Isotretinoin is a powerful medication used mainly to treat severe acne, especially certain types that cause aggravated suffering. While it can be highly effective, you’d be well advised to use extreme caution. Be especially aware of possible side effects. Although well qualified and experienced dermatologists exercise due care, no medication, least of all isotretinoin, should be taken for granted. This article aims to familiarise you with this potent medication, how it works, and what you should be watchful for.

What conditions call for isotretinoin?

Severe acne can cause deep, painful cysts and nodules which leave behind scars. Isotretinoin is a prescription medicine invaluable for such conditions. It was first approved by the US Food and Drug Administration (FDA) in 1982 for the treatment of severe nodulocystic, fulminant or recalcitrant acne. A derivative of retinol or vitamin A, it can be taken orally or applied topically for optimal results.

How does isotretinoin work? Let’s start at the very beginning – of acne.

Isotretinoin works at clearing acne by working on skin oiliness, blocked ducts, bacteria build-up and skin inflammation in a multi-pronged manner.

Oil glands, located at the base of hair follicles, produce sebum, an oily liquid. This sebum carries dead skin cells produced in the lining of the follicle through the canals created by the hair follicles, to the pores on the surface of the skin.

Excessive production of sebum can clog pores, which in turn, blocks any more sebum from being pumped out onto the surface of the skin. Called ductal hypercornification, this causes the oil to accumulate below the skin, as a result of which blackheads and whiteheads form. All of this creates a fertile ground for bacteria that feed on this oil, to multiply. This triggers the immune system to cause inflammation on the surface of skin. Which is acne.

Isotretinoin Action Step 1: Control and Clear

Isotretinoin starts by shrinking the oil glands by a third to more than half. It then reduces sebum production by up to 80%.

It is the most comedolytic of all acne agents, reducing the excessive production of skin cells in the lining of the follicle and sloughs off dead skin cells, to keep pores from getting clogged.

Further, it lowers the acne-causing bacteria, P. acnes and effectively reduces the entire flora of bacteria that feed on the sebum towards the base of the hair follicle.

Isotretinoin also reduces the inflammation that is provoked when the pore is blocked with dead skin cells, bacteria and sebum. As a result, it reduces the blemishes that acne leaves behind.

Isotretinoin Action Step 2: Refresh and Rebuild

By sloughing off the uppermost layer of skin when applied topically, isotretinoin exfoliates the old surface to reveal the fresh, smooth skin below.

Early and elementary anti-scar action now begins. Isotretinoin accelerates collagen density which, in turn, increases both the distribution and the thickness of elastic fibres in the skin to make it appear more smooth, supple and taut.

Isotretinoin does more to restore.

Although it is primarily a treatment for acne, it has several other benefits. It helps reduce the appearance of wrinkles and shrinks open pores, improves skin thickness and elasticity, and, lightens hyperpigmented areas and evens skin tone.

How much is just right?

To achieve a clear, acne-free skin the treatment may take 6-8 months. Prescribed in a dosage of 0.5-1.0 mg per kilogram of body weight, it is divided into two doses, and is better absorbed after meals – 40% absorption as against 20% on an empty stomach. The medication is continued until 120 mg per kilogram of weight has been cumulatively consumed.

With isotretinoin, side-effects are central to your decision

This is important. Side effects are a major factor to be considered and cautioned against before opting for isotretinoin as a line of treatment. Being a systemic medication, its effects are far-reaching – impacting the entire body. Moreover, these side effects occur in almost every individual who takes this treatment. Although these could be moderate and reversible, they have often been severe or long term.

The list is long and may alarm you, but it is important that you are aware of what Isotretinoin treatment can entail.

  • Hair loss, headaches, reduced blood flow to the brain, neurological symptoms, and depression
  • Vision problems, yellowish deposits on eyelids, hearing impairment, nosebleed
  • Facial hair overgrowth, inflammation or dryness of the lips, bleeding and inflammation of the gums, dry mouth
  • Skin problems such as hives rash (including eczema), hives, increased vulnerability to sunburn, oozing or bleeding skin
  • Nail abnormalities
  • Muscle tissue breakdown
  • Bone overgrowth, calcification of bones, tendons and ligaments; joint pain, arthritis, tendonitis, lower back pain
  • Respiratory symptoms
  • Blood disorders such as low iron content, low platelet and white blood cell count
  • Abnormal menses
  • Inflamed pancreas, elevated liver enzymes, inflammatory bowel disease or ulcerative colitis

Caution: Isotretinoin and pregnancy do not mix.

Make that extreme caution. Volumes of clinical evidence point to the damaging effects of isotretinoin on the foetus. Women of childbearing age are advised to ensure that they test negative for pregnancy before, during and 30 days after the period of treatment.

Safe is beautiful.

Clearly Isotretinoin should only be consumed under the supervision of a qualified physician who can closely monitor the effects through this treatment. That said, it is generally advisable to explore other lines of treatment that are kinder to your body. Although severe acne can drive a sufferer to despair, responsible dermatologists would urge you to opt for safer, gentler approaches such as Salicylic Peels and Blue Light. Trust their expertise as they combine newer, more effective techniques and technologies to free you of acne.

– By Kaya’s Expert Dermatologists


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