Brief Answer:
Isotretinoin in Acne

Detailed Answer:
Hello. Thank you for writing to us at healthcaremagic

Dermatologists all round the world have been using Isotretinoin for acne with consistently reproducible results.
Once Or twice daily dosing of Isotretinoin for a total cummulative dose of 120-140 mg/kg is the ideal dosing schedule. This would take around 6 months of twice daily dosing in a 60 kg individual.
However some dermatologists may also use it as alternate day dosing Or once daily dosing for a week in every month and like that for a shorter period e.g 3-4 months.
Taking it for 2 weeks every 2-3 months may be another such modification that may have been advised by her dermatologist.
It can very well be combined with Oral antibiotics like Azithromycin in addition to topical treatment for acne.
The basis of modifying the dosing schedule of Isotretinoin is to reduce the side effects which are mostly dryness of lips (cheilitis), generalized dryness, increased hair shedding etc. With reduced dose and duration of treatment these side effects are obviously reduced.
The most concerning issues about Isotretinoin is that it is teratogenic i.e it can adversely affect the fetus, therefore retinoids are best avoided altogether in females of reproductive age group Or can be given in females only if adequate contraception is assured.
This restriction on pregnancy is till the patient is on Isotretinoin and for 1 month after discontinuing Isotretinoin.
Apart from the adverse effect on pregnancy, Isotretinoin can be assumed to be fairly safe for treatment of acne.
Minor reversible side effects like cheilitis, dry skin, increased hair shedding are common and usually the only side effects of Isotretinoin treatment.
Other side effects like minor elevations of liver enzymes, elevations of serum triglycerides are reversible and usually don't warrant discontinuation of treatment. Nevertheless they should be monitored in patients on Isotretinoin treatment.
Isotretinoin is absolutely non-hormonal i.e it has no hormonal side effects and does'nt alter menstural cycles in anyway.
Finally, there have been few reports of suicides in patients on Isotretinoin but that is because the patient were already suicidal because of severe acne or other psychological problems. On the contrary Isotretinoin improves the quality of life of acne patients.
In my view Isotretinoin brings remarkable improvement in severe acne and is considered to bring about the most significant improvement in moderately severe and severe grade acne. This is specially of benefit in acne patients who had lost all hope for an effective curative remedy for acne.
The dosing schedule and doses can be made flexible according to the severity of acne, however, the chances of relapse are more with shorter or low dose regimens.

Regards

---

Brief Answer:
Need more information

Detailed Answer:
Hi.

I usually prescribe Isotretinoin as once a daily dose initially and make it to twice daily after a month. I continue it till the total cummulative dose of 12-0-140 mg/kg is reached.
It can very well be combined with Oral antibiotics like Azithromycin in addition to topical treatment for acne.
I would like to know whether, Is there any menstural irregularity? Is there any coarse facial hair?

Regards

---

Brief Answer:
Oral+topical treatment

Detailed Answer:
Hi.

Acne is a recurrent condition and can continue for years Or decades and can reappear after seemingly complete cure.
If I was the treating doctor I would have asked her to take Isotretinoin once daily or twice daily for 4-6 months.
Oral antibiotics e.g Azithromycin, may also be started for Inflammatory acne.
Once significant improvement has been achieved, she may still be continued on a maintenance regime to prevent a relapse.
Topical treatment is an important part in the overall treatment of acne and consist of topical antibacterials like clindamycin, benzoyl peroxide, nadifloxacin etc. They are antibacterial and antiinflammatory.
Besides oral and topical antibacterials, Topical Retinoids like Adapalene or Tretinoin are usually part of the treatment of acne. Topical Retinoids are antinflammatory and comedolytic.
On account of the comedolytic activity of topical retinoids they are also useful for maintaining the improvement and useful as a maintenance treatment.
Therefore once significant improvement has been achieved, topical retinoids may still be continued as part of the maintenance regime and prevent a relapse.

Regards

---