How to get the most out of Isotretinoin: An Evidence Based Approach


So you've just been prescribed isotretinoin (roaccutane). Congratulations, good skin is in your future. This drug is a wonderful drug and works so well but it's important to understand this drug carefully as it is a powerful drug with many strong side effects and if taken incorrectly or at the wrong times can lead to serious harm.


1. It's in the RETINOID family

Retinoids are amongst some of the most effective ingredients for healthy skin and isotretinoin is the mother of all retinoids. Isotretinoin is derived from vitamin A and works by targeting the causes of acne. It targets sebum production in the skin and therefore prevents comedogenesis (stops your skin follicles from becoming clogged). It is effective in decreasing the amount of Propionibacterium acnes, which is the most prevalent acne-causing bacteria and helps to reduce inflammation. It targets the causes of acne from several different angles which is what makes it so effective.


2.When can you get started?

I always encourage people to see their GP as soon as possible if they have severe acne. The sooner you see your doctor, the earlier you can be put on the acne pathway which starts with milder treatments and eventually leads to isotretinoin. Isotretinoin has some serious side effects and so can only be prescribed by dermatologists. Your GP might decide to refer you onto the dermatologists if you've experienced scarring, acne on your trunk or psychosocial issues associated with acne. For some people, sadly the side effects don't outweigh the positives.


3. You need to up your moisturiser game

The sclera of your eyes will dry leading to pain, irritation and in some cases conjunctivitis. Your lips will crack and your skin will peel. Prepare for these side effect, because they can be severe. You can prepare by buying emollients over-the-counter or having some prescribed. Bulk buy lip salve and don't leave your house without one handy. I was having to apply vaseline combined with carmex every 10 minutes.


4. What else should I do to my skincare routine

A solid skincare routine might consist of the following steps: Cleansing- Exfoliating-Toning- Moisturising. But you need to switch this up. Choose a cleanser that is moisturising and gentle to your skin, it is no longer about removing the oil from your face, but trying to add moisture in. Whilst on isotretinoin you can leave out the exfoliator because your skin will be extra sensitive. For the same reason it's important not to undergo microdermabrasion or use acid peels on your skin in order not to damage the sensitive underlying tissues. Use your toner as usual but try to avoid toners that have alcohol in. And moisturise as often as needed. It is also important to protect your skin from the elements and sun protection will become more important than ever vital whilst on isotretinoin as your skin will become significantly more sensitive to UV radiation.

Why not try: Aveeno Protect and Hydrate Sunscreen Lotion


5. Hows your mood?

Isotretinoin is known to affect mood. Some people notice that they are more depressed and irritable whilst on isotretinoin. I was so happy that my skin was clearing up that all I could feel was joy with isotretinoin as well as relief. However if you're already struggling with mental health problems or are going through a particularly hard time, it may not be worth it. It's important to look out for signs of serious depression or anxiety and weigh up whether this side effect outweighs the benefit. I've come to realise that there are few things that are more important than your mood and your happiness. Not even clear skin. Speak to your dermatologists if you feel as though you're unable to manage.


6. Pregnancy and isotretinoin?

If there is anything you take away from this post, its this: Isotretinoin is the most terratogenic drug available on the market. This means that it can induce serious abnormalities in the unborn child and so under no circumstance can you get pregnant whilst on isotretinoin. It is so important that you take birth control seriously whilst on isotretinoin. It is even recommended to use two forms of birth control. It is also important to remember not to use topical retinoids whilst pregnant, even though topical retinoids are significantly less potent, there's still a chance that it can be absorbed by the skin and into the blood stream.

7. How can you optimise your treatment

Take isotretinoin with a high-fat meal. Isotretinoin is best absorbed through the stomach when it is attached to fatty molecules. The higher levels available in your body, the greatert the efficacy of the drug. So enjoy your isotretion with a couple slices of avocado in the morning!


Isotretinoin is metabolised through the liver. Alcohol is also metabolised by the liver. This means that drinking a lot whilst on roaccutane reduces the effectiveness of roaccutane. I would have a single glass of wine or a G&T on the odd occasion, but it is important to be weary of the effects isotretinoin can have on your liver.


Isotretinoin is a derivative of vitamin A and so it is important not to take any multivitamins that contain vitamin A as too much vitamin A can lead to blurred vision, cracked, peeling skin and hair loss.


8. What was your journey like:

I loved taking isotretinoin and seeing the week by week improvement it had on my skin. It made more difference to my skin in 6 months than any other treatments ever did. I experienced dryness and discomfort but overall, I had a good ride. It is a wonderful drug for skin but make sure you stay healthy and remember that your happiness is always most important! Good luck and let me know how your journeys go down below.






References:

Layton A, The use of Isotretinoin, DermatoEdocrinology, 2009 May-Jun; 1(3): 162–169


Rademaker M, Making sense of the effects of the cumulative dose of isotretinoin in acne vulgaris, The International Journal of Dermatology, 2016

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