Oral isotretinoin therapy

What is isotretinoin?

Isotretinoin is from a group of medicines known as retinoids used to treat many skin problems. They are taken from vitamin A.

Isotretinoin can only be given by a dermatologist (a doctor who is trained in treating skin problems) and is given for over several months. Your GP cannot give you isotretinoin.

What is it used for?

Isotretinoin is used to treat serious acne, which has not been fixed by normal acne treatments. It may be used in less severe acne if you are older, normally over 30 years old, or if scarring is a problem.

Most people are clear of their acne for many years after treatment, but this is not always the case. About a third of people get some acne back, but it is usually not as bad as it was before.

How does it work?

Isotretinoin works by reducing:

• grease (sebum) in the skin
• inflammation (redness and soreness)
• the start of whiteheads and blackheads
• bacteria

How should I take my medication?

Your medication should be taken once a day. It should always be taken with food or with a glass of milk to help your body take it in. The tablets should be swallowed whole and not sucked or chewed.

Your acne will be more likely to come back if you do not take the full treatment, so you must make sure you come for your doctor appointments.

If you are someone who has started their period, you should start taking your medication on the 2nd or 3rd day of your menstrual cycle.

Who cannot take isotretinoin? 

You cannot take isotretinoin if you are:

• pregnant or think you may be pregnant
• breastfeeding
• allergic to this medicine

Should I be extra careful when taking isotretinoin?

You should be extra careful taking isotretinoin:

• when you have high levels of cholesterol or triglycerides (a fat-like substance) in your blood
• if you have diabetes. Isotretinoin may increase your blood sugar levels, so these may need to be checked during your treatment
• if you have epilepsy
• if you regularly drink a lot of alcohol
• if you have a history of depression
• if you have liver or kidney disease

What are the possible unwanted effects of isotretinoin?

Impacts on pregnancy

The most serious side effect is that isotretinoin is teratogenic, which means that it will damage an unborn baby if taken during pregnancy. You must not become pregnant whilst on the treatment or for 1 month after stopping the treatment.

Depression

Some people have changes in their mood and ability to concentrate. There have been reported cases of people feeling depressed or suicidal. If you experience any significant changes in your moods, you should seek medical attention as soon as possible, as stopping the medication alone may not make your feelings go away.

Liver and blood fats

Inflammation of the liver and raised blood fats can happen. Your doctor will do blood tests to check your liver and blood fats before and during your treatment. It is recommended you drink plenty of water whilst on this treatment.

Headaches

These are normal on isotretinoin but tell your doctor if you are waking up with a headache or if you experience headaches with changes in your vision, as this can affect the pressure of the fluid surrounding the brain. If headaches are persistent, it may be worth having an eye test if an eye test hasn’t been performed recently, to rule out any underlying cause.

Other side effects

Almost all patients have some unwanted reactions to treatment, even before they see their acne getting better.  These effects often reduce as treatment continues and include;

• dry lips and nose. You can apply yellow soft paraffin or Vaseline to dry areas
• dry skin and eczema. You can use a moisturiser such as Aveeno regularly throughout the day
• redness of the skin and easy burning in sunlight. Apply a factor 50 sunscreen regularly during hot weather, this would need to be non-comedogenic (does not cause blocked pores) such as la Roche Posay Anthelios (blue)
• eye or nasal irritation. You can get hypromellose eyedrops if your eyes or nose become dry
• muscle aches and pains
• hair loss or hair becoming curly
• fragile skin. Do not wax during this treatment or for 6 months after treatment
• skin infections, particularly around the nails

Most unwanted effects disappear once the treatment course is over.

There have been cases of increased bruising, bleeding more easily, or increased levels of a substance called uric acid in your blood, which can affect those with gout. Very high uric acid levels may also affect your kidneys. The number of white cells in your blood (cells that are involved in fighting off infections) may be reduced, so you may be more at risk of infections.

Your sight may also be affected, particularly at night. If this occurs, you should report it immediately to your doctor and avoid driving and operating machinery. If you are or are intending to become a pilot, discuss this with your dermatologist. Isotretinoin may cause you to fail more detailed night vision tests required for flying an aeroplane. This can impact you long after treatment has finished.

What are the chances of hair loss during treatment?

Hair loss occurs in some patients and is only short-term. Hair growth returns to normal within several weeks of treatment ending.

Will I still have scars? 

Isotretinoin will not treat any existing scars, but it will prevent further damage to your skin.

Frequently asked questions

I have been taking isotretinoin for a week and my acne has gotten worse. Should I stop taking it?

For some people, acne can get worse in the first month of treatment, but you should continue to take the treatment. Your dermatologist may give a short course of steroids to stop this from happening. If you are concerned, you should contact your doctor.

Can I use any other acne products whilst I am taking isotretinoin?

You should not use any other acne treatments unless told to by your doctor.

Which washes and moisturisers can I use whilst on Isotretinoin?

We recommend you use non-comedogenic (does not clog the pores) moisturisers such as Aveeno, Cerave, Effaclar (duo+), sunscreens such as Anthelios (blue) Sunsense-daily face (tinted), and cleansers such as Effaclar wash or Cerave Foaming cleanser.

Can I take antibiotics when I am on this treatment?

This is normally okay, but one group of antibiotics called tetracyclines should not be taken. You should always inform your doctor, dentist, or pharmacist that you are taking isotretinoin before they give or advise on any other medicines.

My eyes are sore since starting isotretinoin or I cannot use contact lenses for as long as before. What should I do?

Your eyes may feel dry and irritated because of the drying effect of your medicine. Your pharmacist can suggest eye drops (hypromellose) to help with this problem. You may need to cut down on the time you wear your contact lenses, or you may be more comfortable wearing glasses during treatment.

Can I exercise as normal during treatment?

Some people have muscle aches and pains whilst taking isotretinoin. This can happen in people who exercise regularly and in those who take no exercise.  It is best not to increase the exercise you do whilst on treatment.

Can I drink alcohol whilst on treatment?

You will probably be advised not to drink alcohol or to reduce the amount of alcohol you drink whilst on treatment. This is because of a possible effect on the liver and an increase in blood fats in some people.

Can I continue to take vitamins during treatment?

The only vitamin to be concerned about is vitamin A as this is related to your treatment. Do not take any vitamin A supplements at all.

Can I use a sunbed while I am taking the medication?

Isotretinoin can make the skin more likely to burn badly in sunlight, so you should not use a sunbed whilst on treatment.

Is it ok to go on holiday to an area with hot and sunny weather?

It is advisable to apply a complete sunblock to the skin before going out into strong sunlight as your skin could be more likely to burn in sunlight and you may develop a rash. Sunlight may also make you more likely to develop large brown patches on your face, which fade when you stop treatment.

I am going on holiday next month and have to have several vaccinations. Are there any vaccinations I cannot have?

There have been no reported reactions between isotretinoin and any of the common vaccinations.

Can I take tablets to protect me against malaria whilst on holiday?

Yes, there have been no reported problems between anti-malarial tablets and isotretinoin.

If I am a woman, how long will it take for the isotretinoin to be out of my system, as I want to start a family and need to avoid any risk of damage to my baby?

Contraceptive precautions must be taken before, during and for one month after treatment. Isotretinoin is cleared from the body in 4 weeks, so there will be no increased risk of damage to the baby if you become pregnant more than 1 month after stopping isotretinoin.

If I am a man, do I need to use contraception?

Studies show that isotretinoin therapy should not affect your ability to have healthy children now or in the future. However, you must not share your treatment with anyone else.

If I have tablets leftover from my treatment even if my course is finished, can I keep on using them?

Even when you have finished your treatment, your acne may not completely clear for a few months.  You should not continue taking isotretinoin unless your dermatologist tells you to. Do not share your tablets with anyone else.

I am a blood donor. Can I continue to donate blood whilst on treatment?

You should not donate blood during or for at least 1 month after isotretinoin treatment. If you do, your blood could be given to someone who is pregnant and cause them to have a baby with a serious birth defect.