What is Isotretinoin?
Isotretinoin, commonly known by the brand name Accutane, is a medication used to treat severe acne that has not responded to other treatments. It is a powerful medication derived from vitamin A and is effective at reducing the size and activity of oil glands in the skin.
Indication:
Isotretinoin is prescribed to treat persistent forms of acne.
Off label it may be used for other dermatological conditions under the guidance of your dermatologist.
Contraindications:
Do not take Isotretinoin if you:
1. Are pregnant or planning to become pregnant soon.
2. Are breastfeeding.
3. Have an allergy to Isotretinoin or any of its components.
4. Have liver disease.
5. Have a high level of blood fats (triglycerides).
6. Soya oil allergy
7. Impaired night vision
Safety during Pregnancy or Lactation:
**Isotretinoin is not safe during pregnancy.**
Pregnancy must be avoided at all costs while taking Isotretinoin. It can cause severe birth defects in developing fetuses. Two forms of effective contraception is essential for sexually active individuals during treatment and for at least one month after discontinuation.
Drug Interactions:
Inform your healthcare provider about all medications, vitamins, and supplements you are taking, as some drugs may interact with Isotretinoin. This can affect its effectiveness and safety.
Stop all tetracycline (doxycycline or minocycline) and vitamin A supplements prior to Isotretinoin.
Common Side Effects:
– Dry skin and lips
– Dry eyes
– Nosebleeds
– Muscle aches and joint pain
– Increased sensitivity to sunlight
Rare but Serious Side Effects:
While rare, Isotretinoin can lead to more severe side effects, such as:
– Depression or mood changes
– Changes in vision
– Severe headaches, dizziness, or blurred vision,
– Severe abdominal pain
– Chest pain or difficulty breathing
– Allergic reactions (rash, itching, swelling, severe dizziness, difficulty breathing)
– Hair thinning
Monitoring Tests:
Your dermatologist may require regular blood tests to monitor your liver function, cholesterol levels, and blood cell counts. These tests help ensure your safety while on Isotretinoin.
Dosing Plan:
10mg (1 tablet) every 2nd day for 2 weeks, then 10mg (1 tablet) daily.
Taken with food, any time of day.
Your dose will be titrated depending on your response and side effects.
A treatment course is usually 12-18 months.
Precautions:
1. Avoid alcohol during Isotretinoin treatment.
2. Use effective contraception if you are of childbearing potential.
3. Limit sun exposure and use sunscreen, as Isotretinoin can make your skin more sensitive to sunlight.
4. No strenuous exercise beyond what is normal for you already.
5. No waxing, aggressive chemical or physical exfoliation, ablative laser therapy.
6. No donating blood
7. No vitamin A supplements.
It’s crucial to strictly follow your dermatologist’s instructions and attend all scheduled follow-up appointments. If you experience any unusual or severe side effects, contact your healthcare provider immediately.
Tips:
Maintaining a proper skincare routine while on Isotretinoin (Accutane) is crucial to minimize side effects and ensure the best possible results. Here’s a skincare routine to follow:
1. **Gentle Cleansing:**
– Use a mild, non-comedogenic cleanser to wash your face twice a day, in the morning and before bedtime.
– Avoid harsh scrubs or exfoliants that can irritate your skin.
– Pat your face dry with a clean, soft towel, rather than rubbing.
Recommendations: Cerave hydrating wash, QV gentle wash or Cetaphil Gentle wash.
2. **Moisturise:**
– Apply a fragrance-free, non-comedogenic moisturizer immediately after cleansing. Isotretinoin can make your skin dry, so moisturizing is essential.
– Reapply as needed throughout the day to keep your skin hydrated.
Recommendations: Cerave Cream, QV face moisturiser, La Rosche Posay Effaclar H Isobiome moisturiser, Avene Hydrance hydrating cream,
3. **Sun Protection:**
– Use a broad-spectrum sunscreen with SPF 30 or higher every day, even on cloudy days.
– Reapply sunscreen every 2 hours, especially if you spend time outdoors.
– Wear protective clothing, such as a wide-brimmed hat and sunglasses, to shield your skin from the sun’s harmful UV rays.
Recommendations: La Rosche Posay Anthelios, Avene Aqua fluid, Cetaphil sunscreen, SunSense daily face.
4. **Lip Care:**
– Isotretinoin commonly causes dry, chapped lips. Use a hydrating lip balm throughout the day to keep your lips moisturised.
Recommendations: Dermal therapy lip balm, La Rosche Posay cicaplast Levres Lips or Propaira zinc lip balm.
5. **Avoid Harsh Products:**
– Stay away from abrasive skincare products, astringents, or products containing alcohol.
– Do not use products that contain benzoyl peroxide, alpha hydroxy acids (AHAs), or beta hydroxy acids (BHAs) unless recommended.
6. **Short, Lukewarm Showers:**
– Hot water can further dry out your skin. Take short, lukewarm showers and use a gentle, fragrance-free body wash.
– Pat your body dry instead of rubbing with a towel.
7. **Eye Care:**
– If you experience dry eyes, artificial tears or preservative-free lubricating eye drops can provide relief.
8. **Nose Care:**
– If you experience a dry nose or bleeding nose, Saline nasal sprays can provide relief. Apply some Vaseline inside the nostril before bed to hydrate the mucosal surfaces. Use Nozeoil spray
9. **Avoiding Picking:**
– Picking at your acne will contribute to scarring. Use a pimple patch to minimise picking where necessary.
9. **Be Patient:**
– It may take a several weeks or months to see significant improvement in your acne.
– Continue your skincare routine and medication as prescribed.
Remember, everyone’s skin is different, so what works best may vary from person to person. If you experience any unusual or severe side effects or have questions about your skincare routine please get in touch.
For personal use only. Intended for the patients of Dr Anes Yang. Please refer to the disclaimer.
Dr Anes Yang 
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