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July 31, 2019
Oral isotretinoin (originally marketed as Accutane) is the most powerful and effective medication for severe nodular acne. While many people might believe they need to see a dermatologist for such a treatment, the clinicians at Treasure Valley Family Medicine are experienced in treating all forms of acne, including those severe or resistant cases requiring isotretinoin.
Isotretinoin is a natural derivative of Vitamin A and can actually be found in the blood stream of healthy people. Given in high doses, both Vitamin A and isotretinoin have similar risks and side effects. It is important that those patients taking isotretinoin not take a Vitamin A supplement! One of the ways isotretinoin works is to reduce oil production.
Isotretinoin is not a first line treatment due to cost, side effects, and the potential to cause serious birth defects. While every patient is unique, we do not generally consider isotretinoin until a patient has failed to improve on 3 months of oral antibiotics combined with topical treatments. Nothing else compares to it in efficacy, however, as 85% of patients who take their prescribed dose are virtually free of new acne lesions after 4-5 months. Of note, it is normal that acne looks worse after the first 4-6 weeks of therapy.
Every patient considering isotretinoin must register with iPLEDGE, a program dedicated to preventing pregnancies that could be adversely affected by isotretinoin use. iPLEDGE requires that females of reproductive age have monthly pregnancy tests and use 2 forms of birth control. There is a waiting period of 30 days following the initial pregnancy test before a confirmatory test can be repeated and isotretinoin prescribed.
After every visit, patients must log into their online iPLEDGE account to review safety information. Women then have 7 days to pick up their prescription from an iPLEDGE-certified pharmacy while men have a 30 day window. Isotretinoin can only be prescribed for 30 days at a time and monthly visits are required for the 5-6 month course of treatment. Baseline liver function and lipids are screened and monitored throughout treatment as transient elevations are common.
The most common side effect of isotretinoin is skin and lip dryness. Dry lips are actually a good indicator of adequate absorption! This side effect can be managed by limiting sun exposure and vigorous activity, staying hydrated, and by using a thick protective ointment on the lips such as Vaseline or Aquaphor.
Other common side effects include:
Depression and thoughts of suicide occur in less than 1% of patients. However, in an abundance of caution, if a patient has uncontrolled depression or anxiety, has recently been hospitalized for behavioral health, or has attempted to harm themselves previously, isotretinoin may not be appropriate. TVFM clinicians have many alternatives at their disposal for such patients. For more information, please read the patient information section of iPLEDGE at: Oral isotretinoin (originally marketed as Accutane) is the most powerful and effective medication for severe nodular acne. While many people might believe they need to see a dermatologist for such a treatment, the clinicians at Treasure Valley Family Medicine are experienced in treating all forms of acne, including those severe or resistant cases requiring isotretinoin.
Isotretinoin is a natural derivative of Vitamin A and can actually be found in the blood stream of healthy people. Given in high doses, both Vitamin A and isotretinoin have similar risks and side effects. It is important that those patients taking isotretinoin not take a Vitamin A supplement! One of the ways isotretinoin works is to reduce oil production.
Isotretinoin is not a first line treatment due to cost, side effects, and the potential to cause serious birth defects. While every patient is unique, we do not generally consider isotretinoin until a patient has failed to improve on 3 months of oral antibiotics combined with topical treatments. Nothing else compares to it in efficacy, however, as 85% of patients who take their prescribed dose are virtually free of new acne lesions after 4-5 months. Of note, it is normal that acne looks worse after the first 4-6 weeks of therapy.
Every patient considering isotretinoin must register with iPLEDGE, a program dedicated to preventing pregnancies that could be adversely affected by isotretinoin use. iPLEDGE requires that females of reproductive age have monthly pregnancy tests and use 2 forms of birth control. There is a waiting period of 30 days following the initial pregnancy test before a confirmatory test can be repeated and isotretinoin prescribed.
After every visit, patients must log into their online iPLEDGE account to review safety information. Women then have 7 days to pick up their prescription from an iPLEDGE-certified pharmacy while men have a 30 day window. Isotretinoin can only be prescribed for 30 days at a time and monthly visits are required for the 5-6 month course of treatment. Baseline liver function and lipids are screened and monitored throughout treatment as transient elevations are common.
The most common side effect of isotretinoin is skin and lip dryness. Dry lips are actually a good indicator of adequate absorption! This side effect can be managed by limiting sun exposure and vigorous activity, staying hydrated, and by using a thick protective ointment on the lips such as Vaseline or Aquaphor.
Other common side effects include:
Depression and thoughts of suicide occur in less than 1% of patients. However, in an abundance of caution, if a patient has uncontrolled depression or anxiety, has recently been hospitalized for behavioral health, or has attempted to harm themselves previously, isotretinoin may not be appropriate. TVFM clinicians have many alternatives at their disposal for such patients. For more information, please read the patient information section of iPLEDGE.