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| Retinoids - maximise the benefits, reduce the risks |
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Prior to starting on isotretinoin capsules the following are normally tested:
Dryness Retinoids work by reducing the size of the sebaceous glands and the amount of oil they produce. Therefore, one of the most common side effects is dryness, scaliness or irritation of the skin. This can be significantly reduced by taking precautions such as washing with a gentle soap-free cleanser and using an oil-free non-comedogenic moisturiser (preferably with sunscreen SPF 30). When you start treatment with retinoid creams or gels, apply only a thin smear every second evening to the areas prone to acne. After several weeks, if skin dryness and irritation is minimal, you can move to nightly application for maximum benefit. By this time the skin has partially adapted to the irritating effects of these creams or gels and is better tolerated. People taking isotretinoin capsules commonly find their lips are particularly dry and may need to use a lip balm containing sunscreen frequently. Dryness of the throat, nose and eyes are also potential side effects, which can be helped by eye drops and the application of a soft petroleum jelly (eg, Vaseline) just inside the nostrils. Flare-ups People taking isotretinoin capsules or using retinoid creams/gels should be aware that although this is the most effective acne treatment, their acne may get worse about three weeks into treatment. An antibiotic may be prescribed in conjunction to try and prevent this. Don't give up! This initial flare-up is thought to be partially due to excess oil being squeezed from the sebaceous glands. With continued therapy, acne flares generally become less severe, less frequent and in most cases the acne improves. If anyone is concerned about a flare-up in their acne after starting a new acne therapy they should contact their prescribing doctor for advice. Sun sensitivity Retinoids make skin more easily irritated by sun, wind and water. Increased sun sensitivity leading to quicker sunburn is common in Australia, particularly in spring and summer. It is important to take extra sun protection measures such as wearing sunscreen, broad-brimmed hat, protective clothing and seeking shade. People on isotretinoin capsules can regularly use a SPF30+ broad-spectrum waterproof sunscreen without worrying about it worsening acne. Check the UV Index via news reports, weather updates or websites such as www.arpansa.gov.au Joint aches Tiredness, muscular, joint aches and pains may uncommonly occur. Generally these side effects are dependent on the number of capsules you are taking per day. If severe and unmanageable, reducing the dose taken each day may be an option to improve these side effects. However, this may prolong your course of capsules. Rare side effects These include hair loss, depression, severe headaches associated with nausea, vomiting and vision changes may occur. If any of these symptoms occur, stop therapy and contact your doctor or dermatologist. People with a family history of high cholesterol or triglycerides are at risk of having these blood fats increase while on isotretinoin treatment. A repeat blood test is usually done after a month or so after starting isotretinoin therapy to recheck these tests. Avoiding alcohol is advised. It's important to have regular reviews by the prescribing doctor who can tailor therapy to suit the individual and provide more information on how to manage or prevent side effects. |
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| Special precautions for women considering oral isotretinoin |
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Birth defects can be caused if you use oral isotretinoin:
Before a woman of childbearing age (when periods start) is prescribed isotretinoin, she (and her family) needs to be carefully counselled about the risks involved. You must use strict birth control for:
You should wait until the second or third day of your next menstrual period before you can start taking isotretinoin. This is an extra check to make sure you are not pregnant. To avoid pregnancy while on the drug and for one full reproductive cycle after ceasing the drug, very effective contraceptive measures are necessary. The use of two effective forms of birth control (such as the oral contraceptive pill and use of a condom) is often recommended as even the oral contraceptive pill occasionally fails. There are many issues involved in choosing and taking the oral contraceptive pill, such as the importance of taking the pill at the same time each day. Irrespective of what contraceptive measures are chosen, two negative pregnancy tests are usually required before starting isotretinoin. One may occur early, for example while discussing treatment options and a second test will be taken during the first five days of the menstrual cycle just before starting isotretinoin. Anyone concerned that they have become pregnant while on isotretinoin should contact their doctor and dermatologist immediately. An emergency oral contraceptive pill is available from hospital emergency departments and over-the-counter at pharmacies. If this option is considered, it must be taken within 72 hours after unprotected sex to be effective. It's best to see a doctor to discuss the options that are available. A dermatologist will provide information on pregnancy prevention strategies. For more information on contraceptive options, contact a local doctor or family planning association. Isotretinoin does not affect your fertility in the long-term. If a female is considering pregnancy after oral isotretinoin, this can be attempted one month after all isotretinoin has been finished. |
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| Isotretinoin and mood disorders? |
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| Isotretinoin and mood disorders Unfortunately depression and suicide are very common in western countries, including Australia. It's understandable that young people with acne may feel unhappy and consequently may develop mood disorders, such as depression, because of their appearance. So, it's no surprise to find many studies that show acne can cause depression. As a result, it is very important that the effects of treatment on depression also be studied. There are several comprehensive studies by scientific experts and worldwide regulatory authorities, such as the Food and Drug Administration (FDA) in the United States, that have not found a definite link between isotretinoin and depression or suicide. In fact, studies suggest that the risk of depression is reduced in those with severe acne being treated with isotretinoin. This is because isotretinoin improves acne and can therefore improve an individual's overall feeling of well-being. If you have a history of depression and/or a family member with depression and isotretinoin is being considered, make sure you discuss this with your doctor so they can monitor your mood more closely. There have been reports of depression and suicide in people taking isotretinoin and there are many possible reasons for this. Both severe acne and newly diagnosed depression particularly affect teenagers and young adults. Although studies suggest isotretinoin does not cause depression and there is no link it is very important to monitor all people on therapy for severe acne for depression and suicide risk, including those being treated with isotretinoin. Therapy will usually be stopped due to the possibility of an idiosyncratic reaction or intolerance to isotretinoin. Idiosyncratic reactions to medications are usually rare and the reason for it occurring is not understood or predicted by pre-treatment investigation. Depression - how to help As a family member of someone who is depressed, it isn't easy to know what to say or do. Family and friends should always be on the lookout for depressive symptoms in people. People with depression often need considerable encouragement to seek professional help from a doctor or mental health worker so this is something you can try to encourage. For more information, click here to order a beyondblue Information Pack for Carers, Families and Friends of those with Depression The following organisations also provide counselling and/or information servicesBeyond Blue Lifeline Kids Helpline |
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