Isotretinoin Acne And Side Effects
Isotretinoin (INN) is a medication used for the treatment of severe acne. It is sometimes used in prevention and treatment of certain skin cancers. In some cases, it is used to treat Harlequin type ichthyosis. It is a retinoid, meaning it derives from vitamin A and is found in small quantities naturally in the body. Oral isotretinoin is marketed under various trade names, most commonly Accutane (Roche), Amnesteem (Mylan), Claravis (Barr), Decutan (Actavis), Isotane (Pacific Pharmaceuticals), Sotret (Ranbaxy), Oratane (Genepharm Australasia) or Roaccutane (Roche); while topical isotretinoin is most commonly marketed under the trade names Isotrex or Isotrexin (Stiefel).
Dosage
The dose of isotretinoin a patient receives is dependent on their weight
and the severity of the condition. High dose treatments are administered
between 0.5 mg/kg/day to 2 mg/kg/day (usually at 0.5 to 1 mg/kg/day,
divided into two doses), for a total treatment of 4–6 months. A second
course may be used two months following the cessation of the initial
course if severe acne recurs. Efficacy appears to be related to the
cumulative dose of isotretinoin taken, with a total cumulative dose of
120–150 mg/kg used as a guideline. High dose treatments should only be
used as a last resort due to adverse side effects.
Other studies show that lower dosage treatments are just as effective.
In these experiments, subjects used 20mg/day, which is 0.25 mg/kg/day
for an 80 kg (176 pounds) person.
Adverse effects
Increasingly higher dosages will result in higher toxicity, resembling
vitamin A toxicity. Adverse drug reactions associated with isotretinoin
therapy include:
Common: Mild acne flare, dryness of skin, lips and mucous membranes,
infection of the cuticles, cheilitis, itch, skin fragility, skin
peeling, rash, flushing, photosensitivity, nose bleeds, dry eyes, eye
irritation, conjunctivitis, reduced tolerance to contact lenses,
hyperlipidaemia, raised liver enzymes, headaches, hair thinning, myalgia
and/or arthralgia.
Infrequent: severe acne flare, raised blood glucose level, increased
erythrocyte sedimentation rate, fatigue.
Rare: impaired night vision, cataracts, optic neuritis, menstrual
disturbances, inflammatory bowel disease, pancreatitis, hepatitis,
corneal opacities, papilloedema, idiopathic intracranial hypertension,
skeletal hyperostosis, extraosseous calcification, and it is believed
that severe depression can occur, although there is no conclusive
evidence for this.
The following adverse effects have been reported to persist, even after
discontinuing therapy: alopecia (hair loss), arthralgias, decreased
night vision, inflammatory bowel disease,degenerative disc disease,
keloids, bone disease. High dosages of isotretinoin have been reported
to cause rosacea (a disease of severe facial skin redness and
irritation).
Erectile dysfunction in the form of difficulty in maintaining erection
was reported in several patients in a clinical study. The impotence may
have been caused by the psychiatric side effects of isotretinoin. Sexual
dysfunction is not, however, acknowledged as a side-effect in the
official literature accompanying the drug.
While vitamin E supplements have been advocated by some to reduce the
toxicity of high-dose retinoids without reducing drug efficacy, test
results have proven this to be false.
Patients receiving isotretinoin therapy are not permitted to donate
blood during and for at least one month after discontinuation of
isotretinoin therapy due to reported birth defects to unborn children.
Depression
Several studies have suggested a possible link between isotretinoin and
clinical depression. However, no conclusive evidence has been produced.
Despite this, the argument that isotretinoin caused depression and
suicide has won a few lawsuits, and is partially responsible for the
strict control of the drug, especially in the United States. Various
case reports of depression, suicidal ideation, suicide attempt, and
suicide in patients treated with isotretinoin have been reported to the
U.S. FDA Adverse Events Reporting System, with 431 cases reported
between 1982 and May 2001 – of these 37 patients had committed suicide.
While analyses have suggested an association between isotretinoin
therapy and depression, no causal relationship has been established and
further studies are required.
Studies have shown that patients with acne, the population group
eligible to receive isotretinoin therapy, have an increased risk of
clinical depression compared with the general population. Chee Hong
describes Isotretinoin-related depression as "an idiosyncratic
side-effect", claiming, often anxiety can bring on acne and depression,
creating more anxiety. Correspondingly, treatment of severe acne with
isotretinoin has been shown to reduce anxiety and depression, for tests
have shown acne to be a main depressant in most tested patients' lives.
Psychological effects
In addition to possible anxiety, several studies have shown that male
patients taking isotretinoin show increased sensitivity to testosterone,
and related psychological effects such as unusual irritability,
over-inflated self-confidence and increased sexual desire. It should be
noted that none of these symptoms have been known to be present more
than one month after the end of the treatment.
WARNING: Consult with you doctor before using this treatment for acne