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?

It 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 isotretinoin

What Patients need to know about this drug?

1. 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 vitamin A.
2. Isotretinoin must be taken with food, preferably fatty food. 
3. Note that acne may worsen and sometimes fares during the second to third week on the medication.
   
4. Wash gently with unscented mild cleansers like dove or Cetaphil or Physiogel cleanser
5. 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 block. Use 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 are necessary.
• 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 instructions.
• 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.