Retinoids - maximise the benefits, reduce the risks
Prior to starting on isotretinoin capsules the following are normally tested:
- blood tests looking at blood fats (cholesterol and triglycerides), liver function, a blood count and some hormone tests
- pregnancy tests in relevant females are also performed.
Retinoids work by reducing the size of the sebaceous glands and the amount of oil they produce. Therefore, one of the most common side effects is dryness, scaliness or irritation of the skin.
This can be significantly reduced by taking precautions such as washing with a gentle soap-free cleanser and using an oil-free non-comedogenic moisturiser (preferably with sunscreen SPF 30).
When you start treatment with retinoid creams or gels, apply only a thin smear every second evening to the areas prone to acne.
After several weeks, if skin dryness and irritation is minimal, you can move to nightly application for maximum benefit. By this time the skin has partially adapted to the irritating effects of these creams or gels and is better tolerated.
People taking isotretinoin capsules commonly find their lips are particularly dry and may need to use a lip balm containing sunscreen frequently. Dryness of the throat, nose and eyes are also potential side effects, which can be helped by eye drops and the application of a soft petroleum jelly (eg, Vaseline) just inside the nostrils.
Dryness may be worsened in a dry physical environment such as air conditioning or a low humidiy climate.
People taking isotretinoin capsules or using retinoid creams/gels should be aware that although this is the most effective acne treatment, their acne may get worse about three weeks into treatment. An antibiotic or anti-inflammatory may be prescribed in conjunction to try and prevent this. Don't give up!
This initial flare-up is thought to be partially due to excess oil being squeezed from the sebaceous glands. With continued therapy, acne flares generally become less severe, shorter in duration, less frequent and in most cases the acne improves.
If anyone is concerned about a flare-up in their acne after starting a new acne therapy they should contact their prescribing doctor for advice.
Retinoids make skin more easily irritated by sun, wind and water.
Increased sun sensitivity leading to quicker sunburn is common in Australia, particularly in spring and summer. It is important to take extra sun protection measures such as wearing sunscreen, broad-brimmed hat, protective clothing and seeking shade.
People on isotretinoin capsules can regularly use an oil-free, SPF30+ broad-spectrum waterproof sunscreen without worrying about it worsening acne. Check the UV Index via news reports, weather updates or websites such as www.arpansa.gov.au
Tiredness, muscular, joint aches and pains may uncommonly occur.
Generally these side effects are dependent on the number of capsules you are taking per day. If severe and unmanageable, reducing the dose taken each day may be an option to improve these side effects. However, this may prolong your course of capsules.
Rare side effects
These include hair loss, mood change, severe headaches associated with nausea, vomiting and vision changes may occur. If any of these symptoms occur, stop therapy and contact your doctor or dermatologist.
People with a family history of high cholesterol or triglycerides are at risk of having these blood fats increase while on isotretinoin treatment. A repeat blood test is usually done after a month or so after starting isotretinoin therapy to recheck these tests. Avoiding alcohol is advised.
It's important to have regular reviews by the prescribing doctor who can tailor therapy to suit the individual and provide more information on how to manage or prevent side effects.
If unwell, especially with glandular fever, your doctor may choose to hold treatment for a few weeks.
Last updated March 2016