What is isotretinoin?
Isotretinoin is a medication used to treat severe acne that has not responded to other treatments and is scarring or impacting on a person’s wellbeing. Isotretinoin is one of a group of drugs called retinoids which are related to vitamin A. Only a specialist dermatologist can prescribe isotretinoin.
How does isotretinoin work?
Isotretinoin improves acne by:
- Reducing the size and activity of the sebaceous (oil) glands of the skin
- Reducing the number of comedones (blackheads, whiteheads) and cysts
- Reducing the number of bacteria (Propionobacterium acnes) in the oil gland and upper part of the hair follicle.
What does isotretinoin treat?
Isotretinoin is mainly used to treat severe or persistent or scarring acne.
It is occasionally used to treat other conditions:
- Severe folliculitis
- Hidradenitis suppurativa
What monitoring is required for isotretinoin treatment?
A blood test is required before and periodically during treatment with isotretinoin. Blood tests check the blood count, liver function and blood fats (cholesterol and triglycerides). Isotretinoin may rarely cause an elevation of triglycerides (blood fats) or minor liver function abnormalities.
In females, a pregnancy test is undertaken before commencing treatment and may be repeated periodically during treatment.
What precautions should be taken during isotretinoin treatment?
- Isotretinoin frequently causes severe birth defects or miscarriage. Under no circumstances should a woman fall pregnant while on this medication. Strict, reliable birth control methods are recommended for 1 month before, for the duration of isotretinoin treatment, and for 1 month after the treatment has been completed. If pregnancy occurs during the treatment, the medication must be stopped and the treating dermatologist informed immediately. (Note: Isotretinoin does NOT affect male sperm or fertility).
- Blood cannot be donated during treatment with isotretinoin as the donated blood may be given to a pregnant woman and cause a birth defect.
- Excessive alcohol should not be consumed while on this medication.
- Breastfeeding is not recommended while taking this medication.
- Tetracycline antibiotics (such as minomycin or doxycycline) should not be taken with isotretinoin. Other medications can also interact with isotretinoin.
- Any other form of vitamin A should not be taken with isotretinoin treatment.
- Isotretinoin is best avoided in children less than 10 years old as it may stunt bone growth.
What to expect when taking isotretinoin and potential side effects
During the first 4 to 8 weeks of treatment the acne may occasionally worsen before it starts to improve. It can take some months before the acne is under control. Sometimes the initial flare-up can be severe and require additional treatment.
The most common side effect of this treatment is dry skin. This can occur all over the body, but particularly effects the lips, nose and eye region. The skin may appear red, scaly and irritated. It may be itchy.
The following suggestions may help with skin dryness:
- Apply a moisturiser to the face and body after showering daily.
- Keep showers short and avoid very hot water.
- Avoid liquid soaps/shower gels/detergents/masks/exfoliating agents/toners/scrubs on the skin – these will only increase the dryness and irritate the skin. A gentle soap-free cleanser is recommended.
- Avoid other anti-acne creams, lotions, cleansers (unless advised by the dermatologist).
- Lubricating eye drops or ointment are useful for dry eyes. Avoid wearing contact lenses if they irritate or apply lubricating eye drops more frequently when they are worn.
The skin commonly becomes more sensitive to the sun during treatment. This increases the risk of sunburn. Strict sun protection with clothing, hat, sunglasses and the use of a broad-spectrum sunscreen is recommended.
Skin is generally more fragile while on the treatment. Peeling, scale or redness on the skin and occasionally superficial bruising may appear. These symptoms can be reduced by:
- Moisturising more frequently
- Avoiding waxing any part of the skin whilst on the treatment
- Avoiding Iaser treatment, dermabrasion, chemical peels, tattoos, piercings and non-emergency surgery whilst on this treatment (unless advised by your dermatologist).
Other less common side effects may include:
- Headaches: These are rarely serious but can be related to raised intracranial pressure.
- Changes in vision: If blurred or double vision occurs the medication should be stopped and the dermatologist contacted immediately. Some may notice that their vision adapts more slowly to the dark.
- Hair loss: This is usually temporary. The hair regrows after treatment is stopped.
- Nosebleeds: This is related to dryness and thinning of the lining of the nasal passages. Nosebleeds are more likely to happen with a cold or hayfever and/or frequent nose blowing.
- Tiredness, stiffness or tenderness of joints or muscles may develop after physical activity. Reducing or modifying physical activities may help with these symptoms.
- Facial redness and flushing may be noticed during treatment.
- Paronychia (ingrown nails) may develop in toenails or fingernails.
- Rarely vomiting, diarrhoea and bleeding from the bowel may occur.
- There are reports of mood change and depression in people taking isotretinoin. Very rarely the mood changes may be due to the medication. Any changes in mood should be reported to the treating dermatologist.
Most side effects are not severe and improve after treatment is stopped.
Other potential side effects have been reported. Please refer to the product information that is provided with the medication.
Links to support groups for isotretinoin and acne
This information has been written by Dr Eleni Yiasemides