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    Isotretinoin treatment

    Isotretinoin is an anti-inflammatory agent derived from vitamin A that decreases the skin’s production of the oily substance sebum, which is thought to help lessen the number of bacteria that inhabit these areas of the skin.

    . A course of treatment usually lasts between 16 weeks and 24 weeks, and at least 8 weeks should pass before another course is given (during which time a full assessment of the response to treatment should be made by a specialist).

    Thefollowing people should not receive treatment with isotretinoin:

    Children aged 12 years or younger
    Women who are, or who might be, pregnant (see below)
    Women who are breast-feeding
    People with impaired liver function
    People with high levels of fat in their blood
    People with hypervitaminosis A – the presence of too much vitamin A in the body, symptoms of which include irritability, fatigue, skin changes, hair loss, headache, and stomach ache
    People who are allergic to peanuts, soya, or the sugar sorbitol: isotretinoin contains these ingredients
    Isotretinoin should be used with caution in people with: a history of depression (see below); diabetes; dry-eye syndrome; and impaired kidney function.

    The following medicines should not be taken alongside isotretinoin treatment:

    • Vitamin A (see above)
    • Keratolytic agents (e.g. salicylic acid – the active ingredient of some treatments for warts, corns, calluses, patches of dry scaly skin, acne, and fungal nail infections)
    • Tetracyclines (antibiotics used for treatment of: infections such as chlamidya and those of the respiratory tract; acne; gum disease; and chronic bronchitis).

    Advice for people who have been prescribed isotretinoin:

    • Attend all appointments scheduled for you, which should be about once a month. This ensures that the specialist can check the medicine is working safely for you
    • An improvement in the appearance of the skin may not be seen for until a few months of treatment. There may also be a slight worsening of acne on starting treatment, which usually subsides in 7-10 days
    • Some side effects of isotretinoin are dose-related; some are generally reversible after changing the dose or stopping treatment; and some may persist after treatment has stopped
    • Lip balm, moisturiser, and eye ointment may help alleviate any drying of the skin
    • Avoid the sun and exposure to ultraviolet light (ie avoid the use of tanning beds); use sunscreen (sun protection factor, SPF, 15) from the start of treatment
    • Avoid waxing, surgical dermabrasion, or laser surgery of the skin during treatment and for at least 6 months after stopping. This will help prevent any stripping, scarring, or pigmentation of the skin
    • Do not donate blood while you are taking isotretinoin and for at least one month after stopping. This will help prevent transmission of the drug to those who should not receive it
    • Do not give your medication to anyone else. Return any unused capsules to the pharmacy

    Isotretinoin is available only on prescription and should be prescribed only in a consultant-led team. Prescriptions for isotretinoin should be issued under the consultant’s name from a hospital-based pharmacy. This way, specialists with the most experience can advise patients about the important safety issues associated with isotretinoin.

    Retinoids- Patient Information.
    These are good at unplugging blocked pores. They include adapalene, tretinoin, and isotretinoin which come in various brand names. They also have some effect on reducing inflammation.
    Therefore, one is often used early on in acne to help to unblock pores and to treat blackheads or whiteheads (comedones) and mildly inflamed spots. You need a prescription for all retinoid preparations.

    When you use a topical retinoid:
    You may develop some skin redness and skin peeling. This tends to settle over time.
    The spots sometimes get a little worse before improving.
    Your skin may be more sensitive to sunlight. Therefore, it is best to apply at night and wash off in the morning. A sun protection cream may also help if you are out in the sun.
    The most common side-effects are burning, irritation, and dryness. Therefore, you may be advised at first to use a low strength, less frequent applications, and to use for a shorter duration.
    You should not be pregnant, or intend to become pregnant, as there is a slight risk of harm to unborn babies. Discuss contraception with your doctor if necessary.

    Dr G Mohan.

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