Isotretinoin 101: What You Need to Know Before Starting Treatment

Isotretinoin 101: What You Need to Know Before Starting Treatment

If you're looking for a powerful way to beat acne, isotretinoin might be the answer you've been searching for. This oral medication is often prescribed for severe acne, especially when other treatments have failed to deliver results. It can significantly improve skin clarity, but it’s important to understand the potential risks and side effects before starting treatment. 

After all, making informed decisions is crucial to achieving the best outcome for your skin, agree?

And don’t worry—if you want to learn more about isotretinoin, this article is just what you need! Keep reading as we at DMD Skin Sciences guide you through everything you need to know about isotretinoin and how it can transform your skin.

What is Isotretinoin and How Does it Work?

Isotretinoin is a synthetic derivative of vitamin A specifically formulated to tackle severe acne. It works by targeting the skin’s oil glands, which can sometimes produce excessive sebum, leading to clogged pores and breakouts. By reducing the size of these glands and slowing down oil production, isotretinoin helps prevent the accumulation of oil and dead skin cells, significantly reducing the risk of acne.

Isotretinoin also prevents the growth of acne-causing bacteria and promotes faster skin cell turnover. This means dead skin cells are shed more regularly, contributing to clearer skin over time. Many individuals find relief from persistent acne after starting this treatment, particularly those suffering from painful cystic acne, as isotretinoin helps reduce both the size and discomfort of these blemishes.

Additionally, isotretinoin effectively reduces inflammation, calming red, swollen pimples, and preventing the formation of comedones—clogged hair follicles that lead to blackheads and whiteheads. By improving skin texture and making it less prone to blockages, isotretinoin’s ability to tackle multiple causes of acne make Isotretinoin a top choice for treating almost all types of acne.

Who is a Good Candidate for Isotretinoin?

Despite the many benefits of isotretinoin, you might be wondering if it is the right treatment for your acne. This section will help you identify whether you meet the criteria for this medication.

Criteria with Treatment

Candidates for isotretinoin typically exhibit the following characteristics:

  • Persistent Acne: If your acne has been ongoing and resistant to other forms of treatment, isotretinoin may be appropriate.
  • Cystic or Nodular Acne: This acne type is often more painful and can lead to scarring, making isotretinoin a more suitable option.

Note that if you have a history of mental health issues, your doctor may approach isotretinoin with caution, as there are reports of mood changes associated with the medication. A meta-analysis found that about 4.57% of isotretinoin users developed psychiatric disorders within a year, with depression occurring in 3.83% of cases. Additionally, the Food and Drug Administration (FDA) reports noted over 17,000 psychiatric adverse events linked to isotretinoin from 1997 to 2017.

Specific Populations to Avoid

Certain populations should avoid isotretinoin due to its risks. For example, pregnant or breastfeeding women are advised against taking this medication because it can cause serious birth defects.  Women of childbearing age must use effective double contraception during treatment and for at least one month after discontinuation, as well as consult with their doctor on when to stop isotretinoin before pregnancy.

People with certain medical conditions, such as liver disease, allergy to Vitamin A,  or specific types of depression (as mentioned above), may also need to explore other treatment options.

Importance of Consultation

Before starting isotretinoin, a thorough consultation with certified dermatologists like us at DMD Skin Sciences is essential. During this appointment, your doctor will evaluate your skin type, acne severity, and medical history to determine if isotretinoin is right for you. We will also discuss potential risks, side effects, and the importance of regular follow-ups during treatment.

Being informed can help you feel more confident in your treatment decision. This consultation is also a great opportunity to ask any questions or voice concerns you may have about the medication and its effects.

Potential Side Effects of Isotretinoin

Isotretinoin can be a lifesaver for severe acne, but it’s not without any side effects. Here’s what to expect in case you start this treatment—and how to handle the adverse reactions. 

Dry Skin and Lips

Many users report significant dryness, which can be uncomfortable. It’s essential to use a good moisturizer, like the MISSION: SKIN° HydroLock Lite Moisturizing Cream, which absorbs quickly and helps increase skin moisture while reducing dryness. Its ceramides improve and maintain skin barrier function, ensuring your skin stays hydrated and supple.  Additionally, using a quality lip balm can help combat dryness on the lips, and drinking plenty of water can help keep your skin hydrated.

Nosebleeds

The drying effect can also extend to your nasal passages, leading to occasional nosebleeds. Keeping the inside of your nose moisturized can help, so consider using saline nasal sprays or gels.

Muscle Aches

Some individuals may experience muscle discomfort or aches, particularly if they engage in intense physical activity. To help manage this, consider gentle stretching before and after exercise, staying well-hydrated, and using over-the-counter pain relievers like ibuprofen or acetaminophen as needed. If muscle pain persists, it's important to consult with your healthcare provider for further guidance.

Sensitivity to Sun

Isotretinoin can make your skin more sensitive to sunlight, increasing the risk of sunburn, especially in the Philippines. Wearing sunscreen daily is essential; look for broad-spectrum sunscreens with an SPF of at least 30. 

For those with acne-prone skin, consider the MONT DE LUR Crystal Serum Sunscreen SPF50 PA++++ or the MONT DE LUR Crystal Silicone Sunscreen SPF50 PA++++. These lightweight sunscreens offer high SPF 50 protection against UV radiation, infrared radiation, and visible light while being gentle on sensitive skin. The Crystal Serum provides a dewy finish, while the Crystal Silicone Sunscreen offers a matte dry-down.

Another option is the MONT DE LUR Tinted Mousse Sunscreen SPF50+++, which offers SPF 50 protection against UV radiation while helping to control oil production and providing a powder finish.

No matter which sunscreen you choose, be sure to apply it 30 minutes before going outside and reapply every two hours or after swimming.

Purging

Does isotretinoin cause purging? Yes, this acne treatment can cause this phenomenon where there is a temporary increase in breakouts when starting the medication. That’s especially since isotretinoin accelerates the turnover of skin cells and brings underlying issues to the surface. While this can be frustrating, it often indicates that the treatment is beginning to work.

To help manage the discomfort associated with purging, use gentle skincare products, stay hydrated with a good moisturizer, and consider topical treatments like salicylic acid. Additionally, taking Levocetirizine or Bilastine may help alleviate any itching or irritation, but consult with your dermatologist before adding any new medication.

If you are a DMD patient and think you are experiencing purging, kindly get in touch with Dr. Mike D, the DMD Nurses, or our team to start our anti-purging protocol to help address it as soon as possible.

You can also watch this video from Dr. Mike for ideas of how to deal with purging:

 

@dr.mike.d Replying to @Emilya♡ What to do when Purging? #fyp #foryou #acnescars #acnescarph #dermph #dermatologist #dermatologistph #dermatologistphilippines #acneexpert #acne #acnecure #azelane #acnetreatmentph #hormonalacne #acnetreatment #acnetreatmentphilippines #skintok #edutok #tiktoku #tiktokskwela #eduwow #learnontiktok #skincare #backtotiktokskwela #healthtokph #acnederm #acnederma #acnedermatologist #acnefree #acnejourney #acnebreakouttreatment #acnepimplesremoval #acnescarsremoval #acnedoctor #learnitontiktok #purging #womenoftiktok ♬ original sound - Dr. Mike D

 

Being open with your dermatologist at DMD Skin Sciences about any side effects is vital for your comfort and safety. Regular check-ins will allow your doctor to make any necessary adjustments to your treatment plan.

Expectations and Results

When starting isotretinoin, it’s essential to have realistic expectations about the treatment process. At first, you may notice some initial flare-ups as the medication begins to work. This is entirely normal and often a sign that the treatment is starting to affect your skin. Over the next few months, most patients experience a gradual improvement in their skin condition.

You might see visible changes within 4 to 8 weeks, but complete results often take several months to fully materialize. For instance, many individuals will notice significant acne clearance after a three-to-six-month treatment period.

Staying patient and committed to the treatment, even when initial results may not meet your expectations, is important. Keep in mind that acne can be stubborn, and isotretinoin is designed to provide a gradual but long-term solution.

Long-Term Remission

One of the most appealing aspects of isotretinoin is the potential for long-term remission, with many patients finding that their acne does not return after completing a course of treatment. Research indicates that a cumulative isotretinoin exposure of 120 to 150 mg/kg is associated with the best chances for prolonged remission, and higher doses (≥1 mg/kg/day, such as a 10 mg dose of isotretinoin) correlate with lower relapse rates compared to lower doses (0.1-0.5 mg/kg/day).

While the same study showed that about 39% of patients experienced a relapse within the first 18 months after stopping treatment, another study found that 90.2% achieved complete remission after an average of 13.5 months, with only 10.6% relapsing within a year.

While some may need additional treatment to maintain clear skin, the bottom line is this: isotretinoin offers real hope for achieving long-term clear skin!

Conclusion: Achieve Smoother, More Radiant Skin

In summary, isotretinoin is a powerful tool in the fight against severe acne, offering significant benefits when used correctly. However, it's crucial to weigh these benefits against potential risks. We encourage you to consult with us at DMD Skin Sciences to determine if isotretinoin is the right choice for you. 

We offer the DMD Glow Program, a comprehensive approach to treating acne and achieving clear skin. In other words, your journey to clear skin starts with a consultation—reach out to DMD Skin Sciences today!

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