Aim: To compare the efficacy and tolerability of oral isotretinoin in daily, alternate, pulse and low-dose regimens in acne of all types and also to assess whether it can be used for mild and moderate acne also. Methods: One hundred and twenty patients with acne were randomized into four different treatment regimens each consisting of 30 patients.
Tan notes. Tan says, noting daily doses may vary from 0. It is essential that clinicians discuss with their patients that the daily dose can be adjusted, for parents of many of the adolescent patients may have negative associations with oral isotretinoin in terms of its side effect profile.
Beyond the usual concerns with use of oral isotretinoin, "parents may associate it oral isotretinoin with visible, disturbing side effects such as excessive dryness and chapping of their lips," he says.
Duration of therapy would be affected by the form of oral isotretinoin that is prescribed, Dr. In terms of duration of therapy, Dr. Tan advises that clinicians treat at least one month after patients are clear of their acne.
Low-dose isotretinoin, e. Isotretinoin is an isomer of retinoic acid that has been used for the treatment of acne for over 30 years. Treatment with isotretinoin results in decreased sebum production.
This reduces acne, prevents scarring and may lead to a better quality of life and improved mental health in some patients. Isotretinoin is highly teratogenic and is contraindicated in women if pregnancy is possible unless effective contraception is used Table 1.
Patients with elevated lipids can usually be managed with close monitoring. Advise patients to avoid donating blood during treatment and for at least one month after treatment has finished.
Table 1: Contraindications and cautions for treatment with isotretinoin. To improve absorption and reduce fluctuations in systemic availability, isotretinoin should be taken with or just after food. Low-dose regimens of isotretinoin are generally considered to be as effective as weight-based dosing regimens. A retrospective review of 1, patients treated with isotretinoin over a six-year period concluded that continuing treatment for at least two months after acne had completely resolved was more important than the dosing regimen in determining treatment success.
For additional information, see: www. Previously, treatment with isotretinoin could only be initiated by dermatologists. In , patients began treatment with isotretinoin in the community Figure 1 with approximately equal numbers of patients prescribed low-dose and weight-based treatment regimens.
In , general practitioners became able to prescribe fully subsidised isotretinoin to improve access to people living in less affluent areas. Paradoxically, flares of acne are frequently reported by patients after three to six weeks of treatment with higher doses of isotretinoin.
The frequency can then be increased to daily, if tolerated, after four weeks. Expert opinion is that flares of acne are more common in patients with a large number of macrocomedones facial closed comedones larger than 2 — 3 mm in diameter or very severe acne. To decrease flares, expert opinion is that patients with particularly inflammatory acne can be prescribed trimethoprim, mg per day, for the first six to eight weeks of treatment with isotretinoin. Patients with acne that is likely to take longer to clear should be advised of this before starting isotretinoin so that treatment is not stopped if results do not occur as quickly as the patient expects.
Experience suggests that females with acne limited to the face are likely to respond to isotretinoin treatment within three months. Males with acne on their trunk or back may take five to eight months to respond to treatment with isotretinoin. Patients with macrocomedonal acne may require as long as 12 to 18 months of treatment with low-dose isotretinoin. Additional risk factors for a slow response to treatment include: age under 14 years, age over 25 years in females, severe acne, current smoking and polycystic ovary syndrome.
Further information and images of macrocomedonal acne is available from: www. The New Zealand recommendations for isotretinoin are based on early studies. It's best to avoid alcohol while taking isotretinoin capsules, or at least keep the amount you drink to a minimum. This is because there's a risk of damage to your liver - and that your cholesterol levels will increase.
If you do drink, try not to drink more than the recommended guidelines of up to 14 units of alcohol a week. A standard glass of wine ml is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
Page last reviewed: 18 January Next review due: 18 January Isotretinoin capsules Roaccutane On this page About isotretinoin capsules Key facts Who can and can't take isotretinoin capsules Side effects How to cope with side effects How and when to take it Advice for women Cautions with other medicines Common questions.
About isotretinoin capsules Isotretinoin capsules are a very effective treatment for severe acne spots. Isotretinoin capsules are also known by the brand names Roaccutane and Rizuderm.
Isotretinoin capsules start to work after a week to 10 days. They work very well - 4 out of 5 people who use them have clear skin after 4 months. You will a have blood test before you start taking isotretinoin and regular blood tests during your treatment. Your skin may become very dry and sensitive to sunlight during treatment. Using lip balm and moisturisers will help. It's very important not to become pregnant while using isotretinoin capsules and for at least 1 month after stopping.
This is because isotretinoin can harm an unborn baby. Women will be given a reminder card about this. If you become depressed or think about harming yourself while taking isotretinoin, stop taking the medicine and tell your doctor straight away. Isotretinoin capsules aren't suitable for some people. Do not take isotretinoin capsules if you : have had an allergic reaction to isotretinoin, soya the capsules contain soya or any other medicines in the past have an inherited digestive disorder called fructose intolerance the capsules contain sorbitol To make sure isotretinoin capsules are safe for you, tell your doctor if you : have had a mental health illness like depression are pregnant or think you could be, or you're breastfeeding have ever had an allergic reaction to isotretinoin or any other medicine have liver or kidney disease have high levels of cholesterol or other fats in your blood have high levels of vitamin A have Crohn's disease or ulcerative colitis If you have diabetes , talk to your doctor before beginning treatment with isotretinoin capsules.
Common side effects The common side effects of isotretinoin capsules happen in more than 1 in 10 people. Talk to your doctor or pharmacist if these side effects bother you or don't go away: skin becoming more sensitive to sunlight dry eyes dry throat dry nose and nosebleeds headaches and general aches and pains Serious side effects Serious side effects are rare and happen in less than 1 in 1, people. Important Tell your doctor straight away if you become depressed or think about ending your life while taking isotretinoin capsules.
Serious allergic reaction In rare cases, it's possible to have a serious allergic reaction anaphylaxis to isotretinoin capsules. Information: You can report any suspected side effect to the UK safety scheme.
What to do about : dry skin or lips - apply a moisturiser and lip balm often the best type of moisturiser is an oil-free face moisturiser for sensitive skin. Try to keep your showers shorter than 2 minutes, using lukewarm water rather than hot. Do not use a sunlamp or sunbeds. If you wear contact lenses and these become uncomfortable, you might have to wear glasses instead while you're taking this medicine.
Light exercise shouldn't be a problem, but try to avoid heavy exercise as it may make joint or muscle pain worse. It's important to take the capsules as instructed by your doctor. The dose of isotretinoin capsules varies from person to person, and depends on your weight. What if I forget to take it?
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