Isotretinoin, Side effects, Contraindication and Precautions

 Acne, is a common issue among many young people. No matter how much treatment some receive, they never seem to improve, and they keep running to hospitals wondering how they will recover. Today, I will provide information about a medication used for acne, i.e. isotretinoin. It is not enough to just know how to take this medication; it is also important to understand the potential side effects and the situations in which it should not be used.

"Isotretinoin is a Vitamin A derivative that reduces the activity of oil-producing glands in the skin. It helps in the regeneration of the skin."

For what type of acne is this medication suitable?

1. It is suitable for those with more severe forms of acne.
2. It is also appropriate for those who have not responded to other treatments such as antibiotics or creams. However, it should only be used with a doctor's recommendation.

This medication comes in capsule form, and the dosage is 0.5 mg/kg per day. If you weigh 60 kg, you should start with 30 mg per day or 15 mg in the morning and evening. Always take isotretinoin after a meal, and make sure to drink a glass of water with it. For more severe acne, the medication should be taken for 15 to 20 weeks.

Now, let’s talk about the potential side effects:

1. Dry and cracked lips: Use lip balm for this.
2. Dry  mouth and dry eyes: Use moisturizer for the mouth and artificial tears for the eyes.
3. The skin becomes more sensitive to the sun: Use sunscreen when going out in the sun. Avoid using any kind of cleansing or waxing on your face while on this medication.
4. Hair may become thin or fall out, but this issue gradually decreases after stopping the medication.
5. Some may experience body aches as well.

In more severe cases, isotretinoin may cause:

• A decrease in high-density lipoproteins (HDLs),
• Elevated liver function tests (LFTs),
• Decreased blood levels, including hemoglobin and hematocrit. Red and white blood cell counts may decrease, while platelet count may increase. If a decrease in white blood cells is noticed, stop the medication immediately.

What precautions should be taken while on this medication? 

• Patients taking isotretinoin should not donate blood during treatment and for one month after stopping the treatment. 
• If isotretinoin is combined with tetracycline, pseudotumor cerebri (a condition with increased pressure around the brain) may occur. Therefore, isotretinoin should not be given with tetracycline. If symptoms of pseudotumor cerebri occur, stop isotretinoin immediately and refer the patient to a neurologist for further evaluation.

Who should not take isotretinoin? 

• Isotretinoin is contraindicated in pregnant women and women who may become pregnant. It has been shown to cause serious harm to a developing baby when taken during pregnancy. Women should use birth control pills or avoid sexual activity while taking isotretinoin and for some time after stopping it. Men who are taking isotretinoin should not participate in sperm donation while on the medication. 
• Those who are allergic to Vitamin A should also avoid taking this medication.