Isotretinoin is a potent oral medication belonging to the retinoid class, primarily used to treat moderate to severe acne vulgaris. This drug effectively reduces sebaceous gland secretion, prevents follicular keratinization, and has anti-inflammatory properties, making it especially suitable for cases unresponsive to other treatments such as antibiotics or topical ointments.
The typical treatment cycle lasts 15 to 20 weeks, with long-lasting effects and a significant reduction in the formation of acne scars. However, due to the potential for serious side effects, patients must use this medication under the supervision of a dermatologist and strictly follow prescribed guidelines.
The scientific name of isotretinoin is "Isotretinoin." Common brand names include:
Other brand names may exist in different countries or regions, but the scientific name and active ingredient remain the same. Always verify the medication label and consult your physician before use.
Isotretinoin is classified as a "retinoid" medication, an oral form of vitamin A derivative. These drugs regulate epidermal cell differentiation and sebum production, used to treat resistant or severe skin conditions.
Unlike topical retinoid products, oral isotretinoin has systemic effects, offering stronger efficacy but also carrying higher risks of side effects. Prescription should be made by a specialist after proper evaluation.
Isotretinoin is mainly indicated for:
In Taiwan, this medication requires approval from the Ministry of Health and Welfare and a signed informed consent form prior to use.
Minor side effects include:
Serious side effects should be reported immediately to a physician:
Strictly prohibited for pregnant women or women who may become pregnant: Isotretinoin can cause severe fetal malformations. Patients must participate in the "iPLEDGE program" (or similar monitoring system in other countries) and undergo pregnancy testing before and during treatment.
Contraindications include:
Concurrent use with the following medications may enhance side effects:
Alcohol consumption is prohibited during treatment, as alcohol can exacerbate liver toxicity. Consult a physician before using moisturizers or topical medications to avoid worsening dryness symptoms.
Starting doses are typically 0.25 to 0.5 mg per kg of body weight daily, divided into two doses (morning and evening). The treatment duration depends on acne severity, with a total dose usually between 1.0 and 2.0 mg per kg.
Take with food to enhance absorption; avoid fasting to reduce gastrointestinal discomfort. Regular blood tests to monitor liver function and lipid levels are necessary, along with skin response tracking during therapy.
If a dose is missed by more than 3 hours, skip the missed dose and take the next dose at the scheduled time. Do not double the dose to compensate. If missed within 3 hours, take as soon as possible.
Do not increase the dose to make up for missed doses, as this may cause toxicity. If treatment is interrupted due to missed doses, re-evaluate the treatment plan with your physician.
If overdose is suspected, seek immediate medical attention. Symptoms may include severe vomiting, abdominal pain, altered consciousness, or drowsiness. Treatment may involve gastric lavage, activated charcoal, and supportive care.
Do not attempt to treat overdose yourself. Go to the emergency room or poison control center immediately and bring the medication bottle for reference.
During isotretinoin treatment, the skin may become dry or flaky. It is recommended to use soap-free, low-irritant cleansers, and avoid hot water. Use fragrance-free, moisturizing lotions, and avoid products containing alpha hydroxy acids or alcohol. Strictly avoid sun exposure; apply SPF30 or higher sunscreen and wear protective clothing when outdoors.
Is it necessary to supplement vitamin A or other nutrients during isotretinoin therapy?Avoid additional vitamin A supplements during treatment, as isotretinoin already provides an effective dose. Excessive intake may increase liver burden or cause toxicity. Obtain vitamin A from dietary sources (such as leafy greens and carrots), following your doctor’s instructions. Vitamin B complex or Omega-3 fatty acids may help alleviate side effects like dry lips but should be used after consulting your physician.
What should be done if joint pain or muscle discomfort occurs during treatment?Minor muscle or joint pain is common and usually transient. It can be alleviated with warm compresses or non-pharmacological methods. If pain persists over two weeks, significantly affects daily activities, or is accompanied by fever or swelling, stop medication and consult a doctor for assessment. Your physician may adjust the dose or recommend short-term NSAID use under supervision.
How should dental treatments (such as tooth extraction or implants) be scheduled during therapy?Isotretinoin may prolong tissue healing and increase the risk of gingival inflammation or bleeding after extractions. Complete necessary dental examinations and treatments before starting therapy. During treatment, avoid invasive dental procedures. If urgent treatment is needed, your doctor will evaluate whether to pause or adjust the medication. Maintain excellent oral hygiene and avoid irritating affected areas during healing.
Is skin rebound worsening common after stopping medication? How can it be prevented?About 10-20% of patients may experience temporary inflammatory rebound after discontinuation, usually resolving within weeks to months. To reduce this risk, continue using topical antibiotics or benzoyl peroxide after stopping medication and maintain good skin hygiene. Your doctor may recommend continuing other oral medications (such as antibiotics) or adjusting topical treatments post-therapy, with strict follow-up.
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