What is isotretinoin and why do I need to change my skincare?
Isotretinoin (oral vitamin A) is the perfect treatment for severe acne. It works by reducing the activity of your oil glands as well as reducing the bonds between cells allowing them to separate and exfoliate more easily.
It is incredibly effective but because of it’s many side effects, it is reserved for use in;
- Severe nodulocystic acne
- Severe acne that has failed 6 to 8 weeks of oral antibiotics plus topical retinoids and benzoyl peroxide
- Severe acne scarring
- Psychological and/or physical distress as a result of acne
The side effects include;
Dryness
90% of people on Isotretinoin get dry lips and only slightly fewer experience dry skin.
Flakiness
As the bonds between dead skin cells loosens, skin can get flaky.
Redness and inflammation.
Skincare to avoid while on Isotretinoin
1. Soap:
The harsh surfactants in soaps can damage important proteins and natural oils in the skin, leading to skin tightness, dryness, skin barrier damage and irritation. Soap is alkaline (it has a pH of 9 to 10), making it potentially irritating even to normal skin, which has a more acid pH of 4.7! more so with skin on isotretinoin. Soap also alters the microbiome of the skin which can contribute to irritation redness and dryness.
2. Alpha Hydroxy acids:
AHAs including glycolic acid, lactic acid, malic acid, tartaric acid break down some of the bonds between skin cells helping older skin cells shed or exfoliate. You already have that happening from the isotretinoin so the extra exfoliation might burn.
3. Vitamin C:
It can be irritating and anecdotally can exacerbate acne…
So what skincare will help?
OK confession time!
No study has been done to look at the very best ingredients to pair with isotretinoin.
The following is based on our experience here at ESK as well as the collaborations with our many dermatologists who are ESK stockists.
Many have put together an isotretinoin skincare kit that they give to their patients based on their experience and the science behind acne and the various actives in skincare.
Here’s what we and they suggest;
1. Lip balm
Always have one in your pocket and opt for pawpaw ointment, ChapStick Ultra 30 or Blistex Ultra Protection at night
2. Zinc sunscreen
People on isotretinoin are more prone to damage caused by the sun’s UV rays. And UV damage from UVB and UVA rays causes inflammation and exacerbates skin dryness, even in skin not affected by isotretinoin. Zinc Shade is a lightweight matte day cream and primer. Its non-greasy, matte finish allows for smooth application and works well under makeup. We spent countless iterations perfecting this lightweight, non-greasy formula to avoid the typical white cast and thick feel of zinc products. The results? A matte finish that works beautifully under makeup. With well tolerated matte finish, it's also well suited to irritable and blemish and bump prone skin. With SPF 15 it also provides broad-spectrum sun protection against UVA and UVB rays. Key features: Lightweight, matte formula suitable for daily use Smooth application with minimal white cast Broad-spectrum UV protection Tested SPF 15 with enhanced UVA coverage Usage: Apply evenly to all exposed areas of skin before sun exposure. Reapply as needed throughout the day.
UV radiation is a common trigger that causes flares in any sensitive skin. Your sunscreen should be Broad spectrum- protecting you against the sun’s UVA AND UVB rays. Minimum SPF 15.
With physical sunscreens, ingredients like zinc oxide or titanium dioxide which reflect and scatter UV radiation rather than absorbing them as chemical sunscreens do. Zinc is generally considered non comedogenic.
Zinc Shade
3. Skin barrier repairing ingredients
These haven’t been specifically studied for acne but we know that the skin barrier is often disrupted during isotretinoin treatment.
This can exacerbate skin dehydration and irritation. Ingredients like Panthenol, Niacinamide, Ceramides and Hyaluronic Acid can all help mitigate moisture loss from the skin.
Repair + is a moisturiser formulated to support skin hydration and barrier function. Its combination of niacinamide, panthenol, hyaluronic acid, and ceramides is designed to help maintain skin moisture, strengthen the barrier function of the skin, reduce the appearance of redness, and support overall skin texture. Key Features:
Repair +
4. Salicylic acid
Salicylic acid is anti-inflammatory, as well as having activity against the bacteria known to cause acne. And while it helps with shedding dead skin cells especially in the follicles, most dermatologists find that it is well tolerated even by those on isotretinoin.
Hydroxy Overnight Mask
Our Hydroxy Overnight Mask is your go-to for clearer, glowing skin! With 5% salicylic acid and 10% urea, it’s a powerful yet gentle way to take on blemishes and keep skin hydrated. In oiler skin, Salicylic acid gently exfoliates for a smooth finish, while urea deeply moisturises. Use it as a spot treatment, or apply it once a week for an all-over refresh. Just cleanse, apply, and let this overnight mask work its magic while you sleep—wake up to softer, clearer, and radiant skin ready to take on the day!
Featuring;
- Gentle exfoliators for a weekly skin refresh
- Convenient size means you can keep it on hand to tackle blemishes when and wherever they happen
5. Retinal Ultimate A Night Cream contains 0.06% Retinal, the most gentle and effective form of Vitamin A, paired with Niacinamide to help maintain skin barrier function and support brighter, firmer and more even looking skin tone and texture. Well suited even for the most irritable skin. Usage: Apply at night after cleansing (and serum if being used) as part of your evening skincare routine.
This is a little more controversial and is based on ESK customer feedback after they have had a visit with their dermatologist.
Most dermatologists don’t recommend topical vitamin A when on isotretinoin.
But overwhelmingly, topical vitamin A has come to mean the prescription form or Retinol, both of which are potentially irritating and don’t add anything to isotretinoin.
Retinal however is very well tolerated and also (unlike the other forms of Vitamin A above) has antibacterial properties.
Ultimate A
Key features:
Other skin hacks
- Stick to only one warm (not hot) shower a day. Hot showers dry out your skin.
- Gently pat dry, don’t rub vigorously with a towel.