Oral A-Retinoid Concerns: Acne, Side Effects, and Treatments

Questions regarding oral isotretinoin and similar medications?

Hello, Doctor.
Due to living in a remote area, the nearest dermatologist is quite far away.
After my visit, the doctor’s response differed somewhat from what I found online, so I would like to ask for your opinion to compare.
1.
The internet mentions that many patients experience a "purging phase" when taking oral isotretinoin, where acne becomes red, swollen, and proliferative.
Currently, I have very few "acne" lesions.
I have oily skin and occasionally develop some red, swollen pimples, along with enlarged pores and numerous comedones, but I do not have large, inflamed acne at the moment.
When I asked the doctor about the purging phase, he mentioned that he has patients who are more severe than I am and are taking isotretinoin.
However, many people online (such as on PTT) claim that almost everyone experiences a purging phase, which makes me worried.
I would like to know if the patients who experience this purging phase are the majority or the minority?
2.
I also found online that taking oral isotretinoin in conjunction with oral antibiotics may increase the risk of intracranial hypertension.
The doctor I consulted mentioned this but said it wouldn’t happen (he advised me to take isotretinoin in the morning and antibiotics in the evening).
I am quite concerned, so I would like to ask Dr.
Wu if this regimen is appropriate.
3.
Since I have a keloid tendency and some keloids on my face (on both sides of my jaw), I would like to know if taking oral isotretinoin will worsen my keloids.
(My keloids on the jaw have been stable for several years, with no significant enlargement or itching, just slight redness.)
4.
While on oral isotretinoin, what types of laser treatments can I undergo? I found literature stating that traditionally it was considered inadvisable, but there is new data suggesting it may not have an impact.
Additionally, can I perform comedone extraction while on isotretinoin?
I apologize for the numerous questions, and I appreciate your thoughtful responses.
Thank you very much!

louis, 10~19 year old female. Ask Date: 2016/11/26

Dr. Wu Yuxin reply Dermatology

1.
Not necessarily.
2.
For this question, you should consult your attending physician, as they are most familiar with your condition and can help you choose the appropriate medication.
3.
Keloids are likely related to individual constitution.
4.
Not recommended.

Reply Date: 2016/11/26

More Info

Dear Patient,
Thank you for your detailed questions regarding the use of oral A-retinoids (commonly known as isotretinoin) for acne treatment. I understand that you are seeking clarity on several concerns, and I will address each of your points based on current medical knowledge.

1. Understanding the "Initial Breakout" Phase: It is true that some patients experience what is often referred to as an "initial breakout" when starting isotretinoin. This phase can involve an increase in acne lesions, which may appear red and inflamed. However, not all patients will experience this reaction, and its occurrence can vary significantly among individuals. While anecdotal reports on forums may suggest that many experience this phase, clinical studies indicate that it is not universal. In fact, some patients, like yourself, may not experience significant breakouts at all. It’s important to remember that the response to isotretinoin can be highly individualized, and your current state of having minimal acne is a positive sign.

2. Concerns About Intracranial Hypertension: The concern regarding intracranial hypertension (pseudotumor cerebri) is valid, especially when isotretinoin is used in conjunction with certain antibiotics. However, the risk is relatively low, and your physician is likely weighing the benefits against the risks in your specific case. It is crucial to monitor for symptoms such as persistent headaches, vision changes, or other neurological signs while on this combination therapy. If you experience any of these symptoms, you should contact your healthcare provider immediately.

3. Impact on Keloids: Regarding your concern about keloids, isotretinoin is known to have effects on skin healing and may influence scar formation. While some patients with keloid tendencies report no significant worsening of their condition, others may experience changes. Since you have a history of keloids that have remained stable, it is advisable to discuss this with your dermatologist. They may recommend close monitoring or alternative treatments if necessary.

4. Laser Treatments During Isotretinoin Therapy: Traditionally, it has been advised to avoid laser treatments while on isotretinoin due to the potential for increased skin sensitivity and delayed healing. However, recent studies suggest that certain laser procedures may be safely performed after a waiting period post-isotretinoin therapy. It is essential to consult with a dermatologist who is experienced in both isotretinoin therapy and laser treatments to determine the best course of action for your skin type and condition. As for manual extraction of comedones (blackheads and whiteheads), it is generally recommended to avoid this during isotretinoin treatment due to the risk of scarring and irritation.

In summary, while isotretinoin can be an effective treatment for acne, it is essential to have open communication with your healthcare provider regarding your specific concerns and any potential side effects. Regular follow-ups can help manage any issues that arise during treatment. Always prioritize your safety and well-being, and do not hesitate to reach out to your doctor with any further questions or concerns.

Best wishes for your treatment journey, and I hope you achieve the clear skin you desire.

Sincerely,
Doctor Q&A Teams

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