts regress and the skin becomes evened out and smooth within one to two months of starting the isotretinoin.

What is the Advantage of Isotretinoin in Acne, Compared to Other Anti-Acne Medications?

Isotretinoin, by striking at the root cause of acne, provides faster relief and least amount of post healing scars and pigmentary changes than other types of treatment for acne.

What are the Precautions to be taken Before and After Treatment with Isotretinoin?

Oral retinoids, being toxic medications, should be used cautiously. Patients should be made aware of the side effects and the precautions to be taken before starting isotretinoin.

Following are the precautions and warnings for female patients:

As systemic retinoids can cause deformities of the fetus, make sure you are not pregnant before starting the medication by performing pregnancy test. The first dose of the medication may be started immediately after the menstrual period.
Use double birth control measures while on the retinoid; both contraceptive pills and barrier methods are to be used at the same time.
If you miss a period while on isotretinoin, immediately stop the medication and consult your doctor.

Precautions for all patients:

Some blood tests to assess the lipid profile, kidney and liver functions, and so on, should be done before starting the medication. The tests should be repeated at one month and three months during the treatment period.
Isotretinoin increases blood triglyceride levels. Hence alcohol and intake of oily, fried foods, eggs and red meats should be reduced during the treatment period. Those suffering from diabetes and high blood pressure should control these also.
Tetracycline and isotretinoin can cause what is known as pseudo tumor cerebri, causing intracranial swelling; hence both should never be used at the same time in a patient.
Other vitamin A containing vitamin supplements should not be taken while on isotretinoin.
Avoid excess sun exposure while on the retinoids, as these can sensitize the skin to sunlight.
In addition to these, care should be taken to avoid the common acne triggers.

What is the Advisable Dosage of Isotretinoin in Acne?

The common dosage of isotretinoin in acne is 0.5 to 1 mg per kg body weight per day as a single dose. Most patients clear within 16-20 weeks. For severe disease involving the trunk, a higher dosage of up to 2 mg per kg body weight per day may be required. Lower doses are sometimes prescribed for milder types of acne.

Most acne clears with one course, but some may require three or more courses with an interval of two to three months in between.

Though it is the best acne medication available at present, before opting for it, the acne patients should be aware of the contraindications and common side effects of isotretinoin.

Sources:

Breathnach SM et al. Systemic Therapy in Rook’s Textbook of Dermatology. 2004; 4:72.15-17.
Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, Fifth Ed, 2005.

Disclaimer

The information given in this article is for educational purposes only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, Dr.Hanish Babu, MD or Suite101 will not be responsible for any consequences. The images provided are for illustration purposes only.

The copyright of the article Isotretinoin in the Treatment of Acne in General Medicine is owned by Hanish Babu. Permission to republish Isotretinoin in the Treatment of Acne in print or online must be granted by the author in writing.

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