You will know that different dosage capsules are available on the market, and your dermatologist will have suggested that you start with a specific dosage. Why that one and not a higher one? Why not a lower one?

What dose of isotretinoin is available?

In the pharmacy you can find doses of isotretinoin from 5mg to 40mg.

How is the appropriate dose calculated?

The dose taken by each person is always individualized according to his or her case. We usually do this based on the characteristics of the acne, the patient’s weight and preferences.

Traditionally, calculations have been based on reaching a cumulative dose of about 120-150mg/kg, which was considered the dose at which the treatment is effective (and in many cases, definitive).

To achieve this total dose, more can be taken each day (higher doses), which will bring the treatment to an end sooner, or less (lower doses), which will extend the treatment over a longer period of time.

The American Academy of Dermatology continues to recommend this total cumulative dose pattern. However, many authors question whether this should be achieved in every case. It seems that the duration of treatment or total cumulative dose that we need to achieve is related to the severity of the acne condition and the same value cannot be established for all people.

This means that the dose we use for each patient should be specifically designed for them, according to the characteristics of their acne and their preferences.

What about adverse effects?

We know that the adverse effects of isotretinoin are proportional to the dose taken. In other words, the higher the dose, the greater the dryness and fragility of the skin, for example.

You can read more about the adverse effects of isotretinoin here.

In this context, the occurrence of a possible worsening in the first weeks of treatment is of particular importance. The higher the dose, the more likely it is to occur. So it seems sensible (and we do it) to start treatment with low doses to minimise the likelihood of this happening.

How long should treatment be continued?

Traditionally, the duration of treatment has been dependent on completing the total cumulative dose I mentioned. This may make some sense in very severe cases of acne.

However, in mild or moderate cases, it is more controversial. The total cumulative dose of 120-150mg/kg can be used as a reference, or the duration of treatment can be determined according to the response. What does seem clear, however, is that even if we see a very clear improvement, it is advisable to continue the treatment for a few more months to consolidate the effect.

What does it take to get rid of acne for good?

Isotretinoin is known to clear up acne for good in up to 80-90% of cases, but this is not always the case; some people’s acne comes back for some time after stopping treatment.

We do not know exactly what causes acne. But we do know a few things:

• the use of low doses does not make the treatment less effective, but it does minimise its side effects.
• there are some factors that make the recurrence of acne more likely and we should be aware of these factors.
  • Being a child
  • Being under 14 years old
  • Being a woman over the age of 25: In adult women, acne has an important hormonal component and therefore the response to isotretinoin may not be optimal if not accompanied by anti-androgen treatment.
  • have polycystic ovary syndrome
  • Have stopped treatment before acne has cleared completely
  • Severe or extensive acne on the trunk

In conclusion…

Isotretinoin (Dercutane) is a safe and effective treatment for acne. Low doses allow for greater convenience and fewer side effects.

The specific circumstances and characteristics of your acne will require your dermatologist to determine the specific dose and duration for your case. This decision will also be influenced by your preferences.

The post What dose of isotretinoin is best? first appeared on Dra. LOREA BAGAZGOITIA.

In this article, I discuss the most common side effects of isotretinoin, as well as when they occur and what precautions to take in each case. Remember, however, that if you have any concerns, it is best to discuss them with your doctor (whether a dermatologist in person or an online dermatologist) before starting treatment.

 DRY LIPS DUE TO ISOTRETINOIN

This is undoubtedly the most common side effect, as it occurs in all people taking isotretinoin. It has been observed to begin as early as the first two weeks of treatment. It is important to be aware of this and to use petroleum jelly or lip balm from the beginning of treatment.

DRY SKIN DUE TO ISOTRETINOIN

Isotretinoin, which is used to treat acne, reduces the production of sebum in the skin. It is therefore normal to feel that your skin is drier than usual, and you may even develop eczema. This is much more noticeable in people with atopic dermatitis. In any case, with or without dermatitis, it is essential to use moisturizers daily to avoid itching or the appearance of eczema patches that can result from treatment. A recent study has shown that it is common to notice skin dryness on the face around the third week of treatment and on the body around the fourth week.

After the 3rd week of treatment, the skin begins to feel dry.

Just as the skin dries out, so do the mucous membranes, which can occasionally lead to nosebleeds (epistaxis). This is one of the most common adverse effects; as long as it is not excessively frequent or bothersome, it is not usually necessary to stop treatment for this reason. If you get nosebleeds very frequently, I advise you to discuss this with your dermatologist as a dose reduction could help to improve this discomfort.

Isotretinoin speeds up the rate at which the skin regenerates; this causes the skin to be thinner and more delicate during treatment. This sensitivity makes sunburn more likely than normal. Therefore, it is necessary to use sunscreen daily, even on cloudy days.

To avoid sunburn, sunscreen should be used on a daily basis.

The fragility of the skin is also evident when using wax, so this method of hair removal is not recommended. You can use a razor, laser, or cream.

It is estimated that this increased skin sensitivity begins to be noticeable before the fourth week of treatment.

DRY EYE DUE TO ISOTRETINOIN

Isotretinoin also affects certain glands that lubricate the eye, so dry eyes may be experienced in the first few weeks. For this reason, the use of contact lenses is not recommended, especially at high doses. Artificial tears may help prevent dry eye discomfort.

Isotretinoin may cause dry eyes. This may be relieved with artificial tears or by reducing the dose.

Treatment may cause difficulty seeing at night. This is called nyctalopia and is reversible, i.e. it will go away when the treatment is finished. Most people do not notice this, but it is important to be aware of it in professions such as pilots or drivers, as it can make it difficult to do your job at night.

MUSCLE DISCOMFORT FROM ISOTRETINOIN

It is normal to feel discomfort in the lower back, ribs, or muscle fatigue, which may occur during the fourth or fifth week of treatment. In cases where the discomfort is severe, your dermatologist may reduce the dose of isotretinoin or prescribe an anti-inflammatory treatment to control it until your acne is completely treated.

It is normal to experience some muscle or joint discomfort during treatment with isotretinoin.

CHANGES IN ANALYTICAL RESULTS DUE TO ISOTRETINOIN

We order this analysis to look for changes in transaminases (which indicate how the liver is working), cholesterol, and triglycerides. However, it is rare to find changes in these values, and unless there is a very large change in the results, we usually do not stop the treatment, knowing that the values normalize in all cases at the end of the treatment.

DEPRESSION AND ISOTRETINOIN

Although it appears on the label and is always talked about, it is still unclear whether there is a causal relationship between taking isotretinoin and depression. No study has shown that isotretinoin causes depression. In fact, there are studies that indicate that isotretinoin improves personal satisfaction in those who take it.

Isotretinoin has not been shown to cause depression. However, it is prudent to monitor for any noticeable changes in mood during treatment.

In any case, although it has not been proven whether or not there is a direct relationship, and knowing that it is unlikely to occur, it seems prudent to be aware of whether there is a clear change in mood in someone being treated with isotretinoin and, if so, to discuss it with the dermatologist.

Here is a specific post about isotretinoin and depression (in Spanish).

IN CONCLUSION…

Isotretinoin is the most effective treatment for acne. It is a safe drug, but it is not without risks and side effects. Most of them are controllable and in all cases reversible at the end of treatment. It is important to be aware of them in order to make the treatment as tolerable as possible.

Do you have side effects related to your isotretinoin treatment?

The post Most common side effects of isotretinoin (“accutane”) for the treatment of acne first appeared on Dra. LOREA BAGAZGOITIA.