After Roaccutane for 6 months.
Roaccutane represents the most advanced treatment of acne and has revolutionised its treatment. The generic name of Roaccutane is Isotretinoin. The information below applies equally to Roaccutane and its generic equivalents Oratane, Acnetane and Acnetret. Reference to any one of them includes all the others.
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Indications for the use of Roaccutane
1. Severe nodulocystic acne
2. Moderately severe acne not responsive to antibiotics (males and females) and hormonal contraceptives (females only)
3. Adult onset acne
4. Acne that is scarring
Generic equivalents of Roaccutane
Roaccutane is the trade name of the original product made by Roche pharmaceuticals.
The following generics are available:
Any of the 4 products may be taken. It is advisable to stick to the chosen formulation throughout your treatment.
Side effects of Roaccutane (Same applies to Oratane, Acnetane, Acnetret)
Mood swings / depression
Temporary hair loss
Abnormal liver function
Side effects of Roaccutane:
Dry lips: Almost all patients experience at least some degree of dry lips. A lip balm which has been especially formulated with sunscreen, is available at the rooms to help with this. It can be applied as many times as is necessary. In fact, keep it with you all the time.
Dry nose: sometimes. Naseptin ointment can be applied for this twice a day
Dry eyes: sometimes. Tears naturale is usually used for this.
Joint pains: Occurs in 16% of people taking Roaccutane. It can be controlled with non-steroidal anti-inflammatories. Discuss this during your visit if you are experiencing this side effect. It often takes the form of backache, but any of the joints may be involved. A dose reduction may sometimes be necessary.
Abnormal liver function tests, Triglyceride and Cholesterol levels: These are measured by means of blood tests before starting treatment, after one month of treatment and at the end. The tests are taken fasting. Please contact the rooms 3 days after the tests are taken to find out the results. Please note that your results are not phoned through to you even if abnormal.
Mood swings and depression: Please report this to the practice at any stage during your treatment. It is wise to let a family member or friend know that you are taking this medication so that they could also observe for any changes in mood and behaviour.
Isotretinoin (Roaccutane, Oratane, Acnetane, Acnetret) is potently teratogenic - i.e. it can cause major foetal abnormalities if taken during pregancy. All females of child bearing potential are required to take a reliable contraceptive from 1 month before treatment, throughout treatment and for one full month (30 days) after the end of treatment.
There is no equivalent side effect in a male. A male may father a child whilst on Isotretinoin.
In females, a pregnancy test is sometimes required where there is any possibility of pregnancy.
Isotretinoin does not cause sterility / infertility.
Roaccutane (Oratane, Acnetane, Acnetret) does not affect ovulation in a female. It does not make it difficult for a female to fall pregnant. It affects the foetus during development of vital organs.
Avoid waxing during treatment
Avoid any laser procedures during treatment (see update below)
Wear a sunblock during daylight hours
Avoid excessive sun exposure
Flare up of acne: in about 10% of individuals, the acne may flare up initially. This usually happens in the first two weeks of treatment. It can be controlled with medication which is usually issued at the onset of treatment. Please get in touch if you notice worsening and do not have any medication for it.
Hair loss: Occasionally, hair loss may be experienced during treatment. This is temporary and recovers when the treatment is over. It can be treated if necessary.
How Roaccutane (Oratane, Acnetane, Acnetret) is used in this practice
Roaccutane is monitored by means of clinical photographs. Your photos will be taken before starting treatment, at intervals during treatment if necessary, and at the end of treatment.
Please see the receptionist after your consultation for the following:
1. Consent form
3. A booklet from the manufacturer (explaining side effects and some useful information on the medication
4. Forms for blood tests (liver function tests, Cholesterol and Triglyceride). The tests need to be done fasting - no eating and drinking after 10pm and blood tests taken the following morning.
5. Secure appointment for one month (live or on-line)
LOST YOUR DIARY? DOWNLOAD A COPY HERE
Please bring you diary along during each visit.
Please phone the secretary for the blood test results after 3 days. All results are checked by the doctor. If you are told that your results are normal, you may start your treatment. If abnormal, you will be advised what needs to be done or put through to the doctor who will discuss the abnormality and the measures to be taken.
Please note that for purposes of confidentiality, results are not phoned through to you even if abnormal.
Because of the nature of Roaccutane (Oratane, Acnetane, Acnetret) treatment, prescriptions are only given during a physical visit or a formal online consultation on a secure platform. Under no circumstances are scripts for Roaccutane issued by phone, fax or email. Please ensure that your follow up appointment is made in advance.
If you have any issues during your treatment, please phone the secretary who will secure an urgent appointment for you.
Follow up is usually monthly during treatment. However, if treatment is progressing well, the interval between visits may be increased. The one month visit is essential.
Blood tests are requested at the start of treatment, one month after starting, and at the end of treatment.
How to take Roaccutane, (Oratane, Acnetane, Acnetret)?
Roaccutane is best absorbed in a fatty medium. It is therefore best to take it with food. A normal balanced diet usually contains enough fat (along with carbohydrate and protein) to aid in absorption of the medication.
What is low-dose Roaccutane?
Under certain circumstances, a low dose of Roaccutane has been advocated. Typically 20mg every second day. The duration is much longer than for the standard dose. Such dose may be justified in the following:
Adult patients who have persistent but not severe acne.
Patients who have recurrent acne after the use of Roaccutane.
Low dose Roaccutane is best avoided in young females because of the risk of pregnancy during long term use.
What is the duration of treatment?
The total amount of Roaccutane taken depends on body weight. The daily dosage, the total dosage and the duration of treatment are calculated at the start of treatment. The typical duration of Roaccutane is around 6 months.
What happens at the end of treatment?
Once the desired total dose has been reached, the treatment is stopped. The medication does not need to be tailed off and no maintenance dose of Roaccutane is given.
What other medications may be used with Roaccutane?
If there is worsening of the acne after starting Roaccutane, oral prednisone is often prescribed to dampen down the flare.
If boils (cysts) develop, steroid injections can be given into the boils to allow them to resolve quickly.
If the acne is very severe and takes longer than expected to clear, Purbac (Bactrim) is sometimes added to the treatment.
Can the acne come back after taking Isotretinoin?
Roaccutane results in a cure in 70% of people taking the medication. The acne can recur in up to 30% of patients. If a recurrence occurs within two months of stopping treatment, a further 2 months of Roaccutane can be taken. If a recurrence occurs after this time, a fresh course has to be taken.
Not all recurrences require another course of Roaccutane. Some can be controlled with just topical medication, other with antibiotics (males and females) or hormonal treatment (females only).
There is no limit to the number of times Roaccutane can be taken. The same precautions apply for each course.
What treatment is there for scarring after Isotretinoin treatment?
Please follow the link for more information on these procedures and be sure to watch the videos demonstrating each procedure.
4. Keloidal scars may be treated with injections of cortisone into the keloids and with silicone gel plasters such as ScarSmooth (buy now).
What about timing of procedures after or during a course of Roaccutane?
A recent consensus paper indicated that it was no longer necessary to delay chemical peels and nonablative lasers while a person is on isotretinoin due to concerns about wound healing.
Reference: Spring, L.K., Krakowski, A.C., Murad, A. et al. Isotretinoin and timing of procedural interventions: A systematic review with consensus recommendations. JAMA Dermatol. 2017; 153: 802–809
What if there is a history of depression or if any psychiatric medications are being taken?
A report will be required from your psychiatrist before considering Roaccutane
New information regarding depression
We now have a large study that looks at depression risks associated with isotretinoin, and isotretinoin actually appears to improve depression in individuals with acne.
Reference: Huang, Y. and Cheng, Y. Isotretinoin treatment for acne and risk of depression: a systematic review and meta-analysis. J Am Acad Dermatol. 2017; 76: 1068–1076
How about Roaccutane and Inflammatory Bowel Disease
Over the past decade, there have been many studies that find no association between isotretinoin and inflammatory bowel disease.
Ref: Acne vulgaris: What's new in our 40th year
Harper, Julie C.
Journal of the American Academy of Dermatology, Vol. 82, Issue 2, p526–527
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