RoAccutane 10

RoAccutane 10

Isotretinoin 10mg is a very low dose. Many a time it does not brings about desired therapeutic effect. So, its side effects is very mild, such as skin irritation and dryness. Nevertheless it should NEVER be taken in a pregnant lady. 

It is commonly marketed as Accutane and Roaccutane as the proprietary name.

What is the definition of isotretinoin?

Isotretinoin is a medication that goes with the same family of compound tretinoin. There are used to treat a very severe form of acne. They are used when all treatment for acne failed or do not responds. Such acne normally causes severe scarring issue. Isotretinoin is one of a group of drugs called retinoids. Retinoids are related to or derivatives of vitamin A.

So, in summary, isotretinoin is related to and derivatives of Vitamin A or tretinoin.

Isotretinoin can be dispensed in oral and topical cream form. In this article, we are talking on the oral form. It is packed as 10, 20, 40 mg capsule.

How does the mechanism of isotretinoin work?

Acne is caused by sebaceous gland activity. Any medication that can reduce this activity will be effective.

Isotretinoin improves acne by the following mechanism or route:

  • Reducing the size and activity, but not the number, of the sebaceous (oil) glands of the skin
  • Reducing the number of comedones (both blackheads, whiteheads) and acne cysts formation during eruption.
  • Reducing even the number of bacteria. The acne bacteria is called Propionobacterium acnes. This bacteria is located in the oil gland and upper part of the hair follicle, where the sebaceous gland duct joins the hair follicle.

Indication for isotretinoin/what it can treat?

Isotretinoin is mainly used to treat severe or persistent or scarring acne.

It is occasionally used to treat other conditions:

  • Severe folliculitis. An inflammation of the hair shaft or follicle
  • Rosacea, basic pathology lies in the skin
  • Hidradenitis suppurativa, an infection causing pus formation

How do you monitor patient on isotretinoin treatment?

  • A blood test is required before and periodically during treatment with isotretinoin.
  • Blood tests check the
    • blood count. RBC, white blood cell, and platelet count as basic.
    • liver function and profile. Function of liver can be compromised.
    • blood fats profile (cholesterol and triglycerides). It is proven that Isotretinoin may rarely cause an elevation of triglycerides (blood fats) or minor liver function abnormalities.
  • In any female, a pregnancy test is MANDATORY. This is undertaken before commencing isotretinoin treatment and may be repeated monthly/periodically during treatment, if at all there is any chance of accidental pregnancy! Isotretinoin will NOT FORGIVE a lady in a hurry to bet pregnant.
  • At the point of stopping the isotretinoin treatment, she must NOT be pregnant for another ONE month. Pregnancy test must ensure this is observed. Again hold on the temptation, not in a hurry to get pregnant. Or ask the guy to stay away from you.

What precautions should be taken during isotretinoin treatment?

  • Most important: Isotretinoin almost always 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,
      • during the duration of isotretinoin treatment, and
      • for 1 month after the treatment has been stopped/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
  • No blood to be donated during treatment with isotretinoin. This is because the donated blood may be given to a pregnant woman and cause a serious birth defect.
  • Excessive alcohol should not be consumed while on this medication. Note that isotretinoin may already compromise liver function. The insult of alcohol will make it worst. The liver is forced to work under tiring environment. It is overworked. No enjoyment or recreation while on isotretinoin.
  • Breastfeeding is not recommended while taking this medication. The drug may quietly sneak across the blood into the milk and gets into the baby.
  • Tetracycline antibiotics (such as minomycin or doxycycline) should not be taken with isotretinoin. Other medications can also interact with isotretinoin. There are just there to disturb the good guys.
  • Any other form of vitamin A supplement or medication should not be taken with isotretinoin treatment. It can cause synergistic effect and toxicity of overdose. It gang up and wronly gives an increased threat to the friendly host.
  • Isotretinoin is best avoided in children less than 10 years old. This is because its presence may stunt bone growth in the innocence growing child.

What to expect when taking isotretinoin and potential side effects

  • During the first 1 to 2 months of treatment the acne may worsen before it starts to get better. It can take some months before the acne is under control. Sometimes the initial flare-up can be severe and require additional treatment. The stubborn acne is not going to succumbs to the solder/enemy so soon (isotretinoin). It will fight with full force until defeated but before that, it create havoc first.
  • The most common side effect of this treatment is dry skin. This can occur all over the body, but particularly bad on the the lips, nose and eye region. The breathing becomes very uncomfortable with dry throat, much like on a long flight in the aircraft. The skin may appear red, scaly and irritated. It may be itchy. The isotretinoin sucks you dry, if you may say!!!
  • The skin commonly becomes more sensitive to the sun, photosensitivity, during treatment. This increases the risk of sunburn. Best stays away from field activity. Strict sun protection with clothing, hat, sunglasses and the use of a broad-spectrum sunscreen is recommended. The skin feels shy and wants to hide behind the clothing!!!
  • Skin is generally more fragile while on the treatment. The skin is delicate by now. Peeling, scaling or redness on the skin and occasionally superficial bruising may appear. These symptoms can be reduced by the following strategy:
    • Moisturising more frequently with moisturiser. Take small sip often. Stays away from dry air-conditioned room.
    • Avoiding waxing any part of the skin whilst on the treatment. The skin may tear off easily!!!
    • Avoiding any unnecessary beauty Iaser treatment, dermabrasion, chemical peels, tattoos, piercings and non-emergency surgery whilst on this treatment (unless advised by your dermatologist). Be patience and hold back in a haste to beautify yourself.

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. It can naked away your skin protective layer.
  • Gently roll and massage the skin while bathing. Do not scratch it hardly.
  • Avoid harsh liquid soaps/shower gels/detergents/masks/exfoliating agents/toners/scrubs on the skin. All these harsh element will only increase the dryness and irritate the skin further. A gentle soap-free, plain cleanser is recommended.
  • Avoid other additional 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.

Other less common side effects may include:

  • Headaches: These are rarely serious but can be related to increased intracranial pressure. This is the pressure inside the skull on the brain.
  • Changes in vision: If blurred or double vision occurs the medication should be stopped and the dermatologist contacted immediately. The problem is usually reversibly. Alternatively, starts on lower dose. Some may notice that their vision adapts more slowly to the dark.
  • Hair loss: Not a permanent issues. 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. Do not prick the nose. Steam inhalation may help a lot.
  • Tiredness, stiffness or tenderness of joints or muscles may develop after physical activity. Take more frequent short rest. Reducing or modifying physical activities may help with these symptoms.
  • Facial redness and flushing may be commonly noticed during treatment. The face looks like a shy lady blushing.
  • Paronychia (ingrown nails) may develop in toenails or fingernails.
  • Very rarely vomiting, diarrhoea and bleeding from the bowel may occur.
  • There are reports of mood change and depression in people taking isotretinoin. This is reversible. Very rarely the mood changes may be due to the medication. Despite this, it is best that any changes in mood should be reported to the treating dermatologist.

Most side effects are not severe and improve after treatment is stopped. There are easily reversible. So, don’t worry.

Other potential side effects have been reported. Please refer to the product information that is provided with the medication.