Managing Acne: Safe Reintroduction of Oral A Acid for Oily Skin

Oral administration of isotretinoin followed by additional doses?

I weigh 53 kg and am a moderate acne patient.
I need to wash my face once every class due to extremely oily skin.
The topical treatments and oral antibiotics have had very limited effects.
It may be due to my naturally oily skin.
A little over a year ago, I took 20 mg for nearly six months, which had very satisfactory results, but I experienced depression, blurred vision, and keratitis, so I discontinued it (I was probably close to reaching the minimum effective dose).
My oil production has decreased by about 40% compared to before, but it is still higher than average, and I have recently started to develop acne again, especially deep cystic acne, which is very bothersome and hard to treat.
Question 1: If I decide to take the medication again, will I need to complete a full treatment course?
Question 2: I am hesitant due to the side effects.
If I take one 10 mg pill every two days for a longer duration, will the side effects significantly decrease, and will it still be effective in shrinking the sebaceous glands?

Chenchen, 10~19 year old female. Ask Date: 2019/10/20

Dr. Wu Yuxin reply Dermatology

The dosage can be adjusted; some individuals may manage well with taking it 2-3 times a week, but it's important to discuss this with a physician.

Reply Date: 2019/10/20

More Info

When considering the reintroduction of oral A acid (isotretinoin) for managing acne, especially in the context of oily skin and previous side effects, it is essential to approach this decision with caution and a thorough understanding of both the medication and your skin's condition.

Understanding Oral A Acid
Oral A acid is a powerful medication primarily used to treat severe acne that has not responded to other treatments. It works by reducing the size and activity of sebaceous (oil) glands, leading to decreased oil production, which can significantly improve acne. However, it is also associated with various side effects, including dry skin, chapped lips, and more serious effects like mood changes and vision problems, as you have experienced.

Questions Addressed
1. Dosage and Treatment Duration:
When considering reinitiating treatment, it is generally recommended to start with a lower dose, especially if you have previously experienced side effects. A common approach is to begin with a dose of 10 mg every other day or even daily, depending on your tolerance and the severity of your acne. The goal is to find the minimum effective dose that manages your acne while minimizing side effects.
Typically, a full course of treatment lasts about 5 to 6 months, but this can vary based on individual response and the severity of the acne. If you previously had a satisfactory response to 20 mg daily, you might consider gradually increasing your dose after assessing your tolerance to the lower dose.

2. Managing Side Effects:
Your concern about side effects is valid, especially given your previous experiences with depression and vision issues. Starting with a lower dose, such as 10 mg every other day, can help mitigate these risks. It is crucial to monitor your body’s response closely. If you notice any adverse effects, it is advisable to consult with your dermatologist immediately.

Additionally, maintaining good hydration and using moisturizers can help manage some of the dryness associated with isotretinoin. Regular follow-ups with your healthcare provider are essential to monitor your mental health and any ocular symptoms, especially since you have a history of keratitis.

Additional Considerations
- Regular Monitoring: Regular blood tests to monitor liver function and lipid levels are necessary while on isotretinoin. This is to ensure that your body is tolerating the medication well and to catch any potential issues early.

- Mental Health: Given your previous experience with depression, it is crucial to have a support system in place. Inform your healthcare provider about your mental health history so they can monitor you closely during treatment.

- Alternative Treatments: If you are hesitant about reintroducing isotretinoin due to side effects, consider discussing alternative treatments with your dermatologist. Options may include hormonal therapies, topical retinoids, or other systemic medications that might be less aggressive than isotretinoin.

- Lifestyle Adjustments: In addition to medication, lifestyle changes such as a balanced diet, adequate hydration, and a consistent skincare routine can support your skin health. Avoiding harsh products that can irritate the skin is also advisable.

Conclusion
Reintroducing oral A acid for acne management can be effective, especially for oily skin types that have not responded to other treatments. However, it is crucial to approach this with a tailored plan that considers your previous experiences and current skin condition. Starting with a lower dose and maintaining open communication with your healthcare provider will help ensure a safer and more effective treatment journey. Always prioritize your mental and physical health while managing acne, and do not hesitate to seek support when needed.

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