By Dr. Ginni
So someone’s mentioned Isotretinoin tablets AKA Roaccutane and you want to know whether it’s for you?
I get asked about this all the time by my patients. There is a lot of fear about this medication. Some of it for good reasons, but it’s often an amazing way to deal with acne when NOTHING ELSE works!
So let’s start at the beginning. What is Isotretinoin?
Isotretinoin is a retinoid, in other words, it is one of the forms of vitamin A. It reduces the skin’s sebum production and stops the formation of new comedones AKA pimples. It also unblocks pores and so it reduces the build-up of bacteria that contribute to the inflammation and pimples.
Taken as a tablet, it’s not for people with a couple of annoying spots. Dermatologists are under strict instructions that this drug is for those of us with severe cystic acne that hasn’t responded adequately to other treatments.
Isotretinoin won’t help existing scars and ideally you’d go on it before scarring has begun. But even if you do already have some scars, we can get you on it to prevent more happening.
Skincare with Isotretinoin
You might have been on an Acne Kit before starting isotretinoin. Once you have settled into this new medication I’d recommend switching to your kit to the Sensitive Skin kit. Along with the creamy soap free cleanser, and our zinc based sunscreen which is non occlusive and non-irritating, we also add both B Quenched with Vitamin B3 and Ultimate A with topical retinaldehyde. Both have evidence in the anti-aging space without any potential irritants from hydroxy acid or vitamin C.
How effective is it?
In a word: very. A single course of isotretinoin is found in studies to bring about a long-term remission in over 80% of patients. That’s impressive! You’ll see improvements in facial acne first, then improvements to the neck, back and finally the buttocks and thighs if you get pimples there, too.
How do you take it?
You’ll nearly always start on a low dose then slowly increase the dose over a few months as needed.
What about side effects?
Yes, they can be pretty intense.
Most are worse at higher doses and are a result of the impact on sebaceous and meibomium (that makes eyelid lubrication) glands plus the high turnover of the skin’s epidermis. The result? Very dry skin and proneness to irritation and skin sensitivity. It also leaves your mucous membranes dry and prone to irritation. Think dry eyes and nose- even nose bleeds.
How can I deal with the side effects?
Here are some tips that will really help you deal with the dryness;
- Use a good irritant free sunscreen. Zinc is non occlusive and tends not to cause irritation.
- Ensure you are using a soap free cleanser for your face.
- You can use petroleum jelly on the inside of your nose. Put it on carefully using a cotton bud.
- Moisturize your skin every day. You can also use a bath oil instead of soap.
- Get to love your lip balm. You’ll need one in every drawer and handbag!
- Eye drops and artificial tears are often essential. Again travel with them. And if you work at a screen, remember to blink!!
Can anyone take it?
No. And this is the thing you need to understand about Isotretinoin. In pregnancy, it is highly teratogenic. That means a VERY high risk of birth defects and brain damage in your baby. So your dermatologist will insist on a pregnancy test before starting it (unless you’re not sexually active) and you’ll need to be on contraception. Men can take it around conception with no risk to the baby.
The next issues are more of a warning than an absolute contraindication.
There have been case reports of insulin resistance and type 2 diabetes in people taking isotretinoin. Several hypotheses have been put forward. None are proven and given that I don’t have a PHD in biochemistry I won’t try to decode it all here. If you’re interested in the nitty gritty, this article (link to: https://care.diabetesjournals.org/content/32/8/e99) is worth a read. People with diabetes can still take isotretinoin, we just monitor your blood sugar levels while you’re on it.
In 25% of people we see an increase in your triglyceride and blood cholesterol levels. Not usually a problem unless they’re high to begin with. You’ll be checked before you start isotretinoin and during the course of the treatment.
Does Roaccutane cause depression?
I constantly see Isotretinoin blamed for suicides in teenagers. Interestingly there is no proven link between isotretinoin and depression, suicide or psychosis. In fact, the studies that have been done suggest that is anything, isotretinoin may protect against depression. Given how miserable cystic acne is, that’s hardly a surprise.
In the first 10 years after it came onto the market, several cases of a form of muscle breakdown called rhabdomyolysis were linked to isotretinoin. That led dermatologists to warn people not to exercise while taking it. These days those cases are seen as rare and people are no longer advised against exercise. We just monitor a level in your blood called CK or creatinine kinase in case you’re one of the rare special cases.
Alcohol and isotretinoin ideally don’t mix. Both can cause your liver enzymes to increase. Not a massive issue. Most dermatologists just say don’t binge!!
Finally just check in with your GP or pharmacist about any medications you can’t use with Isotretinoin.
Suggested ESK Kits:
Other articles you might be interested in:
WHY AM I BREAKING OUT?
ACNE: EFFECTIVE EVIDENCE-BASED METHODS TO TACKLE PIMPLES!
DO I HAVE ACNE OR ROSACEA?