Acne is a common skin condition that affects millions of people worldwide. It can cause physical and emotional distress, leading to scarring and a negative impact on self-esteem. Fortunately, isotretinoin is an effective treatment option for severe acne that has not responded to other therapies.
Isotretinoin is a synthetic retinoid that reduces sebum production, inhibits the growth of acne-causing bacteria, and prevents the formation of new acne lesions. It is indicated for the treatment of severe nodular acne that has not responded to other therapies, including topical and oral antibiotics. Isotretinoin is also effective in preventing scarring and improving the appearance of existing scars.
Prescribing isotretinoin requires careful consideration of the patient’s medical history, including any previous treatments for acne, current medications, and underlying medical conditions. Isotretinoin is contraindicated in pregnant women due to the risk of severe birth defects. Female patients of childbearing potential must use two forms of contraception during treatment and for one month after treatment has ended. Male patients should also use contraception during treatment if their partner is of childbearing potential.
Isotretinoin is also contraindicated in patients with a history of hypersensitivity to retinoids, severe hepatic impairment, or hyperlipidemia. 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.
The approved dose of isotretinoin is calculated according to the patient’s weight, i.e., 500 micrograms per kg, daily (in one to two divided doses) for two to four weeks, increased if necessary to 1 mg per kg, daily, for 16 – 24 weeks; maximum cumulative dose 150 mg per kg, per course. Prescribe low-dose isotretinoin to most patients with acne. The use of low-dose isotretinoin has been shown to be effective in most patients with acne, with fewer side effects than higher doses.
Treatment with isotretinoin should continue for at least three to four months after acne has cleared to reduce the risk of relapse. The time for acne clearance to occur is variable, and some patients require a longer period of treatment. If a relapse occurs, treatment can be repeated if at least eight weeks have passed since the previous course.
Isotretinoin is generally well-tolerated, but it can cause side effects, including dry skin, lips, and eyes, nosebleeds, joint pain, and muscle aches. Patients may also experience an initial worsening of acne before improvement occurs. Rare but serious side effects include depression, suicidal ideation, and inflammatory bowel disease. Patients should be monitored closely for these side effects and advised to seek medical attention if they occur.
Prescribers should also be aware of the potential for drug interactions with isotretinoin. Isotretinoin can increase the risk of hepatotoxicity when used with other drugs that are metabolized by the liver, such as tetracyclines and erythromycin. Isotretinoin can also interact with oral contraceptives, reducing their effectiveness. Prescribers should review the patient’s medication list carefully and adjust the treatment plan as necessary.
isotretinoin is a highly effective treatment for severe acne that has not responded to other therapies. Prescribers should carefully consider the patient’s medical history, including any underlying medical conditions and current medications, before prescribing isotretinoin. Female patients of childbearing potential must use two forms of contraception during treatment and for one month after treatment has ended. Treatment with isotretinoin should continue for at least three to four months after acne has cleared to reduce the risk of relapse. Prescribers should monitor patients closely for side effects and drug interactions and adjust the treatment plan as necessary. With careful prescribing and monitoring, isotretinoin can provide significant benefits for patients with severe acne.