Isotretinoin combats all four major causes of severe acne vulgaris – excess oil production, clogged pores in the skin, too much of the bacteria P. acnes, and inflammation – making it more effective than other treatment options available. Isotretinoin directly targets the sebaceous gland by reducing the size by 90%, reducing the sebum excretion by 90%, decrease comedones by 50%, decrease in P acne by 80% and decrease inflammatory lesion by 90%.
The usual adult dose is 0.5 to 1 mg/kg per body weight per day (in two divided doses) for 15 to 20 weeks. The maximum recommended dose is 2 mg/kg per body weight and may be required for those with very severe cases, or primarily located on the chest or back.
AAD: Recommends Standard Dose: 0.5 to 1.0 mg/kg per body weight per day for 20 weeks. Initiated at a starting dose 0.5 mg/ kg/day for the 1st month and increased to 1.0 mg/ kg/ day thereafter as tolerated by the patient.
EDF: Recommends Standard Dose: 0.3 to 0.5 mg/kg per body weight per day for at least 24 weeks (6 months).
Isotretinoin is usually reserved for people with severe acne vulgaris but can be considered for patients with moderate cases who remain uncontrolled despite taking other treatment available, there is scarring and psychosocial impairment.
Isotretinoin should not be taken by pregnant women, and females who intend on becoming pregnant. Some of the possible birth defects include mental retardation, heart defects, undersized head, malformed ears, cleft lip, eye abnormalities, and facial deformation.
It should be avoided also by lactating mothers since it is unknown what effect the small amounts of Isotretinoin contained within the breast milk may have on a developing baby.
For those with elevated SGOT/SGPT, triglycerides, cholesterol, hyperuricemia, with diabetes, more frequent check of laboratory parameters is necessary.
Patient can expect for their acne to get worse before it gets better. “Initial breakout” happens in the 1st week up to 2 weeks mark. After the initial breakout, it should be smooth sailing. Patient will soon experience the benefits of Isotretinoin and expect guaranteed successful acne treatment.
Patient may experience some concerns while taking Isotretinoin. However, they are only temporary and will go away in a few days or weeks after treatment. Patient may experience initial breakouts for the 1st week to 2 weeks mark. Patient may experience cheilitis (scaling, redness, burning pain and other signs of inflammation of lips), epistaxis (nosebleeds), dryness of the skin, lips and eyes, decreased night vision.
Medical laboratory testing is needed prior to taking Isotretinoin. In healthy patients (normal baseline and liver function tests), repeat the laboratory monitoring after 2 months. If findings are still normal, no further testing is required. But for those with abnormal baseline and abnormal after 2 months, more frequent monitoring is required
There should be an interval of at least 8 weeks before restarting the treatment and should be resumed in accordance with the dosage guidelines
Isotretinoin should be taken with food for better absorption, to avoid nausea, stomach cramps or vomiting.
If the patient missed a dose, just advise to skip it and take the pill on the next scheduled time.
Patient should not take any Vitamin A supplement.
Patient should not do not blood during treatment and 1 month after treatment.
Women who are sexually active should consider using two forms of birth control to prevent pregnancy. For those with plans of getting pregnant, patient should wait at least 1 month after stopping Isotretinoin intake.
Recommendations suggest that Isotretinoin should not be used below 12 years old. However, there are some who are advocating the use of Isotretinoin below this age group especially if it is severe and scarring acne and already impacts the psychosocial well- being of the patient.
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