Oral Isotretinoin for Acne Scars: Treatment Duration and Effectiveness

Oral isotretinoin and acne scars?

Hello, Doctor.
Two months ago, I suddenly started experiencing a severe breakout of acne on my cheeks.
I have had acne in the past, and taking regular antibiotics helped control it, but this time it hasn't worked.
I proactively asked my doctor for oral isotretinoin, and they prescribed me Isotretinoin 10 mg to take once daily for two weeks.
However, they did not mention the need to adjust the dosage based on my weight to reach a certain concentration.
I am worried that after completing the treatment, the acne might return, and I am uncertain if taking it for just two weeks will lead to improvement.
Should I go back to consult my doctor about the duration of the treatment? Additionally, could you recommend any oral or topical medications that can help reduce acne scars more quickly? Thank you for your response.
🙏

Xuan, 10~19 year old female. Ask Date: 2017/09/21

Dr. Wu Yuxin reply Dermatology

You should consult your attending physician about this issue, as they are the most familiar with your condition.
There are topical medications available for reducing scars, and you can also ask your attending physician about them.

Reply Date: 2017/09/21

More Info

Oral Isotretinoin, commonly known as Accutane, is a powerful medication primarily used to treat severe acne, particularly nodular acne that has not responded to other treatments. It is derived from vitamin A and works by reducing the size and activity of sebaceous (oil) glands in the skin, leading to decreased oil production, which is a significant contributor to acne formation.

Treatment Duration and Effectiveness
The duration of treatment with isotretinoin typically ranges from 4 to 6 months, depending on the severity of the acne and the patient's response to the medication. The standard initial dose is usually calculated based on the patient's weight, often starting at about 0.5 to 1.0 mg/kg per day. For example, if a patient weighs 70 kg, the daily dose might range from 35 mg to 70 mg. The goal is to reach a cumulative dose of approximately 120-150 mg/kg over the course of treatment, as studies suggest that this cumulative dose is associated with a lower risk of relapse.

In your case, you mentioned being prescribed isotretinoin at a dose of 10 mg once daily for two weeks. While this may be a reasonable starting point, it is essential to follow up with your physician to discuss the appropriate duration and dosage based on your weight and the severity of your acne. Regular follow-ups are crucial, as they allow for monitoring of side effects and adjustments to the treatment plan as necessary.

Side Effects
Isotretinoin is known for its potential side effects, which can include dry skin, chapped lips, dry eyes, and nosebleeds. More serious side effects can include elevated liver enzymes and lipid levels, which is why regular blood tests are often required during treatment. Additionally, isotretinoin is highly teratogenic, meaning it can cause severe birth defects if taken during pregnancy. Therefore, it is critical for women of childbearing age to use effective contraception during treatment and for at least one month after stopping the medication.

Acne Scars Treatment
Regarding the treatment of acne scars, isotretinoin can help improve the overall texture and appearance of the skin, but it may not completely eliminate scars. For more targeted treatment of acne scars, options include:
1. Topical Treatments: Products containing ingredients like retinoids, alpha hydroxy acids (AHAs), or beta hydroxy acids (BHAs) can help improve skin texture and promote cell turnover.

2. Chemical Peels: These treatments involve applying a chemical solution to the skin, which exfoliates the top layers and can improve the appearance of scars.

3. Laser Therapy: Laser treatments can target deeper layers of the skin, promoting collagen production and improving the appearance of scars.

4. Microneedling: This procedure involves using fine needles to create micro-injuries in the skin, stimulating collagen production and improving skin texture.

5. Fillers: For certain types of scars, dermal fillers can be injected to raise the depressed areas of the skin.

It's essential to consult with a dermatologist to determine the most appropriate treatment for your specific type of acne scars. They can provide guidance on the timing of these treatments, especially in relation to your isotretinoin therapy, as some procedures may need to be postponed until after the completion of isotretinoin treatment due to the skin's sensitivity.

In conclusion, while isotretinoin is an effective treatment for severe acne, it is crucial to have a comprehensive treatment plan that addresses both the active acne and any resulting scars. Regular communication with your healthcare provider will ensure that you receive the best possible care tailored to your needs.

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