Acne is one of the most common skin problems for many individuals. It develops when pores become clogged with excess sebum. It also happens when the epidermis, or outermost layer of the skin, undergoes hyperkeratinization or thickening. This leads to the blockage of the sebaceous gland, causing the sebum to get trapped in the pores. Oftentimes, acne occurs on the face, but it can also appear in other areas like the neck, chest, shoulders, and upper back.
For many people, especially teenagers who get acne early in their puberty, acne will go away on its own, although some may experience it up until adulthood. Acne can range from very mild—only having a few zits once a month—to very severe and even requiring medical intervention. The market is full of cosmetic products targeting this problem. Brands have entire lines of skin care products dedicated to getting rid of acne.
These products work for the majority of people, although sometimes you need a little bit of patience to figure out which regimen works best for you. Unfortunately, some people see no results even after attempts at using these beauty products. They may opt to get facial treatments and medical consultations based on the severity of the case. In some situations, acne may still be present even after using other medicines to treat it—this is where isotretinoin comes into view.
Isotretinoin for acne
Isotretinoin is a drug classified under "retinoids." It is a medication used for treating severe acne and is also clinically prescribed if an acne situation has not responded to other treatments. Although isotretinoin is highly effective, its side effects can be harsh. Thus, it is advisable to consult a dermatologist to know the risks and effects and be properly guided on how to take isotretinoin for acne.
Isotretinoin’s reputation as a reliable method of treating acne comes with a warning of significant adverse effects, although some are known to appear in rare cases only. Its efficacy is attributed to its ability to affect the stages of acne development. It effectively reduces sebum production by up to 90% after 6 weeks of continued use, suppresses the rapid increase of C. acnes, normalizes the rate of skin cell hyperkeratinization, and is also known for its anti-inflammatory effects. While isotretinoin can be effective, desired results may not be achieved, which can lead to other problems, especially if you do not have a sufficient understanding of how to take isotretinoin for acne.
Taking isotretinoin the proper way
It is important that this medication be prescribed by a doctor or dermatologist before being used for treatment. Your dermatologist will explain to you the proper way on how to take isotretinoin for acne and will also provide you with the necessary information. Treatment should be done under the close supervision of your dermatologist so that you can report any adverse effects and they can properly modify the treatment if necessary.
Isotretinoin is advisable to be swallowed whole. It should not be chewed, crushed, or cut in half if in the form of a tablet. If in the form of a softgel capsule, it should not be punctured or have the contents removed from inside the capsule. Some brands also advise taking the drug with meals, while others say it can be taken without. Swallow the drug with a full glass of water or 8 ounces of water. To lessen the chances of side effects, follow your doctor’s advice.
Due to its severe side effects on pregnant and lactating women, isotretinoin is highly regulated, especially abroad. In the Philippines, it is a prescription medication, meaning you can only buy it if you have a prescription from a licensed doctor. One popular brand of isotretinoin in the Philippines is Acnetrex, which is available in 10 mg or 20 mg. It is FDA-approved and available in major pharmacies in the country.
The dosage will vary from one patient to another. A patient’s body weight will be taken into consideration, and the strength of the medication will also determine the number of capsules to take daily. The length of time spent using the drug is determined by the severity of the situation.
For adults and children, the dose is based on body weight. The usual starting dose is 0.5 mg per kilogram of body weight per day for 15 to 20 weeks. The drug is usually taken twice a day. If, in any case, a dose is missed, skip the missed dose and take the next dose in the regular dosing schedule. It is not advisable to take an extra capsule to make up for a missed dose.
Changes to the dosage may be determined by a doctor if the acne is not positively responding to the current medication or if side effects are present.
Isotretinoin, like all other medicines, may impose a risk of developing side effects for some patients. These side effects range from moderate to serious, and it is also important to talk with your doctor about managing them or even stopping the medication entirely.
Common side effects
Taking isotretinoin for acne may cause dry skin, eyes, nose, and lips. Doctors may suggest the use of moisturizers, eye drops, and lip balm. In some cases, side effects may also appear as a skin rash or mild itching on the skin. Within the duration of taking isotretinoin, avoid using exfoliating products or cosmetic treatments, like waxing, hair removal, dermabrasion, or laser treatments. You may also notice your skin becoming more sensitive to the sunlight. As much as possible, stay under shade and use sun creams with high SPF contents.
Other possible side effects include a sore throat and a dry mouth. For adults, it is advisable to drink plenty of water and eat soft foods when experiencing such symptoms. It is also advised to stay out of smoky places and avoid smoking. Painkillers, medicated lozenges, or anesthetic sprays may also be advised to soothe the pain caused by a sore throat. It is also common to experience headaches when taking isotretinoin, so speak to your doctor about taking painkillers and drinking plenty of fluids.
In addition to the list of side effects, patients may also experience back, muscle, and joint pains. It is best to speak with a doctor to relieve these symptoms.
Serious side effects
Experiencing serious side effects from taking isotretinoin can be caused by improper use of the drug, so before anything else, ensure that you have a full understanding of how to take isotretinoin for acne. Immediately stop taking the drug and call a doctor if a more serious side effect presents itself.
Cheilitis or inflammation of the lips, is the most common side effect of isotretinoin. Its incidence rate is as high as 90 to 98%.
Teratogenicity is the most serious potential side effect. Fifty percent of pregnancies spontaneously abort, and of the remainder, about half of the infants are born with cardiovascular or skeletal deformities in such cases. This is why women who are in their reproductive years are sometimes prescribed contraceptive pills along with isotretinoin to avoid any possibility of pregnancy while on treatment.
Neutropenia and agranulocytosis, or the significant decrease in white blood cells, are also reported, although rare.
Stevens-Johnson syndrome is also reported; you should talk with your doctor if any skin reaction occurs while using isotretinoin.
Acute pancreatitis, hepatitis, and increased triglycerides are also reported; thus, monitoring lab values prior to and during therapy is advised.
Hearing impairment is also reported, with symptoms persisting even after discontinuing therapy.
Decreased night vision and changes in eyesight
Depression and psychosis are also reported but are rare.
Blood in the stool can be an indication of gastrointestinal bleeding.
Yellowish sclera (the white of the eyes) or yellowish skin may be signs of liver problems.
Difficulty peeing can be an indication of kidney problems.
Most of these side effects go away in a few days or weeks after you stop taking isotretinoin. If your side effects persist for more than a few weeks, seek your doctor’s advice. Pregnant women and those who are planning to get pregnant are advised to stay away from taking isotretinoin, as it may contribute to serious birth defects in newborns. It can also cause miscarriage, premature birth, and the death of the fetus. You should not also donate blood during treatment and up to 1 month after stopping the medication.
Some people may also need to use this medication again after taking it once. If the need arises, speak with a doctor about starting a regular routine, and patients may be advised to use it again 8 to 10 weeks after the first treatment.
Layton, A. (2009). The use of isotretinoin in acne. Dermato-endocrinology, 1(3), 162–169. https://doi.org/10.4161/derm.1.3.9364
American Family Physician. (2000). Using isotretinoin the right way for acne. Am Fam Physician. 62(8):1835-1836.
National Health Service [NHS] UK. (2022). Side effects of isotretinoin capsules. From https://www.nhs.uk/medicines/isotretinoin-capsules/side-effects-of-isotretinoin-capsules/
Article Reviewed by: Dra. Carol Carpio