Isotretinoin Side Effects in Acne

How to Deal with Oral Retinoid Adverse Actions

Nov 10, 2009 Hanish Babu

The side effects of isotretinoin and how to effectively deal with them are discussed in this article.

Isotretinoin, the oral retinoid, is a very effective medication in severe types of acne but has some serious side effects. Patient education is essential on how to deal with the oral retinoid adverse reactions.

What is the Major Adverse Effect of Isotretinoin?

Oral retinoids are teratogenic. In women, if they get pregnant while on isotretinoin, there is a very high risk of having a severely deformed baby. Hence pregnancy is an absolute contraindication for use of oral retinoids. Women in the child bearing age group should make sure that they are not pregnant before, during and at least two months after completing the course of isotretinoin.

It is safer to start the first dosage of the medication immediately after a menstrual period. Double contraception of pills plus a barrier should be used while on isotretinoin and two months after the medication. Some authors advice only a gap of one month to become pregnant after stopping isotretinoin; it is safe to use contraception for an extra one month, just in case.

What are the Side Effects of Isotretinoin? And How Can You Deal with Them?

Dryness is the most common side effect of isotretinoin. Some patients may experience worsening of their acne during the first few weeks of starting the oral retinoid. This is expected and does not warrant discontinuation of the medication. The following is a list of common side effects of isotretinoin and a few tips on how to deal with them:

1. Dry skin - Take short showers with lukewarm water, soap free liquid cleansers, oil free face moisturizers immediately after wash.
2. Dry lips - A lip balm with sunscreen and containing cocoa butter is best. It should be used as often as possible. Avoid lip licking; this will increase chances of cracking. If bleeding and fissuring of the angles of mouth, see your doctor.
3. Dry nose - Dryness of nose can cause pain and nasal bleeding. Use nasal lubricants like Rhinaris lubricating nasal gel. If nasal bleeding develops, see your doctor.
4. Dry Eyes - This could be a real problem necessitating avoidance of contact lenses. Artificial tear drops should be used every hour to keep the eyes moist. At bed time an overnight eye moisturizer like Allergan Lacri-Lube ointment should be applied.
5. Dry hair and dandruff - Gentle shampoos should be used with a conditioner to protect the scalp and hair while on isotretinoin. Avoid using dyes and drying shampoos.
6. Dry genitals - These may cause pain during intercourse and necessitate use of a lubricant like K-Y jelly.
7. Dry anus - Dryness around the anus can cause irritation, itching and cracking. Applying Vaseline to the area after several times a day will help avoid dryness in this area.
8. Sun Sensitivity. Avoid too much sun exposure while on isotretinoin. Use regular sun protection while outdoors.
9. Body aches and joint pains - Some patients experience generalized muscle and joint stiffness and tenderness. Plenty of fluids, rest and analgesics are helpful.
10. Decreased night vision - Some patients experience decreased vision during night. Care should be exercised while driving at night if you are on isotretinoin.
11. Increased triglyceride levels - In persons with familial triglyceridemia, especially, this could increase cardiac risk and should be monitored in all patients taking isotretinoin. Triglyceride levels should be estimated prior to starting treatment, two to three weeks after the start of treatment and subsequently at four weekly intervals. If levels exceed 400 mg/dl, repeat blood lipids every two to three weeks. If value exceed 800mg/dl isotretinoin should be stopped as the risk of pancreatitis is very high in such patients.
12. Liver and kidney toxicity is monitored through appropriate tests before and during the treatment with oral retinoids.
13. Pseudo tumor cerebri, which causes a benign intracranial swelling and increased pressure within the cranial vault, is seen in some patients on isotretinoin. Tetracycline can also cause the same adverse effect; hence both medications should never be used at the same time in a patient.
14. There have been reports of suicidal tendencies and attempts to commit suicide by teenagers on isotretinoin. This serious side effect should be made known to the patients and their friends and relatives and they should be asked to remain alert to any mood swings and behavioral aberrations in the patient during the course of the treatment with isotretinoin.
15. Other rare side effects include skin infections, especially around the nails and inside the nose, peeling of the skin on the palms and soles, skin rashes, bleeding from the gums, dizziness, loss of weight, diarrhea, osteoporosis and abnormal menstrual periods.

Are There any Side Effects Which Would Necessitate Discontinuation of the Isotretinoin?

Certain side effects should be considered serious enough to necessitate stoppage of the oral retinoids. If any of the following adverse effects are experienced, stop the medication immediately and consult your doctor:

• severe abdominal pain, vomiting, diarrhea or anal bleeding
• headaches with vomiting and blurred or double vision
• yellow discoloration of eyes, skin and high colored urine with loss of appetite and nausea, signifying drug induced hepatitis

From the above discussion of the side effects of isotretinoin, it is clear that oral retinoids are to be taken only if absolutely indicated. Isotretinoin can work wonders in the treatment of acne, but the benefits come with a price. Hence it is to be used only for very severe types of acne where the potential for acne scar formation outweighs the risks of the medication.

Sources:

• Sanjiv Jain. Acne in Fun with Dermatology. Jaypee Brothers, New Delhi. 1998; 1: 92-98
• Breathnach SM et al. Systemic Therapy in Rook’s Textbook of Dermatology. 2004; 4:72.15-17.
• Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, Fifth Ed, 2005.

Disclaimer

The information given in this article is for educational purposes only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, Dr.Hanish Babu, MD or Suite101 will not be responsible for any consequences. The images provided are for illustration purposes only.

The copyright of the article Isotretinoin Side Effects in Acne in General Medicine is owned by Hanish Babu. Permission to republish Isotretinoin Side Effects in Acne in print or online must be granted by the author in writing.

Isotretinoin Side Effects: Education Important.

Oral Retinoids in Acne: Pregnancy to be Avoided.

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