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.
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)
Abnormal liver function
Mood swings / depression
Abnormal liver function
Isotretinoin (Roaccutane, Oratane, Acnetane, Acnetret) is potently teratogenic - i.e. it can cause major foetal abnormalities. All females of child bearing potential are required to take a reliable contraceptive from 1 month before treatment, throughout treatment and up to one month after the end of treatment.
A pregnancy test is sometimes required where there is any possibility of pregnancy.
Isotretinoin does not cause sterility / infertility.
There is no equivalent side effect in a male. A male may father a child whilst on Isotretinoin.
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
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
2. Roaccutane diary (a copy may be downloaded here)
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
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. 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 aborbed 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 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.
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 the acne is very severe and takes longer than expected to clear, Purbac (Bactrim) is sometimes added to the treatment.
If boils (cysts) develop, steroid injections can be given into the boils to allow them to resolve quickly.
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?
1. Chemical peels and microdermabrasion can be offered a month after the end of treatment.
2. Microneedling can be performed 6 months after treatment
3. Fractional laser treatment and surgical correction of scars can be considered 1 year after treatment.
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
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
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