Isotretinoin: Side Effects & Precautions

Isotretinoin is fast becoming a very popular name amongst those suffering from Acne. But is it good for your acne?  It is definitely a very rewarding medicine, but needs to be taken with extreme caution as it comes laced with its own bunch of side effects.

What is Isotrteinoin?

Isotretinoin is said to be a “wonder drug” for acne.It is a derivative of Vitamin A and acts by decreasing the production of sebum (an oily material secreted by skin glands) which is responsible for acne formation. It also increases shedding of the skin and thereby removes the built up sebum collection. Therefore, by decreasing the production and by increasing the excretion, Isotretinoin lowers the sebum level in the skin and thereby lowers acne formation. 

Does isotretinoin really work for acne?

Isotretinoin works very well to control the acne and its scars which could eventually follow. But the catch is, it is not an absolute nor a permanent cure for acne. Despite a complete course of isotretinoin for acne, many report recurrence and reappearance of acne after a gap of many months or years. But definitely the recurrences are less severe and more manageable. The chances of recurrences also largely depends on the dosage and the duration for which the medicine was prescribed for acne.

The dose of isotretinoin is determined by the dermatologist depending on the body weight. It can vary from 0.5 mg/kg to 1mg/kg depending on the severity of the acne. The treatment usually last for 16-24 weeks, again based on the severity of acne and the dose given.

Who should take Isotretinoin?

Isotretinoin, although a very effective treatment for acne, should not be used by anyone and everyone having acne. It comes with side effects and it is very carefully prescribed by specialist doctors to only those who really need this medicine. Most commonly isotretinoin is prescribed for these types of acne

Severe Acne. Acne is said to be severe if it appears as big, painful, lumps and swelling, not readily treated by commonly prescribed medicines, or those which leaves behind scars after healing. 

isotretinoin for acne

Failure of all other treatment modalities Isotretinoin capsules are not the first choice of treatment in most of the people with acne. Always other acne creams and antibiotics are tried first. Only if these fails and are not able to give satisfactory results, isotretinoin is prescribed. This is again because the other modalities of treatment have much fewer side effects compared to isotretinoin.

Severe Psychological bearing. Now, this is controversial…….. as almost all the acne patients I have met are psychologically disturbed because of their acne. It lowers ones self esteem and confidence. A good counselling and thorough knowledge about the treatment course and prognosis, usually helps in soothing them down. Only if acne is causing a lot of emotional distress or is limiting ones professional growth (like actors, air hostesses, models), isotretinoin can be considered as one of the options.  

Who should not take isotretinoin ?

Before starting isotretinoin, the dermatologist would always look into all the risks and inform about the consequences one should expect while on treatment.

Planning a baby Isotretinoin is known to cause serious birth defects in the babies, if the mother takes it during pregnancy. It is category X drug, which means that the drug is totally prohibited during the entire pregnancy. Therefore, if someone is planning a pregnancy, they should strictly not consider taking isotretinoin.   

High lipids in body Isotretinoin may cause lipid imbalance in the blood. Those having any kind of liver or kidney disease, or having a known lipid imbalance should always be precautious. These routine tests are always done before starting isotretinoin for acne, and repeated at frequent intervals.

Pre-existing mood disorders In a few, it might cause a change in mood and behaviour pattern. Any known mood disorder should always be informed to the dermatologist.

Children <12 yrs Kids younger than 12 years are not prescribed isotretinoin as it is known to hamper the bone development and prematurely stops the bone growth. I personally prescribe it only to adults more than 18 years of age.  

Side Effects

If one googles for the side effects of isotretinoin, they may find a never ending list. But most of these side effects are very rare. I am hereby mentioning few common side effects which almost anyone taking isotretinoin will experience and should be aware of.

Pregnancy and Birth Defects: It is a known teratogen (a drug which is known to cause deformities in the fetus, early abortions or even death of the baby) Therefore it is strictly prohibited for pregnant female or those planning to conceive. 

Pregnancy-Contraindication-Warning-isotretinoin-

FDA has initiated a new programe called iPLEDGE, wherein all the females starting isotretinoin are informed about this side effect and advised to take monthly pregnancy test while on treatment to avoid accidental pregnancy. All the dermatologist, as a rule, conduct  a pregnancy test before starting the treatment, in between and at the end of the treatment.

Isotretinoin have not been found to be passed on in sperms. Therefore, according to the guidelines, males planning a family might still take or continue isotretinoin. But I personally educate the males too about the use contraceptive measures and to avoid having a pregnancy if possible, just to be on the safer side. 

Dryness of Skin and Lips: Isotretinoin cause severe dryness of lips and skin. the lips appears chapped and excessively dry and might crack leading to pain. Therefore one must carry lip balm all the time and apply as much as possible.

isotretinoin dry lips

 

Though lips are most visibly affected, nose and eye can also get very dry. There might be stuffy feeling in the nose. Avoid picking the nose as it might lead to nose bleeds. The eyes might feel irritable. Avoid wearing contact lenses, if  possible, when on the treatment, as it might increase the irritation. Lubricating eye drops are advisable.

Skin might become dry and very sensitive to sun. Chances of sun burn increases many folds and also eczema outbreaks are common. 

Hair Fall: Easy breakability and increased hair fall has been seen in those on isotretinoin treatment. It is temporary and should stop once the treatment finishes. Avoid all parlor hair treatments and spa till the treatment.   

Worsening of acne: Worsening of the present acne is very common at the start of the treatment. Improvement starts setting in only after 4-6 weeks of continuous treatment. Other treatment modalities like antibiotic creams are usually added to control the initial flare

Depression and Mood changes Few studies have shown isotretinoin to cause depression and mood swings. But it is difficult to differentiate if the depression is due to the acne itself or because of the drug, as mostly only those with severe acne and those with severe psychological bearing because of acne, are put on isotretinoin.

On the contrary, many studies have proven beneficial affect of isotretinoin on the mood as it treats acne well, improves ones appearance and boosts the self confidence of the acne patients.

It is advisable for the patients or their guardians to inform the dermatologist about any mood changes or depression episodes before or during isotretinoin treatment.

Inflammatory bowel disease: Isotretinoin may start or worsen inflammatory bowel disease. some might experience abdominal cramps or blood in stools. These are rarely seen, but should always be reported to the doctor. 

Precautions to be taken if you are on isotretinoin

Do not get pregnant. As mentioned earlier, isotretinoin causes serious damages to the unborn babies. When on isotretinoin treatment, always use two methods of contraception and be doubly sure not to get pregnant till at least one month after last dose of isotretinoin.

Do not donate blood. For the same reason as above, do not donate blood till at least one month after your last dose. You never know, but your blood may be transfused to a pregnant female and it might have serious consequences.

Do not breast feed. It is still unclear whether isotretinoin can pass through breast milk. therefore, to be on a safer side avoid breast feeding when on isotrtinoin and till one month after the last dose of isotretinoin. 

Sun exposure. Avoid prolonged sun exposure and wear Broad Spectrum Sunscreens when on isotretinoin, as it increases the skin’s sensitivity towards sunlight and one might burn or tan or develop rashes  

Cosmetic treatments. Avoid undergoing any cosmetic treatments like waxing, lasers, chemical peelings or deep exfoliations as there are high chances of scarring while one is on isotretinoin. Postpone these for at last 6 months after stopping isotretinoin.

Inform Doctor about supplementary medicines.  Inform doctor about any other medicines you are taking as few medicines when taken along with isotretinoin, might lead to side effects. For e.g. Vit A supplements, or any tetracycline antibiotics, or antiepileptics (seizure medicines)

Night Driving. Isotretinoin might temporarily affect night vision, only rarely can this be a pemanent side effects. Driving at night should therefore be avoided as much as possible. 

Because of the same reason, the pilots are not allowed to take isotretinoin or they can join duties only after completion of the entire course of isotretinoin and after clearance form their doctor regarding their visual acuity. 

Why is isotretinoin not improving your acne

Other causes of acne not ruled out: Hormonal imbalances are a very common cause of acne, especially in females. Polycystic ovarian syndrome (PCOS) and Cushing’s Disease are known causes of acne. Also few medicines like lithium, Steroids and phenytoin can lead to acne eruptions. These acne, which are due to secondary causes, would not respond to isotretinoin.   

Infection Many a times, acne can be co infected with bacteria. Till these infection s are not properly taken care of, by antibiotics, isotretinoin will fail to show improvement.

Low dose Low dose or treatment given for shorter duration, might lead to recurrence in the acne. As per the guidelines one must take a total dose of 120mg/kg of their body weight. Recent studies show that this dose can be lowered if the acne is less severe and if the treatment is given more like a prophylaxis than like a solo treatment.

Like most of the medicines, Isotretinoin has its own goodness and side effects. But if given under proper guidance, it is the most useful and powerful treatment for acne. I would like you to share your experience with isotretinoin (if any) and am also most willing to resolve your doubts about isotretinoin. Write to me. 

 

 

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