ISOTRETINOIN (ISODERM, ATRACTIN etc)
What is isotreinoin do?
Isotretinoin is the magical thing to a cure for acne that has been
invented thus far. Isotretinoin is a vitamin A derivative that has been
found to be very effective in all types of acne ranging from mild to severe and several other skin conditions.
In most cases it will improve acne to an impressive degree, and many
adult patients are permanently cured, needing no further acne therapy.
Others will require mild topical therapy for maintenance, and a small
minority (about 7-10%) will require a second course of isotretinoin.
Very rarely a third course is needed.
Why does Isotretinoin work for acne?
seems that this medication shuts down the functioning oil gland and
loosens the plugs in the pores emptying them out during the 5 or 6
months the medication is used.
How long will I be on isotretinoin?
Length of use of medication is approximately 16-20 weeks at standard
dose. In more severe cases or at lower doses it may be used longer. The
dose is based on body weight.
Do I have to do blood tests on isotretinoin?
Yes, your dermatologist will decide about the blood tests, usually it is done after six weeks of starting of treatment.
How is isotretinoin treatment different for women?
Isotretinoin is suitable for unmarried females. Females with child bearing age should consult with dermatologist to start isotretinoinWhat Patients need to know about this drug?
- There are drug interactions with isotretinoin. Do not take this
with tetracycline, minocycline or doxycycline. Other antibiotics
are safe, as are vitamin preparations containing regular doses of
- Isotretinoin must be taken with food, preferably fatty food.
- Note that acne may worsen and sometimes fares during the second to third week on the medication.
- Wash gently with unscented mild cleansers like dove or Cetaphil or Physiogel cleanser
- Do not scrub your face. Wash gently with your hands.
What are the side effects from isotretinoin?
This medication has many side effects at higher doses, but most of
them are mild at the lower doses we now use and can be readily managed
through the period on the isotretinoin. Overall this drug is very safe
when used correctly. Dr. Abdul Hameed inform his patients all the
information regarding isotretinoin.
What are some of the common side effects with isotretinoin?
- Chapped lips- cheilitis- occurs in almost all
patients and can be quite sever at higher doses. It seems to get better
with time. Simple Vaseline Petroleum Jelly, Vaseline with sun
your choice on lips 8 to 10 times a day to prevent cracking.
- Dryness - A moisturizer like Cetaphil
Moisturizing Cream, Physiogel gel cream. Avoid all fabric softeners and dryer sheets. Sometimes
prescription medication may be needed if full blown eczema
develops. If you are still having problems, consult with Dr. Abdul Hameed
- Itching as the skin gets drier, you may feel
itching that will be improved by the use of a moisturizer. .
- Sun sensitivity- means you are more likely to
get sunburn in a short period of time. This can be very marked and it is
essential that sun avoidance, proper clothing and full spectrum
UVA/UVB sunscreens be used during sun exposure. A lotion or cream
sunscreen or block with a sun protection factor (SPF) of 50 or
greater is essential. Always wear a broad brimmed hat. Alcohol
based spray sunscreens are not recommended because they dry out the
skin even further.
- Hair Thinning this is quite uncommon, temporary, and usually reversible once isotretinoin has been discontinued.
- Dry Nose and nosebleeds- as lips dry,
nose lining can dry too. One can develop nosebleeds easily. Again,
lots of Vaseline Petroleum jelly is necessary, apply inside of the
nose with a Q-tip. Let Dr. Abdul Hameed know if you have frequent nosebleeds.
- Acne flare ups- occur usually at about weeks 2
through 3. Intra-lesional injection of cysts with a dilute cortisone
solution may be needed. Call the office if you have a significant
flare-up, Dr. Abdul Hameed will examine you and see if additional treatments
- Skin Fragility Totally avoid waxing for hair removal. Do not pick blemishes.
General Side Effects
- Headache occurs in 5% of patients.
- Anthralgia, myalgia, bone pain These joint,
muscle, bone aches and pains usually occur patients with previous
injuries or arthritis or those involved in contact sports.
Uncommonly this can occur in normally healthy people.
- Elevation in blood fats (cholesterol and triglycerides) (50%) -
Isotretinoin seems to mobilize stores of fat in susceptible
individuals so that there are mild elevations in these particular
blood lipids or fats. Usually this is of no consequence. This
lipid/triglyceride alteration is aggravated by alcohol so alcohol
consumption should be limited during isotretinoin therapy.
- Blood sugar abnormalities (rare) - Diabetics
or pre-diabetics may have difficulty with control of blood sugar.
You should report any personal or family history of diabetes.
- Hepatitis This can occur rarely from
coincidental viral hepatitis A, B, or C. Report any pale stool, dark
urine or color change of the skin to Dr. Abdul Hameed
- Miscellaneous Patients who experience hearing
impairments like ringing in ears or any changes in hearing should stop
the medication and call Dr. Abdul Hameed for assessment.
- Allergic reactions such as rashes are also rare.
This medication is absolutely forbidden for patients who are pregnant or could get pregnant.
Birth Defects There is absolutely no doubt that isotretinoin causes
major deforming birth defects, but it has an effect only on a growing
fetus. One month after the isotretinoin has been stopped; it is out of
the system and will have no effect at all on pregnancy and the
development of a baby.
Birth Control Requirement Before isotretinoin is used, female
patients must be on birth control ( usually the pill) for 1 month
before they start the medication and for the whole time they are on the
isotretinoin, and for one month after they have stopped the
isotretinoin. Two negative pregnancy tests must be obtained before
starting the isotretinoin and must be rechecked monthly while on the
medication and again 1 month later.
OUR RULES FOR FEMALES OF CHILD-BEARING POTENTIAL
- Any fetus exposed to isotretinoin can potentially have
deforming birth defects. Pregnancy is absolutely forbidden while on
isotretinoin and for 1 month after the discontinuation of isotretinoin.
You must be capable of understanding and carrying out all the
- Mandatory contraceptive measures are required. You will be
given oral and written warnings about the hazards of taking
isotretinoin and exposing a fetus to the drug.
- You must have two negative pregnancy tests prior to starting
isotretinoin, at that time any general blood work needed for taking
isotretinoin will be ordered. Only when Dr. Abdul Hameed enters your
negative pregnancy test to start isotretinoin.