Isotretinoin

Isotretinoin is an oral retinoid prescribed for certain types of acne, particularly severe, persistent or acne that has not responded adequately to other treatments. It is a vitamin-A-derived drug that works on several of the processes involved in acne.

Dermatologists may consider it when acne is deep, painful, causing scarring, or significantly affecting someone's quality of life. The dose, duration and monitoring need to be decided by your dermatologist.

Acne is not caused by just one thing. Excess oil, clogged pores, changes involving C. acnes and inflammation all contribute to acne. Isotretinoin works on several of these pathways.

It can:

• Reduce sebum (oil) production
• Reduce the activity and size of the sebaceous glands
• Help prevent pores from becoming blocked
• Reduce the environment that supports C. acnes
• Have anti-inflammatory effects

This is one of the reasons isotretinoin can be so effective for severe acne.

Isotretinoin is not necessary for everyone with acne.

A dermatologist may consider it when someone has:

• Severe inflammatory acne
• Deep nodules or cysts
• Acne that is leaving scars
• Persistent acne despite appropriate treatment
• Acne that has not responded adequately to other treatments
• Acne that is having a significant impact on quality of life

The decision is individual. Your dermatologist will consider your acne severity, previous treatments, medical history and potential risks before prescribing it.

There is no single treatment duration that works for everyone. A typical course is often around 4–6 months, but it can be shorter or longer depending on the individual response and the treatment plan. Your dermatologist may adjust the dose during treatment depending on how your acne responds and how well you tolerate the medicine.

It is therefore important not to compare your dose or treatment duration with someone else's.

Some people may notice their acne temporarily becomes worse after starting treatment, this is called as purging. This does not necessarily mean the medicine is not working.

The American Academy of Dermatology notes that acne can temporarily worsen during the first 1–2 months in some patients. If this happens, let your dermatologist know rather than stopping the medicine yourself.

The most common side effects are related to dryness.

You may experience:

• Dry or cracked lips
• Dry skin
• Dry nose
• Dry eyes
• Increased skin sensitivity
• Sun sensitivity

The good news is that many of these effects can be managed with the right skincare and by adjusting treatment when necessary.

Your skincare routine should generally become simpler and gentler.

Consider:

Morning: Gentle cleanser → moisturiser → broad-spectrum sunscreen

Night: Gentle cleanser → moisturiser

For dry lips, use a suitable lip balm or occlusive moisturising product regularly. Avoid adding multiple strong exfoliating or irritating products without discussing them with your dermatologist. Your skin may be more sensitive while taking isotretinoin.

This depends on your individual treatment plan.

Ingredients such as strong exfoliating acids, scrubs and other potentially irritating acne treatments may increase dryness and irritation when combined with isotretinoin.

Your dermatologist may decide which topical products should be continued, reduced or temporarily stopped.

More active ingredients do not necessarily mean better results. During isotretinoin treatment, protecting your skin barrier is important.

No. Isotretinoin must not be taken during pregnancy. It can cause serious birth defects and pregnancy loss. Because of this significant risk, strict pregnancy-prevention measures and pregnancy testing are required for people who can become pregnant.

If you are pregnant, planning pregnancy or think you may be pregnant, contact your doctor before treatment is advised. Breastfeeding should also be discussed with your doctor before treatment.

Your dermatologist may recommend blood tests to monitor things such as liver function and blood lipid levels.

The exact monitoring schedule is individualised rather than being identical for every patient. Your medical history, dose and other risk factors can influence what monitoring is appropriate.

It can lead to long-lasting clearance of acne, and some people remain clear after one course. However, acne can return in some patients and some may require further treatment.

So it is better to think of isotretinoin as a treatment that can produce prolonged remission rather than promising that acne can never come back.

Diet does not replace isotretinoin or other medical acne treatment.

However, maintaining a balanced diet is important during treatment. Focus on adequate protein, vegetables, fruits, whole grains, healthy fats and sufficient fluids rather than following restrictive "acne diets".

Also, tell your dermatologist about any vitamins or supplements you are taking. In particular, do not start vitamin A supplements while taking isotretinoin unless specifically advised by your doctor, because isotretinoin is related to vitamin A and combining them can increase the risk of toxicity.

Think of isotretinoin as a treatment that needs medical supervision, patience and good skin care.

Remember to:

• Take it exactly as prescribed.
• Attend your follow-up appointments.
• Complete any recommended blood tests.
• Use a gentle cleanser and moisturiser
• Keep your lips moisturised.
• Use sunscreen and protect your skin from excessive sun exposure.
• Avoid waxing during treatment.
• Tell your dermatologist about any new or concerning symptoms.
• Avoid pregnancy during treatment and follow your doctor's pregnancy-prevention advice.