Isotretinoin (Roaccutane)
Isotretinoin (Roaccutane)Isotretinoin has revolusionised the treatment of acne since it became available in South Africa in 1984, according to the National Dermatology Working Group. (By Eachknowledge.blogspot.com )
Isotretinoin has revolusionised the treatment of acne since it became available in South Africa in 1984, Nineteen hundred eighty four according to the National Dermatology Working Group led by Dr Dave Presbury.
It is the only treatment that affects all four aetiological factors implicated in the acne process namely:
- the production of sebum
- comedogenesis
- colonization of the skin surface & follicular duct with Propionibacterium acnes & monocyte chemotaxis with an anti-inflammatory effect.
Isotretinoin is the treatment of choice for you:
- severe acne (nodulocystic acne, & extensive acne or pimples involving the face & trunk)
- lesser degrees of acne, particularly where scarring is occurring
- where other options have failed or are unsuitable or not tolerated.
Isotretinoin can also be prescribed for other conditions: Seborrhoea, Gram-negative folliculitis, Rosacea, & Hidradentis suppurativa.
More & more patients are failing to respond to long-term antibiotics, both topical creams or tablets. This is due to the increase in resistance of P.acnes to many antibiotics.
Scarring from acne may have long-term physical & emotional ramifications. Other treatments are slower in onset of action, & scarring may occur before they take effect.
Dosage & success rate
In 60 – 80 sixy to eighty% percent of people, the treatment can lead to a permanent cure at a dose between 0,5 – 1 mg/kg zero,five to one mg or kilo gram body weight per day for 16 – 20 sixteen to tweenty weeks. New evidence suggest that a cumulative dose of 120 mg /kg body weight during the course at a daily dose of at least 0.75 mg/kg zero point seventy five mg or Kilo gram body weight may be more important than the duration of the treatment.
In 60 – 80 sixy to eighty% percent of people, the treatment can lead to a permanent cure at a dose between 0,5 – 1 mg/kg zero,five to one mg or kilo gram body weight per day for 16 – 20 sixteen to tweenty weeks. New evidence suggest that a cumulative dose of 120 mg /kg body weight during the course at a daily dose of at least 0.75 mg/kg zero point seventy five mg or Kilo gram body weight may be more important than the duration of the treatment.
If acne persists or recurs a second full course may be considered any time after a two month gap following treatment.
Please note that some people – those with multiple macrocomedones & polycystic ovarian syndrome may take a while to respond to the treatment. Bacterial infections should be treated with the appropriate antibiotics. Note that tetracyclines should not be taken with isotretinoin.
With an expected 60 – 80 percent cure rate, 20 – 40 percent of people may need an extra oral antibiotics, hormonal treatment (Diane) or repeat isotretinoin.
People who might need a second course, include:
- Those with severe acne
- Those who have worsening acne before the age of Fifteen
- Women older than 25 years at the onset of treatment (twenty five years)
- Those with a prolonged history of acne
- Those with loads of acne on the back or trunk
- Polycystic Ovarian Syndrome
An acne flare can be anticipated in 6 percent of patients early in the course.
Possible side-effects & drug interactions
The keywords here are:
The keywords here are:
- Definitely not before or during pregnancy because it can lead to defects in the unborn baby
- Depression – patients should be counseled about possible mood changes, & if they are severe, the drug should be stopped & the patient sent for psychiatric help.
- Liver function & lipid monitoring in people with diabetes or hereditary elevated levels of triglycerides
- Not to taken with tetracycline antibiotics. The combination of tetracycline antibiotics & isotretinoin is contraindicated as each may in rare cases induce benign intracranial hypertension.
It is well known that the use of isotretinoin before & during pregnancy can impact on the development of the foetus, & can lead to congenital birth defects.
The guidelines for the use of isotretinoin in women should be observed very strictly:
- No women should take isotretinoin if she is pregnant or believes that she might be pregnant.
- Pregnancy must be avoided 4 weeks four weeks prior to, during treatment & 4 weeks four weeks after treatment has been stopped.
- Strict & reliable contraception must be used thoughout this period.
The side-effects of isotretinoin are those of excessive vitamin A. Avoid vitamin A supplement before, during & even after treatment.
Slight elevations of liver enzymes may occur in 10 percent of patients treated with isotretinoin. However liver problems seem to be extremely rare.
Side-effects are common, but other than the potential harmful effects on the unborn child, the side-effects are uncomfortable or unpleasant rather than dangerous. Watch out for signs of depression. The drying effect is exaggerated by the dry winter climate in summer rainfall areas of South Africa.
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