Oral Retinoid Acne Treatment

Oral isotretinoin, also known as Roaccutane (Roche), reduces the secretion of oil (sebum), from the sebaceous glands found in the skin. As a result of this, less oil secretion means that there is less of it for bacteria to thrive on. This therefore leads to decreased inflammatory/infection rates of the hair follicle leading to the prevention of acne formation.
It is primarily used for nodulo-cystic acne ('hard raised pus-filled spots'), conglobate acne (this rare type of acne develops on the back, bottom and thorax. It is an accumulation of pustules and cysts, and this may be due to a strong bacterial infection) and severe acne/scarring.

It is usually given to people who have not responded to:
1.Acne creams (benzoyl peroxide, retinoids etc.)
2.Antibiotics (erythromycin, tetracyclines etc.)
Oral isotretinoin has also been shown to be quite useful in women who are in the 3dr and 4th decades of life. Studies have shown that acne developing in women (in the 3rd and 4th decades of life) is not usually responsive to antibacterial treatment; Roaccutane has shown efficacy in these cases.

Isotretinoin is quite a toxic drug and a lot of care and supervision must be undertaken when taking this medication. It should always be prescribed by a consultant dermatologist.

The course of treatment is usually 16 weeks. In many cases, repeat treatments are not required although can be undertaken with the clinical consent of your consultant dermatologist.

Main Side effects of isotretinoin include
1.Sever dryness of the skin and mucous membranes (such as the mouth, nose etc.)
2.Nose bleeds
3.Joint pains
4.There are many more side effects which have been associated with this drug; these are rare and can be obtained from any drug formulary or from the Roaccutane website.

Contraindications
1.This drug is highly teratogenic ( meaning it can be very harmful to the developing baby during the course of pregnancy) and MUST not be given to women of child bearing age unless they practise effective methods of contraception
2.People with liver disease should not take this medication as it can further impair the liver and exacerbate the disease process
3.Patients with kidney disease are advised not to take this and guidance from a consultant dermatologist should be taken
4.Patients with high cholesterol are strongly advised not take this medication and regular liver function tests should be performed in all patients before treatment with oral isotretinoin is commenced

Efficacy
Isotretionoin is very good at obliterating acne but at the cost of some side effects which may cause problems in some patients. Although these side effects are rare, they can still occur and, if experienced, you must consult your doctor for advice. Many patients have reported good results with oral isotretinoin and usually only one course of treatment is required. If you are considering this form of treatment, it would be in the your best interest to seek medical advice from a dermatologist.


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