isotretinoin for severe acne

    Isotretinoin Accutane Treatment

    Isotretinoin is an oral retinoid for nodulocystic acne, severe acne or acne with severe scarring.

    Although a highly effective treatment for more severe cases of acne, side effects can and must be managed.

    • For severe acne that has not responded to conventional therapies
    • Pregnancy is an absolute contraindication
    • Blood tests monitoring is essential
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    Nodulocystic Acne associated with scarring

    Isotretinoin Accutane treatment singapore

    Oral isotretinoin or Accutane treatment is a retinoid (closely related to Vitamin A) for the treatment of severe or resistant acne. It is marketed by different companies such as Roaccutane, Accutane, Oratane and Acnotin. The introduction of this drug into the market in the early 1980s has helped countless individuals improve their acne significantly, and greatly improving their quality of life. Oral isotretinoin is currently the single most effective medical therapy for severe acne, cystic acne, and moderate acne not responding to standard therapies.

    OUR APPROACH

    HOW DR.NG TREATS ACNE

    As a clinician with more than 15 years of experience, Dr Ng. understands the impact of how acne can affect an individual. Acne knows no boundaries, afflicting a wide range of age groups and affecting both genders for varying lengths of time. Dr. Ng provides a patient-centric approach that is backed by the latest scientific evidence as well as his own wealth of experience to create a care plan for the best acne treatment that is unique to your skin type. Early intervention can help prevent acne scars, restore your skin and confidence.

    Infograph of Isotretinoin

    Who Is Oral Isotretinoin for?

    • Severe Acne Vulgaris not responding to oral antibiotics and topical retinoids and bezoyl peroxide after 6-8 weeks treatment
    • Nodulo-cystic Acne
    • Severe scarring
    • Psychological and/or physical distress as a result of acne
    4 core factors contributing to acne

    How does Isotretinoin Work?

    The four main factors contributing to acne vulgaris include:

    1. Excessive sebum (oil) production
    2. Clogged pores due to abonormal skin turnover
    3. Inflammation
    4. Bacterial C.acnes involvement

    Standard acne treatments that include antibiotics, topical retinoids and benzoyl peroxide can only target these processes partially. Moreover, we are now seeing many individuals with moderate stage acne vulgaris who are becoming resistant to oral antibiotics worldwide.

    Oral isotretinoin effectively targets all the above 4 factors contributing to acne. It targets the sebum gland, and the production of keratin that is involved in clogging the pores. By 6 weeks, there will be about 80-90% reduction in sebum. At 12 weeks, 80-90% of whiteheads and blackheads will be reduced. The significant reduction in inflammation and change in the skin’s micro-environment reduces the total C. acnes bacterial count.

    How much Isotretinoin accutane treatment do I need to take?

    Majority of individuals who have severe facial acne need a course of treatment that lasts 4-6 months on average. Treatment for back acne is at least 6-8 months, as it slower to respond to treatment.

    The dosage of oral isotretinoin is weight based. Traditionally, doctors would start off with 0.5mg/kg/day and increase the dosage to 1mg/kg/day gradually after the first month. For example, if you weigh 60kg, your initial starting dose would be 30mg of oral isotretinoin daily, and may be increased up to 60mg of oral isotretinoin per day. Now such high dosages would inevitably increase the side effect profile, tolerability and costs.

    Another factor regarding treatment is the goal cumulative dosage, often between 120-150mg/kg. Lower rates of relapses are noticed in dosages >120mg/kg, compared to those <120mg/kg. There does not appear to be much difference in extending the cumulative dose beyond 150mg/kg in some studies.

    Fortunately, there have been studies to demonstrate that low dose isotretinoin (0.25-0.4mg/kg/day) is as effective as conventional dosing. The lower dose option has the advantages of lesser side effects, improve tolerability and more affordable costs.

    What are the common side effects?

    Invariably, the most common side effect encountered is dryness. Dryness to the skin, nose, eyes, lips and genitalia is common. Dry skin can be improved by using a non-comedogenic moisturizer. We advise lips balms to manage chapped lips, and artificial tears eye drops to combat dry eyes. There can be sensitivity to sunlight while on treatment, and the use of a regular sunblock (of at least SPF 30) is strongly advised.

    You may experience mild joint and muscle pains, but not significant enough to interfere with sports and exercise in the great majority of individuals. Some report temporary hair loss or even hair growth during the course of treatment.

    A worsening of acne when starting treatment is also commonly encountered in the first month of treatment. This gradually subsides after the first month of therapy. We may prescribe some anti-inflammatory medication to help with this process.

    A blood test is necessary before you begin the course of treatment. We will check for blood chloesterol levels and liver tests, which has to be done periodically while on treatment. This is for safety purposes, and ensures that the medicine does not adversely increase your blood cholesterol or liver enzymes.

    There have been reports of individuals reporting changes in mood including depression and suicidal thoughts while on oral isotretinoin. However, to date there is no direct evidence from several studies to suggest a direct link between oral isotretinoin and mood disturbances. On the other hand, studies have shown quite the contrary. Oral isotretinoin improves mood, memory and attention span. Given how prevalent depression, anxiety and suicidal thoughts are in the general population, we monitor for changes in your mood during your review.

    Who is not suitable for Oral Isotretinoin?

    It is important that a doctor takes a medical history, and carries out some basic laboratory tests before you consider oral isotretinoin.

    Individuals who cannot take oral isotretinoin include those with:

    • Liver or Kidney disease
    • Excessive high blood cholesterol levels
    • Hypervitaminosis A
    • Pregnancy/Breastfeeding

    Oral isotretinoin can cause night vision disturbances. If your job requires you to drive at night (pilot, drivers) or operate heavy machinery, you will not be suitable for this treatment for the safety of yourself and those around you.

    What Isotretinoin brands are there?

    Oral isotretinoin is the main generic ingredient but it comes in different brand names in Singapore. Despite different names, they are still oral isotretinoin in composition. These drugs are regulated and approved by HSA. Current brands of isotretinoin in Singapore include:

    • Acnotin
    • Nimegen
    • Oratane
    • Roaccutane

    We do not advise purchasing oral isotretinoin online and certainly not without a doctor’s direction and prescription.

    Will Isotretinoin Cure My Acne?

    While some patients need only one course of treatment, a smaller segment of patients may need a second course. In a follow up study of patients over a 3 year period; 38% did not have acne, 42% had their acne controlled by standard therapies, while only 20% needed a second course of oral isotretinoin treatment.

    The recurrence rate between conventional and low dose isotretinoin treatments appear similar.

    Can I take other medicines while on oral isotretinoin?

    It is important to inform your doctor that you are on oral isotretinoin in case there are drug-drug interactions.

    Generally (but not exclusively) avoid:

    • Oral Tetracycline Anbitiotics (e.g. Doxycycline is commonly prescribed for acne)
    • Methotrexate
    • Vitamin A containing supplements
    • Alcohol (may cause liver inflammation)

    How can I reduce Acne flare with Oral Isotretinoin?

    Acne flare when initiating oral isotretinoin therapy can lead to discomfort. This comes in the form of worsening papules, pustules and cysts which may last a few weeks in most cases. We recommend starting a low dose of oral isotretinoin to dampen this flaring effect which is a temporary phenomenon.

    Isotretinoin is contraindicated in pregnancy

    Isotretinoin and Pregnancy

    After the introduction of oral isotretinoin in the United States in 1982, there were hundreds of reported cases of congenital malformations associated with the treatment. To this day, there continues to be about 150 cases of isotretinoin exposed pregnancy in the United States. Oral isotretinoin is given an ‘X’ label under the FDA Pregnancy Category. This drug carries a high risk of severe birth defects that could malform the foetus brain, heart and facial structures.

    Women of child bearing age are counselled regarding the use of contraception before starting treatment. More than one contraceptive method (e.g. condom and contraceptive pills) is recommended while on treatment. 3 months after the cessation of treatment, family planning is then considered safe.

    isotretinoin and acne scars treatment
    Procedures recommended and not recommended while on oral isotretinoin therapy

    What Procedures do I need to avoid?

    There is a concern of delayed wound healing and scarring, and some treatments should be delayed 6-12 months after you stop medication. Such treatments and procedures include waxing, dermabrasion and laser resurfacing.

    However, there are recent studies that show the safety of chemical peels, manual dermabrasion, fraction ablative or non-ablative laser, laser hair removal, and pulsed dye laser on patients who are currently or recently treated with oral isotretinoin. These treatments should be carried out on a case by case basis, and done by a professional with sufficient experience.

    what's the Relapse rate After Oral Isotretinoin accutane treatment?

    While oral isotretinoin is a highly effective treatment for severe forms of acne, the relapse rate is about 20%. Factors implicated for higher risk of relapse includes:

    • Younger age of onset <16 years old
    • Male sex
    • Truncal acne
    • Prepubertal acne
    • Family history of acne
    • Severe oily skin

    As we are dealing with a chronic skin condition, maintenance therapy with at least a topical retinoid is recommended. Maintenance therapy helps to prevent and reduce microcomedomes and thereby potential inflammation. Moreover, topical retinoids stimulate collagen and can improve acne scars.

    Severe acne, cystic acne variants and acne that has not responded to standard therapies are indications for isotretinioin accutane treatment. A clinical assessment of your acne type, severity and scarring potential helps determine the best acne treatment option at APAX Medical & Aesthetics Clinic. Dr Moses Ng, who has more than 15 years of clinical experience and treated thousands of patients will share with you how you can achieve healthier skin as you embark on your acne treatment journey.

    schedule a consultation for Oral isotretinoin accutane treatment in singapore

    We treat a range of acne and acne scars at both our clinics in Woodlands and Kovan. Oral isotretinoin is a powerful and effective treatment for difficult to control acne and severe acne. Dr. Ng makes it his mission to match each patient to the most effective acne treatment according to your lifestyle, skin condition and budget. Schedule a consultation with us today, so you can find out more.

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    Or give us a call at +65 6769 6007 | WhatsApp us +65 9855 3022

    Dr Moses Ng dermatologist

    Oral Isotretinoin

    With the rising trend of antibiotic resistance worldwide, and moderately-severe acne that has not responded to standard acne treatments, oral isotretinoin remains the gold standard treatment. Most of my patients see a significant improvement of their acne by 2-3 months, and many remain acne free after a course of treatment. There are numerous unfounded fears surrounding isotretinoin without firm scientific evidence. A large part of my consultation centers on education,the correct use of this drug, and how to minimise the side effects.

    Dr. Moses Ng
    Further Information:
    • Isotretinoin: Treatment for Severe Acne. American Academy of Dermatology. Click here.
    • Isotretinoin. British Association of Dermatologists. Click here.
    • Accutane (isotretinoin): Acne.org
    References:
    1. Gollnick H, Cunliffe W, Berson D, Dreno B, Finlay A, Leyden JJ, et al. Management of acne: a report from a Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol. 2003 Jul. 49(1 Suppl):S1-37.
    2. Lee JW, Yoo KH, Park KY, Han TY, Li K, Seo SJ, et al. Effectiveness of Conventional, Low-dose and Intermittent Oral Isotretinoin in the Treatment of Acne: A Randomized, Controlled Comparative study. Br J Dermatol. 2010 Nov 29.
    3. White GM, Chen W, Yao J, Wolde-Tsadik G. Recurrence rates after the first course of isotretinoin. Arch Dermatol. 1998 Mar. 134(3):376-8.
    4. Jacobs DG, Deutsch NL, Brewer M. Suicide, depression, and isotretinoin: is there a causal link?. J Am Acad Dermatol. 2001 Nov. 45(5):S168-75.
    5. Bagatin E, dos Santos Guadanhim LR, Yarak S, Kamamoto CS, de Almeida FA. Dermabrasion for acne scars during treatment with oral isotretinoin. Dermatol Surg. 2010 Apr. 36(4):483-9.