Oral Isotretinoin (Roaccutane, Oratane, Acnetane) is the most effective treatment for acne and has been used for more than 30 years, writes Dr Jonathan Smith. Due to its effect on the developing foetus and other possible adverse reactions, it’s classified as a schedule 5 drug and should only be taken under strict supervision of a medical practitioner, preferably a dermatologist.
During the past 10 years, there has been much debate about the use of low-dose isotretinoin, with the aim of keeping acne under control without the inconvenience of severe adverse reactions such as dry lips, nose, eyes and skin, as well as sensitivity to the sun and aching muscles and joints.
The downside of using these low doses is that the acne tends to relapse when treatment is stopped and that the longer the use of isotretinoin, the higher the risk of pregnancy.
Studies have proven that when isotretinoin is taken at a dosage of at least 0,5 mg per kilogram body mass per day (ie 30 mg or more for a 60 kg patient) to reach a cumulative dose of 220 mg per kilogram or more, there’s a significantly decreased risk of relapse.
Retinoid dermatitis (an eczema-like rash) was the only significantly more common adverse reaction for those in the high-dose group. It usually can be controlled easily on topical corticosteroids and moisturisers.
The products which need to be used with oral isotretinoin include an effective sunscreen (SPF50+), a cleanser that doesn’t dry the skin and artificial tears.
If acne doesn’t relapse for three to six months after a full course of oral isotretinoin, the scarring can be addressed with modalities such as micro needling, chemical peels and laser therapy at Lasermed.
People on a low dose/pulse dose of oral isotretinoin may have certain treatments such as superficial chemical peels. It’s best to perform a patch test first to see how the skin reacts.
Lasermed and Dermashop stock the following topical products that will ease the dryness caused by oral isotretinoin:
Avéne Cleansing Gel (soap free)
Avéne Cleanance Hydra Soothing Cream
Dermaquest Essential B5 Hydrating Serum
Dermaquest Delicate Soothing Serum
Bioderma Hydrabio Serum
Heliocare Oil Free Gel SPF 50 (face)
Heliocare Spray SPF 50 (body)
Photoderm Fluid SPF 50
