We look at everything you need to know if you’ve been prescribed isotretinoin, a vitamin A derivative for severe acne, or the branded version Roaccutane
Isotretinoin (brand name Roaccutane) can have serious side effects and its use must be supervised by a dermatologist. It’s reserved for treating severe acne (such as nodular or conglobate acne or acne at risk of permanent scarring) that hasn’t improved with standard treatment involving oral antibiotics and topical medicines.
Isotretinoin belongs to a group of medicines known as retinoids, which are derivatives of vitamin A. Isotretinoin taken by mouth works by reducing the production of the skin’s natural oil (sebum).
Acne occurs due to an excessive production of sebum from over-active sebaceous glands in the skin. The sebum blocks the sebaceous glands, which prevents the oil from flowing freely out and causes an accumulation of sebum under the skin. The bacteria associated with acne thrive in these conditions. They feed on the sebum, and produce waste products and fatty acids that irritate the sebaceous glands, making them inflamed and causing spots.
Isotretinoin decreases the size and activity of the sebaceous glands in the skin, which reduces the amount of sebum that is produced. This stops the glands becoming blocked, and means bacteria are less likely to thrive. It also reduces the inflammation in the skin.
Your acne may get worse when you first start taking isotretinoin, but this usually improves within 7 to 10 days of continued treatment. In most cases, complete or near-complete clearing of acne is achieved with a 16 to 24 week course of treatment, and you’re then likely to remain free of acne for a long time. Repeat courses are not normally recommended, unless a definite relapse is seen after treatment is stopped. Repeat courses should not be started until at least eight weeks after stopping treatment, as your acne may still improve in this time.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with isotretinoin. Just because a side effect is stated here doesn’t mean that all people taking isotretinoin will experience that or any side effect.
Isotretinoin has been associated with causing some severe, potentially life-threatening skin reactions that require immediate medical treatment. It’s important to stop taking isotretinoin and consult your doctor immediately if you develop a skin rash or other related symptoms during treatment. These types of skin rash appear initially as circular patches, often with central blisters usually on arms and hands or legs and feet. More severe rashes may include blistering of the chest and back. Additional symptoms such as eye infections (conjunctivitis) or ulcers of the mouth, throat or nose may occur. Severe forms of rash may progress to widespread peeling of the skin which can be life-threatening. These serious skin rashes are often preceded by headache, fever and body aches (flu-like symptoms).
Talk to your doctor, nurse or pharmacist if you want any more information about the possible side effects of isotretinoin. If you think you have experienced a side effect, did you know you can report this using the yellow card website?
It’s important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with isotretinoin. Similarly, check with your doctor or pharmacist before taking any new medicines with isotretinoin, to make sure that the combination is safe.
Tetracycline-type antibiotics, eg minocycline, doxycycline, tetracycline, must not be taken with isotretinoin.
Do not take vitamin A supplements (including multivitamins containing vitamin A) while you’re taking isotretinoin, as this may result in a condition similar to vitamin A overdose, which may cause changes in the structure of the bone.
Other treatments conventionally used for acne, including antibiotics, exfoliants, medicines which loosen the dead skin on the skin surface (keratolytics), or radiation therapy with ultraviolet light (PUVA), should be avoided while taking isotretinoin. However, non-irritant preparations can be applied to the skin if necessary and it’s fine to use moisturisers.
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