A number of side effects are observed during isotretinoin therapy. The greatest concern is its strong teratogenicity. Of the remaining side effects, most are transient. Rarely is the occurrence of serious disorders found to be an indication to discontinue treatment.
Table of contents:
- Teratogenic effects of isotretinoin
- Side effects on the skin and mucous membranes
- Systemic side effects
- Gastrointestinal disorders and effects on lipid metabolism
- Interactions
- Recommendations during treatment with isotretinoin
- Additional precautions
Teratogenic effect of isotretinoin
The use of isotretinoin, as well as other retinoids, is absolutely prohibited in pregnant women. Damage to the foetus caused by retinoids is very serious. These include abnormalities of the central nervous system, damage to the ears, defects of the cardiovascular system, eyes and skeleton. Therefore, it is necessary to use effective contraception during treatment and six weeks after its completion. This time is sufficient for isotretinoin to be completely excreted from the body.
Side effects on skin and mucous membranes
During the initial period of isotretinoin treatment, there may even be an exacerbation of acne lesions. This is especially true in patients with deep infiltrative lesions. This worsening usually subsides within 2-4 weeks. In contrast, almost all patients develop dryness of the lips and inflammation of the red lips, as well as dryness of the oral mucous membranes. Dryness and brittleness of the nasal mucosa are also noted, which are the cause of frequent bleeding. Dryness and itching of the entire skin may occur. Increased sensitivity to light may occur during treatment, so excessive exposure to natural (sun) and artificial (solariums) radiation should be avoided.
Dry eyes, corneal opacity, decreased night vision acuity and keratitis are noted with isotretinoin use. These changes usually resolve when treatment is discontinued. If dry eyes occur, moisturising ointments or so-called artificial tears may be helpful. Intolerance to contact lenses may occur, which may require the wearing of glasses during treatment. There are also reports of deterioration of dark vision and changes in colour perception. It is essential to inform the treating physician if these disorders are present.
Systemic side effects
Skeletal and muscular disorders
Muscle and joint pains have been reported to occur during treatment, especially in patients doing intense exercise. Therefore, exercise should be limited during treatment if it is normally very frequent and intense.
Effects on the central nervous system
Occasionally, symptoms of mildly elevated intracranial pressure such as headaches, nausea, vomiting, visual disturbances are found. in case of prolonged headache accompanied by nausea or vomiting, contact the attending physician immediately.
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Some patients treated with isotretinoin have been reported to experience mood changes, anxiety, and the occurrence or worsening of depression. Suicidal thoughts, suicide attempts and suicide have occurred in individuals. Also, all mood changes should be reported to the treating physician during follow-up visits.
Gastrointestinal disorders and effects on lipid metabolism
Transient elevations of triglycerides, cholesterol, transaminases, alkaline phosphatase, lactate dehydrogenase and bilirubin have been reported in patients treated with isotretinoin. Triglycerides are elevated in about 50% of patients, cholesterol is elevated in 30%. Elevated serum lipid levels usually return to normal when the drug dose is reduced or treatment is discontinued.
Some patients without a previous positive history of intestinal disorders have been reported to have inflammatory bowel disease. If acute symptoms of diarrhoea occur, isotretinoin should be discontinued immediately and the patient should be seen by the treating physician.
In contrast, kidney damage has not been reported in patients treated with isotretinoin. It can even be given to patients with impaired renal function.
Interactions
Vitamin A should not be taken concomitantly due to the risk of hypervitaminosis A. Alcohol should be strictly avoided during isotretinoin treatment.
taking isotretinoin photo ojoimages
Recommendations during treatment with isotretinoin
The use of topical exfoliants and anti-acne agents should be avoided as this can exacerbate local skin irritation.
Additional precautions
Take care that isotretinoin capsules do not get into the hands of others. Do not donate blood during treatment and for 1 month after stopping isotretinoin because of the potential risk to the fetus in a pregnant blood recipient.
During treatment with isotretinoin and up to 5-6 months after its discontinuation, deep dermabrasion should be avoided due to the risk of hypertrophic scarring. During treatment and for at least 6 months after completion of treatment, wax epilation should be avoided due to the potential for scarring.
Protective lip balms and body moisturising ointments should be used from the start of treatment as isotretinoin causes significant dryness of the lips and, in some individuals, of the entire skin.
