Roaccutane treatment

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Roaccutane/ Oratane is also known as isotretinoin. This medication belongs to the Retinoid class of drugs, and is a deriverative of naturally occuring Vitamin A.

It works by targeting the four causes of acne -

1. Decreasing counts of the bacteria P.acnes which is implicated in acne
2. Decreasing inflammation ( which in turn results in pustules)
3. Decreasing sebum (oil) production of the skin
4. Normalizes the duct of the oil gland

Roaccutane/ Oratane remains as the most effective treatment for acne. Success is seen in nearly 100% of patients. On average 80% of patients require only one course of Roaccutane/ Oratane. Improvement is seen within a few weeks of starting, however if your acne is severe then a transient  flare up can be expected early on treatment. Your dermatologist will warn of this, and may take steps to reduce the flare up.

A course of therapy last between 6-12 months depending on the severity of acne and the body weight of the patient. In cases of very severe acne, such as acne involving the chest and back, a course of treatment may extend to beyond 14 months. Typically your dermatologist will start you on a very low dose to monitor for side effects and ease you into the drug. Depending on the severity of your acne you will be seen every 1-3 months to ensure your treatment is on track and that your side effects are well managed.  By completing the course of medication as set by your treating dermatologist, this will ensure that you have the best possible chance of placing your acne in remission.

Dermatologist calculate your total dose by your body weight. For example, if you are 70kg, you will require 9 boxes. If you go thru one box a month, then your treatment course is 9 months. Your daily dose will depend on your side effects and the type of acne you have.

During the first few week on Roacuttane your acne may actually worsen. This does not mean that treatment is not working- conversely, think of it as acne that is ‘pushing out’. This initial flare up of acne is only temporary and will improve within a few weeks. Do not be discouraged by this, and continue as directed by your dermatologist.  Within the first 6 weeks of treatment you will notice that your skin and lips are drier than before. This is due to a reduction in the amount of oil being produced.  When you can correctly manage the side effects such as dryness, your dermatologist increase the dose of Roacuttane, and your acne will then start to improve.

By the 6^th to 8^th week of treatment your acne will show signs of improvement. This improvement will continue throughout your treatment.

By the end of treatment, you would have improved considerably- the majority of patients will be completely free from acne.

Roaccutane/ Oratane comes in a capsule preperation. Your dermatologist will always give you specific instructions regarding dosage depending on the severity of acne and your body weight. It is very important you do not change the prescribed dose.  Roacuttane/ Oratane is usually prescibed as once a day medication, to be taken with food, usually at night.

The most common side effects of Roacuttane include drying of the mucous membranes, including lips, nose, eyes and skin. Regular use of a lip balm, moisturiser for the skin, and if needed, eye drops, can address these side effects.

Increase skin fragility and sun sensentiviy can also be seen and is often dose related.  Muscle and joint stiffness may also be experienced at higher dosages.

In severe cases of acne, an early flare up can be expected. This is usually short lived, and resolves with a decreased dose of Roaccutane/ Oratane.

Uncommon side effects of Roacuttane include mood swings, blurred vision, headaches, abnormal liver function, elevation of cholesterol, hair loss, and in grown nails. Monitoring of side effects are essential for everyone on this medication. Blood test are conducted at set intervals to monitior blood counts, liver function and cholesterol levels.

You should consult your Dermatologist regarding side effects that may occur during treatement. In some cases your Dermatologist may reduce your dosage, or stop your treatment.

Roaccutane / Oratane must absolutely NOT be taken during pregnancy or whilst you are breast feeding. You must tell your dermatologist if you are pregnant, if you intend to become pregnant or if you think you are pregnant.  You must NOT take Roaccutane / Oratane in this case, as the medication will cause harm to unborn babies. The medication is teratogenic- this means that the drug can and often will cause severe birth defects.  A wash out duration of ONE month is needed prior to conception- ie. Medication will need to be ceased one month before conception.  All possibility of pregnancy MUST be ruled out before treatment. Your dermatologist may give you a pregnancy test PRIOR to prescription of this medication, and tests are conducted at frequent intervals throughout treatment.

All female patients will have to sign a consent form PRIOR to treatment to acknowledge that they fully comprehend the implications of pregnancy whilst on this medication.  If you are sexually active, your dermatolgist discuss in detail issues pertaining to contraception whilst on this medication.

• Do wear a sunscreen
• Do moisturise frequently
• Do check with your pharmacist if you are taking other medication
• Do NOT consume alchol in excess
• Do NOT undertake waxing/ facials
• Do NOT squeeze pimples- this can lead to scarring
• Do NOT use hair colouring containing peroxide or use hair rollers.

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Roaccutane / Oratane treatment tends to dry out the oil glands associated with acne. During treatment your skin will undergo certain changes. The use of correct products will protect your skin, mimimise dryness and side effects and keep your treatments on track.

Face cleansers- these should be designed for sensitve skin. We recommend the follow cleansers –cetaphil cleanser, QV Gentle Cleanser, Neutrogena Extra Gentle ( NOT orange labeled).

Face moisturiser- we recommend oil free moisturiser such as Neutrogena or cetaphil.

Cosmetics / Make up-  in the majority of cases we do not recommend a change of product, however we do endorse non- comenogenic products such as Mineral make up.

This medication does not treat pre-existing scars, however works by treating acne that is visible, thereby decreasing future scarring.

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The majority of scars will heal in time. Anywhere between 30-70% scars will reduce in visibility if NO treatment is conducted.  Macular erythema or redness is very commonly seen during the course of Roaccutane treatment. The regular use of sunscreen and the event of time will dramatically reduce the redness seen with this type of scarring.

Scar revision maybe undertaken between 4-6 months after roacuttane treatment if scars are still visible. We advise scar revision only after your acne is in remission. BE PATIENT.

Fractionated laser/ Fraxel  is a revolutionary method of treating acne scars with an average 60-70% improvement after a series of treatments.  Chemical peels and facials are contraindicated during the course of Roaccutane/ Oratane treatment, however maybe prescribed thereafter.

For patients with mild scarring, or for those who want to improve or maintain their skin texture after Roacuttane treatment, they may enrole in the ClearSkin Program, designed by Dermatologists.

More information on acne scar treatments

This medication is usually reserved for cystic acne.  Additionally patients with scarring acne or acne that fails conventional management maybe suitable for this medication.  Your dermatologist will give you the option of this medication if you are suitable for Roaccutane/ Oratane.

The vast majority of acne patients will not require Roaccuatne / Oratane to treat their acne. Other options for treating acne include topical retinoids and antibiotics  (creams), oral antibiotics and hormornal treatments in females.  

More information on Westside Dermatology Acne Treatments

Blackheads and whiteheads repond well to chemical peels with either glycolic acid or salicylic acid. Once again, careful assessment of your type of acne, as well as a detailed history of your previous acne treatments will give your dermatologist an idea of the best treatment for you.

More information on Chemical Peels

For mild to moderate acne, a change in diet may help. Download the guide from the downloadable resources on the right.

Call the reception staff at Westside Dermatology to make an appointment to see a Consultant Specialist Dermatologist. As Dermatologist are medical specialists, a referral from your GP is advisable. This would enable you to claim a percentage of the consultation fee.

Call  Westside Dermatology on 3871 34 37 to make an appointment or enquire about the referral process.

Dermatologist are the only specialist authorised to prescribe this medication.  We generally reserve the use of this medication to patients with cystic acne. In some situations we may consider this medication if acne does not respond to conventional treatments, or if scarring is eminent. Apart from treating acne, we will implement ways to reduce your scarring. Our aim is to treat acne, place it into remission, and to treat and prevent any scarring.

The information provided in this website is a brief overview of treatment. For patients contemplating use of this medication, your Dermatologist will go into further detail, addressing important points of treatment. Additionally a comprehensive booklet will be provided and a detailed treatment guide will be issued. Product information will also be provided upon prescription.  We encourage patients to read the product information guide for full discussion of the side effects.

For more information on the use of Roaccutane/ Oratane click here.