Acne is a such a common skin problem that sometimes it is not even considered a disease. However, some cases are very severe and may require quite aggressive treatments. That is where isotretinoin plays a major role as the true solution for acne.
Isotretinoin – known as Roaccutane® (Accutane in the USA) – is an oral therapy indicated for severer forms of acne resistant to conventional treatment, such as when large painful lesions form or there is a risk of permanent scarring. This retinoid was first synthesized in the middle of the 20th century, but was not until 1982 that it was approved by the Food and Drug Administration (FDA) for use in the USA for the treatment of acne.
How does it work?
Isotretinoin’s effectiveness is partially explained by the fact that it inhibits the activity of the sebaceous glands (which produce the oil in the skin). However, it also acts as an anti-inflammatory agent, eliminates pimples and acts on the Propionibacterium acnes bacterium associated with the development of acne.
These reasons explain high treatment success rates, with more than 75% of cases of acne entering remission over the long run. However, a certain dosage must be reached, calculated according topatients’ weight. Treatment is also usually lengthy (5 to 6 months), as otherwise the acne is likely to recur.
More than 30 years after its authorization, isotretinoin is considered to be a safe drug if admisnistration is properly supervised.However, for the public at large it continues to be a drug surrounded by myths and doubts.
The main reason its use is controlled by health authorities is because it is a teratogenic substance, meaning that it can cause serious foetal malformations in pregnant women. When prescribed to women of childbearing age, these must agree to a pregnancy prevention programme that lasts from the month before starting treatment to one month after treatment has ended. For male patients who may become fathers there is no contraindication.
The doses used to treat acne produce different side effects. The most frequent (almost 100% of cases) is dry lips. Some patients may experience nosebleeds (usually mild) and dry skin and itching. These problems can be avoided, at least partially, by adequate hydration. Athletes also frequently have aching muscle, especially in early treatment stages.
Other probelsm are that the eyes may suffer dryness – especially a problem for contact lens wearers. Rarer side effects include nausea, abdominal pain, headache and “night blindness” (a temporary problem with adapting to the dark).
Although isotretinoin does not react with the sun, it does reduce skin thickness. Since this may lead to mild sunburn, this treatment is usually avoided in the summer months.
To sum up the side effects, with the exception of dry mucous membranes and skin, they are rare and also well described, so, with appropriate supervision, they are entirely preventable or reversible once the treatment is stopped.
Always under medical supervision
This medicine is undoubtedly today’s solution for severe acne. However, treatment must always be made under the supervision of a dermatologist, who will establish dosage and guidelines that ensure the patient’s safety. Self-medication could lead to serious risks.
When taking isotretinoin, regular tests are necessary, since the drug may cause liver abnormalities and raise serum cholesterol and triglyceride counts. For this reason alcohol is contraindicated during treatment.
The dermatologist’s recommendations
- Do not self-medicate; consult a doctor before starting treatment.
- Women of childbearing age must use contraception from a month before to a month after treatment.
- Hydrate the lips frequently.
- Avoid wearing contact lenses.
- Hydrate the skin regularly (use specific products for the face).
- Avoid drinking alcohol.
- For nosebleeds, moisten the nasal mucosa with saline sprays or similar.
- Avoid exposure to the sun.
- Avoid abrasive treatments, peelings and hair removal during treatment.