Isotretinoin (Roaccutane/Oratane) is a Vitamin A derivative is the gold standard for treatment of acne. Isotretinoin comes in a capsule and is usually taken once a day with the largest meal of the day (dinner time). It remains as the most effective and potent method to treat severe cases of acne. This treatment is restricted for use only by specialist Dermatologist.
Isotretinoin is also known by the drug names of Roaccutane/Oratane. 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 –
Isotretinoin remains as the most effective treatment and gold standard treatment for acne. Success is seen in nearly 100% of patients. On average 80% of patients require only one course, duration is usually six to twelve months. Improvement is seen within a few weeks of starting, however if your acne is severe then a transient flare-ups 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 six to twelve 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 fourteen 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 one to three months to ensure your treatment is on track and that your side effects are being 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 dose by your body weight. Your daily dose will depend on your side effects and the type of acne you have. Side effects will be managed effectively so it is important to remain in touch with the clinic regarding this.
During the first few week being on Isotretinoin your acne may actually worsen. This does not mean that treatment is not working; conversely, think of it as the acne 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 within your skin. When you can correctly manage the side effects such as dryness, your dermatologist increase the dose and your acne will then start to improve.
By week 6-8 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.
Isotretinoin 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. Isotretinoin is usually prescibed as once a day medication, to be taken with the largest meal of the day; 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 sensitivity 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 monitor blood counts, liver function and cholesterol levels.
You should consult your Dermatologist regarding side effects that may occur during treatment. In some cases your Dermatologist may reduce your dosage, or stop your treatment.
THIS MEDICATION MUST ABSOLUTELY NOT BE TAKEN DURING PREGNANCY OR BREASTFEEDING. You must immediately tell your dermatologist if you are pregnant, if you intend to become pregnant or if you think you are pregnant. You must NOT take your intended dose if this case, as the medication will cause harm to unborn babies.
The medication is a known teratogenic; meaning that the drug can and often will cause severe birth defects. A wash out duration of ONE month is needed prior to conception; i.e.. 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 blood test PRIOR to prescription of this medication, and tests are conducted at frequent intervals throughout treatment.
All female patients will 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 dermatologist discuss in detail issues pertaining to contraception whilst on this medication.
Isotretinoin 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.
These should be designed for sensitve skin not acne prone skin. We recommend the follow cleansers; La Roche Posay Toleraine, Cetaphil cleanser, QV Gentle Cleanser or Neutrogena Extra Gentle.
We recommend an oil free non-comodengic moisturiser such as; La Roche Posay Toleraine, Neutrogena Oil Free Moisture or Cetaphil Lotion.
In the majority of cases we do not recommend a change of product, however we do endorse non-comenogenic products. Mineral make-ups are the best for acne prone skin like; Jane Iredale. Lip balms containing SPF 30+ are also recommended.
Sunscreen SPF30+ (minimum) should be applied daily and reapplied every 4 hours as directed on the label. For everyday use a non-comedogenic product is encouraged; La Roche Posay Anthelios (SPF 50+). If exercise or water sports are performed a sport based sunscreen is recommended; Neutrogena SPF50+ Sport.
Westside Dermatology has an onsite pharmacy (My Skin Pharmacy) to help with all your skin care needs.
This medication does not treat pre-existing scars, however works by treating acne that is visible, thereby decreasing future scarring.
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 Isotretinoin 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. You must remember to 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.
This medication is usually reserved for cystic, scarring and resistant 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 meet the criteria.
The vast majority of acne patients will not require Isotretinoin to treat their acne. Other options for treating acne include topical retinoids and antibiotics (creams), oral antibiotics and hormonal treatments in females.
Blackheads and whiteheads respond well to chemical peels with either glycolic, lactic 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.
If the patient is eligible for Isotretinoin to be covered by PBS the prescription cost is $38.80 (current as of 1st January 2017) per box. On average a box will last a patient one month.
Reception staff at Westside Dermatology will be happy to assist you to make an appointment to see a Dermatologist. As Dermatologist are medical specialists, a referral from your GP is advisable to be eligible for a Medicare rebate. This would enable you to claim a percentage of the consultation fee.
Call Westside Dermatology on 07 3871 3437 to make an appointment or enquire about the referral process.
Dermatologists 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 Oratane click here.