Isotretinoin

Uses

Isotretinoin is a drug derived from vitamin A used to treat severe or scarring acne

Isotretinoin is a very effective treatment for acne (acne vulgaris), but because of the expense and potential for side effects, it is usually considered mainly when other forms of treatment have not been successful. It can also be used for other skin conditions, including hidradenitis suppurativa, severe pustular rosacea, and some ichthyotic disorders.

Dosing

Isotretinoin comes as a capsule to take by mouth. Isotretinoin is usually taken twice a day with meals, and should be taken with a full glass of liquid. You will probably start on a lower dosage and your doctor may increase it after he determines how you react to it and what side effects occur.

Side Effects

The most critical issue with isotretinoin is its severe teratogenicity. The presence of systemic retinoids during pregnancy is will cause severe birth defects in virtually 100% of cases. Complete pregnancy prevention using two forms of birth control is required for any female of childbearing potential along with registration with iPledge, which is an online registry designed to monitor and prevent pregancies occuring during isotretinoin use.

Minor side effects are common. Severe side effects occur rarely but can be serious.

Common side effects may include dryness of skin and chelitis, skin fragility, flushing, nose bleeds, dry eyes, hair loss, eye irritation, conjunctivitis, reduced tolerance to contact lenses, hyperlipidemia, elevated liver enzymes, headaches, arthralgia, back pain.

Rare but definite associations with isotretinoin use include pancreatitis and pseudotumor cerebri.

Isotretinoin has also been associated with other conditions via anecdotal reports or a few cases but consensus regarding its role in these conditions is absent. These issues include inflammatory bowel disease, premature epiphyseal closure, psychosis, anxiety, and depression, including suicidal behavior.

Notes of Precaution

Because side effects are common and can be serious, this drug should only be used by providers experienced with its issues.

Most patients are advised to have blood tests monthly during isotretinoin treatment.

Notify your doctor if you are allergic to isotretinoin, any other medications, parabens, or any of the ingredients in isotretinoin capsule.

Notify your doctor if you or anyone in your family has a history of suicidal thoughts or depression, mental illness, or inflammatory bowel disease.

Avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen as Isotretinoin may make your skin sensitive to sunlight.

Be aware that Isotretinoin can cause changes in your thoughts, behavior, or mental health.

Isotretinoin may cause eye dryness, making wearing contact lenses uncomfortable both during and after treatment.

Isotretinoin may also impair night vision.

Avoid hair removal by waxing, laser skin treatments, and dermabrasion during treatment and up to six months afterward.

*Isotretinoin should be stored at room temperature and be kept out of the reach of children.