Does Isotretinoin stunt growth in a child?
My son, Who is 15 years of age, height 5 feet 11 inch weight around 70 kg is getting acne for the last one year mainly around his nose , forehead and some on his neck area and leaving brown / black scars too. In the M/o October 2016, I visited a XXXXXXX dermatologist who prescribed him the following medicines:-
1. Ahoglow-s Face Wash
2. Cap Microdox 100mg
3. Tab Zitacre one Tablet daily
4. Deriva Gel at bed Time
5. Tab Isotroin 20 mg twice a week.
The aforesaid prescription was for 4 weeks only. He took antibiotics around 6-7 weeks later on I discontinued them as there was noticeable improvement in his skin condition, another reason I don’t wish him to be on antibiotics for a longer period. Presently, he is taking the prescribed prescription except antibiotics and Zitcare i.e. he is still using Ahoglow face wash, Deriva Gel and taking Isotroin 20 mg twice a week since October, 2016. My concern is about side effects of Isotroin 20 mg in his growing age and how long he can continue Isotroin without side effects??. Does it effect his growth as a young child?? Please guide me should he complete his course of Isotroin so that he can remain free from acne in his coming years or should I stop Isotroin as he is too young for it ? Please note, there is significant improvement in his skin condition now, though not totally clear and still getting minor acne mainly around his nose and forehead area and his skin is not oily.
Isotretinoin can be continued
Hello. Thank you for writing to me.
He is on a low dose of isotretinoin i.e 20mg, twice weekly. In acne, isotreinoin is usually prescribed for 6-12 months and it is usually sufficient.
This duration of isotretinoin is unlikely to have any side effects on his growth.
Only high doses (i.e 1 mg/kg/day) and prolonged and repeated courses of isotretinoin can rarely cause a side effect like diffuse interstitial skeletal hyperostosis which can present as back pain but this drug anyways does not interfere with body growth.
In my view there is no harm in continuing isotretinoin for his acne. Most of the side effects of isotretinoin like dryness and cheilitis (lip exfoliation) are mild and reversible.
Kindly suggest the duration of the isotretinoin 20 mg if taken twice in a week. Acne condition is minor to moderate not severe one.
Please let me know if frequent blood tests are required as it is mostly done if someone is on isotretinoin .
Let me know the name of tests and when it should be done.
Thanks & Regards
There is no single recommendation for mild to moderate acne. Doctors may device there own regime and duration of treatment depending on case to case basis. You will be surprised to you know that in literature there is no recommendation to give isotretinoin 20mg only twice a week!! but your doctor is justified in giving a lower dose because the patient is responding well to this dose. The why him give a higher dose and consequently more dryness and lip peeling?
However, in general most patients with moderate acne require once daily or twice daily dosing with isotretinoin which is absolutely safe and can be continued for 6-12 months. Shorter courses have a higher chances of relapse of acne.
Still many doctors do not give daily dose because they feel that some patients may not like dryness and cheilitis (lip peeling) and may discontinue isotretinoin. They are justified in giving isotretinoin alternate days or twice weekly.
The good thing about isotretinoin that it is not an antibiotic therefore there is no risk of resistance developing to it. It would be effective every time a patient is given isotretinoin.
In my view if he is well controlled on a lower dose of isotretinoin then the same dose can be continued for may be 4-6 months and thereafter the improvement can be maintained with just topical treatment. He might need some form of maintenance e.g a topical cream to keep his acne under control because acne can come back if he is off all treatment. Acne tendency would ultimately reduce with time.
Baseline LFT and Lipid profile before starting isotretinoin and then these tests can be repeated after 2-4 weeks of therapy. If the tests are normal then further testing can be perfomed only once every 3 months.
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