By: OLGA LUCIA MUÑOZ LÓPEZ, Journalist
Although the benefits of isotretinoin treatments for severe acne control are much proven, many myths about its use by youngsters remain. To clarify the subject, we consulted the dermatologist Franchezca Zapata González.
The specialist explains that isotretinoin (commercially known under the brands Roaccutan®, Isoface®, or Atretin®) is an oral retinoid*, whose main action is to decrease the production of fat in sebaceous glands, avoiding the production of zits and pimples. The dose is calculated based on the weight of the patient and, ideally, it should be prescribed for a determinate length of time with the goal of increasing the possibility of achieving a complete cure of acne.
Not all young people who suffer from acne can benefit from a treatment with oral isotretinoin, not only because of the adverse effects of the medication, but because not all patients are "cured" with this medication, says the dermatologist: “In general terms, the indications for prescribing oral isotretinoin are severe acne (those with cysts, nodules or scars) and refractory cases of acne, i.e. those in which conventional treatment has been performed (topical retinoids, antibiotics and/or contraceptives) without improvement. "
It does not cause sterility, blindness or depression
There are many myths about isotretinoin that have produced unjustified fears in many patients when they are proposed to initiate treatments with this medicine. Among them are statements such as: "It damages my liver and kidneys", "It produces sterility", "It leaves me blind" or "It depresses me".
Regarding the real risks of alterations in health for those who consume this medicine, and in contrast to the myths we stated before, Franchezca Zapata González said: "The most frequent problems have to do with the dryness that occurs throughout the body, evidenced specially on the lips and skin. This dryness or xerosis can be treated in most cases with lip balms and body moisturizers. "
She was emphatic in stating that oral isotretinoin does not produce blindness and that visual disturbances themselves are very uncommon complications, although eyes do tend to dry out during treatment. This increases the risk of conjunctivitis and traumatic corneal ulcers. This effect is effectively prevented by the use of lubricating eye drops.
Another side effect is the increase in blood lipids (cholesterol and triglycerides) that occurs after the first month of treatment and is reversible at 4 to 8 weeks after discontinuation of the drug. This effect can be managed with hypolipemic drugs (which decrease lipids in the blood) and/or a proper diet.
The specialist said that depression is a very rare effect in treatment with oral retinoids: "It usually occurs in the first months and is a consequence of the initial outbreak of acne that occurs in the first months of treatment, rather than an effect of the medication. In patients with a history of depression and psychiatric illness, it is generally recommended to have a joint follow-up with a psychiatrist if they want to start the treatment. "
Another side effect of oral retinoids is hepatic toxicity, which occurs in less than 1% of patients, and usually resolves after discontinuing or decreasing the dose of treatment. This effect is diagnosed when there is an increase of blood levels of liver enzymes, which is why it is recommended to perform periodic examinations every 2 to 3 months, in addition to restricting the intake of liquor during the treatment.
The dermatologist reiterated that isotretinoin does not produce renal alterations and that hematological alterations, such as medullar aplasia, are very rare reactions: "American guides of acne management do not even recommend to perform routine hematological tests (Red and white blood cell measurements) during treatment with isotretinoin.”
Contraceptives + isotretinoin?
A frequent consultation revolves around the fact of why some women initiate oral contraceptives jointly or in replacement of oral isotretinoin. About this topic, the expert reported that this is done because in some patients acne is of hormonal origin and some type of oral contraceptives (Such as Yasmin®, Bellaface®, or Diane 35®) act by counteracting the effect of hormones on sebaceous glands. The choice of contraceptive depends on the type of patient and the type of alteration.
She also answered another frequent question on whether the consumption of these contraceptives causes weight gain, stating that this doesn’t occur in most patients: "Weight gains are more frequent when using methods such as a quarterly injection (Depoprovera); it can slightly increase the percentage of body fat."
The greatest risk: fetal malformations
Franchezca Zapata González confirmed that from the risks and side effects of oral retinoids, the one most feared by dermatologists and doctors is that of teratogenicity or fetal malformations. This occurs only in women undergoing isotretinoin therapies (men who procreate during treatment do not have associated risks).
For this reason, when prescribing isotretinoin to women of childbearing age, it is recommended to use double contraceptive techniques, she said: "The teratogenic effect only occurs while on treatment, and one month after suspending it, the patient may think of becoming pregnant without any inconvenience. That is, isotretinoin does not produce definitive changes in fertility in men nor women."
Recommendations for using isotretinoin
The specialist explained that the best recommendation for those who want to start treatment with isotretinoin is to avoid self-medication, since you should always perform the treatment accompanied by a doctor or dermatologist.
Also, go through the tests ordered by your doctor before and during treatment; avoid drinking alcohol; do not become pregnant to avoid the high risk of fetal malformations; carry a healthy diet to prevent increased blood lipids (fats); use skin moisturizer, eye lubricants, and lip balm; and use sunscreen daily.
* A chemical compound related to vitamin A.