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This is a clinical, prospective, and longitudinal study comparing the efficacy and incidence of averse effects of topical isotretinoin against those of topical retinoic acid in the treatment of acne vulgaris. The criteria of exclusion were as follows: pregnancy or lactation, systemic treatment with steroids, antibiotics, antiandrogens, or oral retinoids in the preceding 24 months, treatment with ultraviolet radiation, hypersensitivity to retinoids, or a severe systemic illness.
From 44 interviewed patients, 14 were excluded. A detailed clinical history was obtained from the remaining individuals, the degree of seborrhea was recorded, and acne lesions were counted. Each patient received either isotretinoin gel 0. The patients were instructed to wash their faces in the mornings and evenings with a neutral soap, and to apply the product after the evening cleansing.
The patients were examined again after 2, 4, 8, and 12 weeks of treatment and, at each appointment, the number of lesions was recorded and the severity of acne was graded according to the classification of Plewig and Kligman. The efficacy of each drug was determined by the reduction in the number of lesions between weeks 0 and 12 of treatment. The results were analyzed statistically using the chi-square test, the exact test of Fisher and the test of Wilcoxon-Mann-Whitney.
The changes in the numbers of lesions between weeks 0 and 12 were analyzed separately for each group of treatment, and the level of statistical significance was fixed at 0. The analysis was performed with the aid of a Stat program, version 4.
Each group was composed of 15 individuals and, as a coincidence, in each group there were nine women and six men. The clinical differences between the groups at the first visit were not statistically significant. In both groups, there was, in general, a good response to treatment Fig. Both drugs had a similar degree of efficacy on inflammatory lesions.
Similar results were observed regarding noninflammatory lesions Fig. Ten of the patients of Group II complained of stinging associated with the treatment, especially at weeks 8 and 12, as well as erythema and desquamation at the 12th week.
Erythema and stinging lasted for minutes or hours, whereas desquamation persisted for several days. Seven individuals receiving isotretinoin mentioned irritation, which was of a mild degree. Abstract This is a clinical, prospective, and longitudinal study comparing the efficacy and incidence of averse effects of topical isotretinoin against those of topical retinoic acid in the treatment of acne vulgaris.
Substances Keratolytic Agents Tretinoin Isotretinoin.
Acne Treatment Post-Accutane.28 Best Products to Help With Accutane Side Effects | The Strategist
Topical isotretinoin vs. topical retinoic acid in the treatment of acne vulgaris.
Some blood tests are required. After hearing so much about how effective isotretinoin is, patients expect dramatic results the first month and need to have their expectations managed.
Temporary improvement vs. Isotretinoin is the only medication to produce a substantial permanent reduction in acne after you stop taking it. Isotretinoin is the only medication where these expectations can largely be met. For some people, it is quite a shock that at age 14 for example, without isotretinoin and sometimes with it if they do not get full clearance they will be treating their acne at least another five years.
This stark contrast between isotretinoin and non-isotretinoin treatment should be made crystal clear. How does it work? Isotretinoin works by shrinking your oil glands and normalizing the way your skin grows, which prevents pimples and clogged pores.
Because your lips have a lot of oil glands they will become dry first, followed by your face and possibly other areas. Using lip balm frequently and moisturizing creams can manage these symptoms quite well. You will also sunburn faster. We expect the medication to do this—this is how it works. Isotretinoin does not make scars or PIH post inflammatory hyperpigmentation , or post inflammatory erythema disappear.
Some of the red marks and brown spots will clear up as your acne clears. The scars will not be affected by isotretinoin. A few months after you finish treatment, we can see what red marks and brown marks remain, assess your scarring, and review your treatment options for clearing those up. Some treatments, like hydroquinone blend bleaching creams, can be initiated immediately after isotretinoin is finished or even during treatment if the skin can tolerate it.
For some treatments lasers, chemical peels, etc. Initial flare is not therapeutic! I f your acne gets worse in the first month or two, let us know so we can treat it! Initial flare is a common but preventable side effect. The more severe, inflammatory, widespread and cystic the acne is, the more common initial flare is. Strategies to prevent initial flare include lower initial dose and concurrent use of prednisone the first month. Acne can also get worse the first month simply because all other acne medications have been discontinued and isotretinoin may take a month or two to begin working, causing a treatment gap.
Keep in mind that non-drying topical medications can be continued as can spironolactone for female patients and any antibiotic except tetracyclines due to the increased risk of Pseudotumor Cerebri. Take with food: Isotretinoin absorbs twice as well if you take it with meals.
Isotretinoin is a lipophilic medication. One study showed 1. For the first few monthly follow-ups, I reinforce this important message of taking the medication with food. The easiest way to asses if the patient is a candidate for bid dosing is to ask if they have breakfast most days.
If they do, ask what they eat. If it is a light meal or they do not regularly eat breakfast, stick with QD dosing. Although the pharmacokinetics do favor twice daily dosing, if that causes more medication to be taken in the fasting state with poor absorption, it is counterproductive.
In isotretinoin-Lidose Absorica came on the market promising higher absorption both in the fed and fasting states.
While it does have a marginal edge in the fed state vs generic isotretinoin keep in mind this was tested with the 1, calorie high fat meal, which very few people eat its real advantage is in the fasting state. Its fasting absorption is 68 percent versus the fed state. This was much better than standard isotretinoin, which only reached Over the course of treatment, poor absorption could lead to lower actual cumulative doses and higher relapse rates.
Patients with low fat diets or those who have irregular meal schedules benefit most from isotretinoin-Lidose. Birth defects: This medication can cause birth defects only while you are taking it and a month after, which is explained at the last visit but does not affect long-term fertility.
What this means is that if you become pregnant while taking it there are very strong odds of losing the baby or of serious birth defects. For this reason every female who is biologically capable of becoming pregnant must take monthly pregnancy tests and have a pregnancy prevention plan.
Your colleagues will almost certainly offer positive feedback and praise for this drug. Many have even prescribed it to their own children. However, when you discuss it with patients, a significant number have a negative opinion. How did this huge disconnect happen? It would take an entire article to detail the history of the bad press isotretinoin has received.
This creates significant challenges reconciling our views with what the patient has heard from non-expert sources. Great care must be taken when discussing isotretinoin as a treatment option, as it has a potential to alienate patients if not done properly. They report feeling overwhelmed and like they had little input and were not given all the treatment options. Even if the patient is open to taking isotretinoin, it is easy to understand their concern taking a medication that requires monitoring and is teratogenic.
The right approach is crucial. Illustrated by Daniel Koppich. Accutane is no joke: For people with severe cystic acne, it can be life-changingly effective. But, it's definitely one of those "it gets worse before it gets better" situations.
So, what's the right way to treat your skin when it's going through such extreme phases? Do you have to passively suffer through the bad times in order to reach the clear-skin times? According to Dr. The clinical differences between the groups at the first visit were not statistically significant.
In both groups, there was, in general, a good response to treatment Fig. Both drugs had a similar degree of efficacy on inflammatory lesions. Similar results were observed regarding noninflammatory lesions Fig. Ten of the patients of Group II complained of stinging associated with the treatment, especially at weeks 8 and 12, as well as erythema and desquamation at the 12th week. Erythema and stinging lasted for minutes or hours, whereas desquamation persisted for several days. Seven individuals receiving isotretinoin mentioned irritation, which was of a mild degree.
Isotretinoin, the drug that revolutionized acne treatment, is the only medication that can clear acne and produce long-term remissions. Since its introduction init continues to be a vital and widely used acne medication worldwide. It is used mainly for severe, recalcitrant nodulocystic acne as well as recalcitrant moderate acne. Abroad, isotretinoin tends to be dispensed more liberally than in the US and with a trend toward lower doses.
This article will not cover the well known pharmacology, dosing, and side effects of this medication. The goal is to have the patient very well educated and for the provider to have all the tools and knowledge to guide the patient through a successful treatment. Educating patients about isotretinoin and how it differs from other treatments is no easy task. Isotretinoin is a unique drug and is completely different than any other acne medication. Below are the topics that are essential to cover during the patient visit and information on how I explain them to patients.
Much of this information is included in the Isotretinoin Fact Sheet to be discussed later that I routinely hand out. Q: What is isotretinoin? Isotretinoin is a pill you take for four to five months. Your acne will start to improve in one to two months, and the vast majority of people are clear at the end of treatment. It is the only acne medication that permanently reduces acne an average of 80 percent—some people a little more and some a little less.
It also makes our skin less oily long-term. Twenty percent of patients take the medication a second time if they still have significant acne. Some blood tests are required. After hearing so much about how effective isotretinoin is, patients expect dramatic results the first month and need to have their expectations managed.
Temporary improvement vs. Isotretinoin is the only medication to produce a substantial permanent reduction in acne after you stop taking it. Isotretinoin is the only medication where these expectations can largely be met. For some people, it is quite a shock that at age 14 for example, without isotretinoin and sometimes with it if they do not get full clearance they will be treating their acne at least another five years. This stark contrast between isotretinoin and non-isotretinoin treatment should be made crystal clear.
How does it work? Isotretinoin works by shrinking your oil glands and normalizing the way your skin grows, which prevents pimples and clogged pores. Because your lips have a lot of oil glands they will become dry first, followed by your face and possibly other areas. Using lip balm frequently and moisturizing creams can manage these symptoms quite well. You will also sunburn faster.
We expect the medication to do this—this is how it works. Isotretinoin does not make scars or PIH post inflammatory hyperpigmentationor post inflammatory erythema disappear. Some of the red marks and brown spots will clear up as your acne clears. The scars will not be affected by isotretinoin. A few months after you finish treatment, we can see what red marks and brown marks remain, assess your scarring, and review your treatment options for clearing those up.
Some treatments, like hydroquinone blend bleaching creams, can be initiated immediately after isotretinoin is finished or even during treatment if the skin can tolerate it.
For some treatments lasers, chemical peels, etc. Initial flare is not therapeutic! I f your acne gets worse in the first month or two, let us know so we can treat it! Initial flare is a common but preventable side effect. The more severe, inflammatory, widespread and cystic the acne is, the more common initial flare is. Strategies to prevent initial flare include lower initial dose and concurrent use of prednisone the first month. Acne can also get worse the first month simply because all other acne medications have been discontinued and isotretinoin may take a month or two to begin working, causing a treatment gap.
Keep in mind that non-drying topical medications can be continued as can spironolactone for female patients and any antibiotic except tetracyclines due to the increased risk of Pseudotumor Cerebri.
Take with food: Isotretinoin absorbs twice as well if you take it with meals. Isotretinoin is a lipophilic medication. One study showed 1. For the first few monthly follow-ups, I reinforce this important message of taking the medication with food. The easiest way to asses if the patient is a candidate for bid dosing is to ask if they have breakfast most days. If they do, ask what they eat.
If it is a light meal or they do not regularly eat breakfast, stick with QD dosing. Although the pharmacokinetics do favor twice daily dosing, if that causes more medication to be taken in the fasting state with poor absorption, it is counterproductive. In isotretinoin-Lidose Absorica came on the market promising higher absorption both in the fed and fasting states.
While it does have a marginal edge in the fed state vs generic isotretinoin keep in mind this was tested with the 1, calorie high fat meal, which very few people eat its real advantage is in the fasting state. Its fasting absorption is 68 percent versus the fed state. This was much better than standard isotretinoin, which only reached Over the course of treatment, poor absorption could lead to lower actual cumulative doses and higher relapse rates.
Patients with low fat diets or those who have irregular meal schedules benefit most from isotretinoin-Lidose. Birth defects: This medication can cause birth defects only while you are taking it and a month after, which is explained at the last visit but does not affect long-term fertility. What this means is that if you become pregnant while taking it there are very strong odds of losing the baby or of serious birth defects.
For this reason every female who is biologically capable of becoming pregnant must take monthly pregnancy tests and have a pregnancy prevention plan.
Your colleagues will almost certainly offer positive feedback and praise for this drug. Many have even prescribed it to their own children. However, when you discuss it with patients, a significant number have a negative opinion. How did this huge disconnect happen? It would take an entire article to detail the history of the bad press isotretinoin has received.
This creates significant challenges reconciling our views with what the patient has heard from non-expert sources. Great care must be taken when discussing isotretinoin as a treatment option, as it has a potential to alienate patients if not done properly.
They report feeling overwhelmed and like they had little input and were not given all the treatment options. Even if the patient is open to taking isotretinoin, it is easy to understand their concern taking a medication that requires monitoring and is teratogenic. The right approach is crucial. If our opinion is that isotretinoin is the only viable option, the conversation is straightforward.
A new acne patient questionnaire is a great starting point. Isotretinoin is on that list listed as Accutane so patients recognize it. Some people circle it and some cross it out this does not necessarily mean they will never consider it, but expect resistance. This level is very difficult to achieve for severe acne patients without isotretinoin and patients need to be educated to that reality.
Many believe that there has to be something else that will get them these results, therefore, a breakdown of available treatments and expected results is often needed. If not, the patient may believe that you are just pushing one treatment option on them.
Accutane is also a good option. The patient may then offer up what they have heard about Accutane, negative or positive. Many will not say anything, which usually indicates they have not heard of it at all and need to know the basics. Even if we convince them that this is the best treatment choice, and they agree, many will not return or will return wanting to try something else. We cannot and should not hold it against patients or look down on them that they have been exposed to misinformation that they accept it as fact.
There are not experts. It is considered safe, very effective, and has never been withdrawn from the market in any country for safety concerns. Within the dermatology community, it is not considered a controversial medication.
Dermatologists are very comfortable with its use, so much so that many prescribe it to their own children or relatives I usually add here that my brother took it on my recommendation. But the most important thing is that you have to be comfortable with it. If the patient wants to consider it as an option right then and there they will pursue that conversation, if not I pivot to other treatments. If the patient chooses other treatments, at least you have set the stage for more informative discussion down the road if they are not getting the results they want.
We have become very comfortable with using isotretinoin but must remember that for a patient, parent or teen, to consider taking a medication that is teratogenic and needs monitoring may just be too scary to consider, even if it is the only thing that will help. Often times our failure to navigate it and guide patients through it prevents patients from getting their medication.
Prescribers should not delegate iPLEDGE responsibilities to medical assistants without first mastering the system ourselves. For me this required several months of clearing people and making multiple calls to iPLEDGE, but it was a worthwhile investment. Going through this process, I concluded that it is unrealistic to expect a person with a medical assistant level education to master iPLEDGE on their own. We have to register them and clear them every month but they do absolutely nothing.
Whether these patients had blood tests is not a criteria for clearing them. They have a day window to pick up their medication. Registration cannot take place without a pregnancy test and even if the pregnancy test date precedes the registration date, the day window starts on the registration date.
This is why it is important to register patients the day the pregnancy test results come in to avoid delays. Schedule a four and a half to five week follow-up rather than four weeks follow-up for the second visit.
localhost › › Acne Treatment. Topical exfoliating agents, retinoids, and drying agents should be avoided because isotretinoin has a drying effect on the skin and mucous localhost is also. Embraced by the dermatology community, isotretinoin is still considered controversial Using lip balm frequently and moisturizing creams can manage these. We do not recommend using any type of topical medications while on Accutane. Most patient's skin is very dry from taking this medication so. The use of a retinoid is key to helping prevent relapse. These medications, in addition to treating acne, are also excellent anti-aging creams. Keep in mind that non-drying topical medications can be continued as can spironolactone for female patients and any antibiotic except tetracyclines due to the increased risk of Pseudotumor Cerebri. This creates significant challenges reconciling our views with what the patient has heard from non-expert sources. Whether these patients had blood tests is not a criteria for clearing them. They can be formed in all sizes and shapes and affect people of all age groups and gender. Shamban continues, "So, if that's happening, you can continue your topical acne skin-care program — that may include benzoyl peroxide, retinoid, or topical antibiotics. Alopecia is a condition where a person's hair falls out. Initial flare is a common but preventable side effect.Skip navigation! Story from Skin Care. Illustrated by Daniel Koppich. Accutane is no joke: For people with severe cystic acne, it can be life-changingly effective. But, it's definitely one of those "it gets worse before it gets better" situations. So, what's the right way to treat your skin when it's going through such extreme phases? Do you have to passively suffer through the bad times in order to reach the clear-skin times? According to Dr. Ava Shamban, Beverly Hills dermatologist and Allure Insider, "It takes 30 days for Accutane to reach therapeutic blood levels, which is why people may still experience breakouts during that time.
Shamban continues, "So, if that's happening, you can continue your topical acne skin-care program — that may include benzoyl peroxide, retinoid, or topical antibiotics. One of Accutane's most infamous side effects, though, is the severe dryness. So, what's the best way to treat that delightful experience?
Make sure to use a nondrying cleanser and a lightweight moisturizer, the dermatologist says. Shamban says. However, she notes that if you started with dry or extra-sensitive skin, there are new acne medications that won't irritate you and still be effective.
Just make sure you ask your dermatologist what your options are. For more insid. I try a lot of skin-care products, both as part of my job and because I love it. As such, everything from Cetaphil cleanser which, love to triple-digit m. But with the promise of cozy evenings and actually being able.
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