Oral A-Retinoids for Persistent Acne Treatment

Acne and oral isotretinoin?

Hello, Doctor.
I have been experiencing persistent acne and comedones since middle school, and now I am in my third year of college.
Initially, my dermatologist prescribed Doxycycline for three days, along with topical Clindamycin and Differin for nighttime use.
During the course of taking Doxycycline, it was very effective, and no new acne developed.
However, shortly after stopping the medication, new acne began to appear, and I later learned that oral antibiotics require a complete course.
I visited a larger hospital and was prescribed Doxycycline for two weeks, which gradually reduced the acne.
Upon follow-up, the doctor advised me to continue for another two weeks without needing to return, and to use Clindamycin topically if any new acne appeared.
Currently, I am in my third week of oral Doxycycline, but acne has started to reappear, and the effectiveness of the Clindamycin ointment is not as good as before.
The new breakouts are mostly located on both cheeks, leaving many inflamed red acne scars, which is quite distressing.
However, the severity is not enough for health insurance to cover oral isotretinoin.
I am considering self-paying for oral isotretinoin.
I have researched the side effects extensively online and would like to consult with you regarding my current situation.
Is it necessary for me to take this medication? Additionally, I weigh 60 kg; can I calculate the duration of treatment directly, or do I need to undergo blood tests? Thank you for your assistance!

Nìmíng, 20~29 year old female. Ask Date: 2015/10/10

Dr. Wu Yuxin reply Dermatology

For stubborn, treatment-resistant acne, vitamin A acid therapy is considered only after three months of continuous traditional treatment has proven ineffective.
Generally, an initial treatment period of at least three months is necessary to assess effectiveness.
Whether it is necessary or not depends on the condition of the acne and should be decided after discussion.

Reply Date: 2015/10/10

More Info

When considering the use of oral A-retinoids (commonly known as isotretinoin) for persistent acne treatment, it's essential to understand both the potential benefits and the risks associated with this medication. Given your history of acne and the treatments you've already tried, including doxycycline and topical clindamycin, it seems that you are experiencing a common challenge in managing persistent acne, especially if you have seen a temporary improvement with antibiotics but then experienced a resurgence of breakouts.

Isotretinoin is a powerful medication that is often prescribed for severe acne that has not responded to other treatments. It works by reducing the size and activity of sebaceous glands, decreasing oil production, and promoting the turnover of skin cells, which helps prevent clogged pores. However, it is typically reserved for cases of severe acne due to its potential side effects and the need for careful monitoring during treatment.

Indications for Isotretinoin
1. Severe Nodular Acne: Isotretinoin is most effective for severe forms of acne, particularly nodular or cystic acne that does not respond to other treatments.

2. Persistent Acne: If your acne has been persistent and is causing significant distress or scarring, isotretinoin may be a suitable option.

3. Previous Treatment Failures: Since you have already tried antibiotics and topical treatments without long-term success, isotretinoin could be considered.

Side Effects and Monitoring
Isotretinoin has a range of potential side effects, including:
- Dryness: Most patients experience dryness of the skin, lips, and eyes.

- Liver Function: Regular blood tests are necessary to monitor liver function and lipid levels, as isotretinoin can affect these.

- Teratogenicity: Isotretinoin is highly teratogenic, meaning it can cause severe birth defects if taken during pregnancy. Therefore, strict birth control measures are required for women of childbearing age.

Treatment Duration and Dosage
The typical course of isotretinoin lasts about 15 to 20 weeks, with a cumulative dose of 120-150 mg/kg being the goal for most patients. Given your weight of 60 kg, your total treatment dose would be calculated based on this range. However, the exact duration and dosage should be determined by your healthcare provider based on your specific situation, including the severity of your acne, response to treatment, and any side effects you may experience.

Conclusion
In summary, if your acne is significantly affecting your quality of life and has not responded adequately to other treatments, isotretinoin may be a necessary option. However, it is crucial to have a thorough discussion with your dermatologist about the potential benefits and risks, as well as the need for regular monitoring during treatment. They will also be able to guide you on the appropriate dosage and duration based on your individual needs.
If you decide to pursue isotretinoin, ensure that you are fully informed about the requirements for monitoring and the importance of adhering to contraceptive measures if you are of childbearing age. Your healthcare provider will be your best resource in navigating this treatment option effectively.

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