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Your Guide To Accutane (Isotretinoin) Acne Medication

Accutane Treatment for Acne

What is Accutane (Isotretinoin)?

Accutane, available as Acnotin, Roaccutane, Nimigen and Oratane in Singapore, is a powerful medication for the treatment of facial acne and body acne (bacne). These prescription medications contain the active ingredient Isotretinoin, a derivative of Vitamin A, through which the medication exerts its beneficial effects on the skin.

Accutane is FDA-approved for the treatment of severe acne because it is able to provide remission of acne in about 70% of people who take a sufficient course of the drug.

At SL Aesthetic Clinic, our preferred brand of Isotretinoin is Acnotin. We have been prescribing Acnotin since our clinic’s inception in 2006.

How does Accutane (Isotretinoin) work?

Compared to other acne treatments that only treat acne via 2 or 3 pathways such as lasers, antibiotic, chemical peels, and topicals, Isotretinoin is effective for the treatment of acne because it works via 4 different mechanisms:

  1. It clears acne primarily through permanently regulating and reducing skin oil production
  2. It prevents clogged pores (keratolytic)
  3. It reduces inflammation, basically minimising acne swelling
  4. It reduces bacteria that causes acne – Propionibacterium acnes (anti-microbial)

How Long Does Accutane Take to Show Results?

With Isotretinoin-based medications, you will notice your skin becoming less oily after 1 to 2 weeks of consistent medication. After 3 to 4 weeks, you will start to notice your acne improving.

Does Accutane (Isotretinoin) Make Acne Worse?

Some patients may experience a worsening of their acne in the first few weeks of treatment. This is known as the “purging” or “flare” phase. However, patients should not be discouraged as this is only temporary. We encourage patients to continue with the Accutane (Isotretinoin) medication as the results will improve with continued use.

When To Take Accutane (Isotretinoin)?

In the past, Isotretinoin was reserved for severe, scarring acne and high doses were used, often with side effects, which then limited its use. The paradigm has since shifted for doctors to use lower doses to treat mild to moderate acne which may not respond to other topical treatments.

FAQ

What Dose of Accutane (Isotretinoin) Should I Take?

Isotretinoin is available in strengths of 10mg, 20mg and 40mg per pill. At SL Aesthetic Clinic, we recommend that adults start at a dose of 20mg once a day or once every 2 days. This however, is dependent on the severity of your acne and your body weight. To find out what dose of Accutane (Isotretinoin) you should be taking, speak to our doctor in a detailed consultation for a personalised acne treatment plan.

How Long is a Course of Isotretinoin Treatment?

The treatment duration is dependent on your body weight and the severity of your acne. There are three main ways of taking Isotretinoin:

  1. Cumulative Dosing Based on Body Weight

Studies have shown a lower recurrence rate when a patient takes a total of 120mg/kg of Isotretinoin body weight of Isotretinoin.

For example, a patient who weighs 50 kg will be required to take 6000mg of Isotretinoin in total. Isotretinoin medication typically comes in a monthly supply of 30 pills per box, each pill with a 20mg dose. This totals at 600mg of Isotretinoin per box. Hence, the patient will be required to complete 10 boxes, or approximately 10 months for his acne treatment.

This is the preferred duration of acne treatment with Accutane (Isotretinoin) at SL Aesthetic Clinic, with the goal of lowering the patient’s acne relapse rate.

  1. Result Dependent Duration

In this method, Isotretinoin is started and continued until the acne is in control; no formation of new acne, and then sustained for 3 more months. In our experience, we prefer that patients take Isotretinoin for at least 6 months in order to significantly lower the risk of an acne relapse. Stopping Isotretinoin prematurely can result in a high possibility of acne relapse.

  1. Low Intermittent Dosing

Isotretinoin can be taken intermittently at a low dose (e.g. one pill per week), but this is used mainly for long term control of acne rather than as a primary course of acne treatment. This method should be used only if advised by your doctor.

Side Effects of Accutane (Isotretinoin)

As Isotretinoin is ingested as an oral medication, it is readily absorbed by the body. Hence, it has several effects on the body. Most of these side effects resolve after stopping or completing a course of Isotretinoin:

  1. Dry lips and skin – a common side effect, these can be alleviated with regular use of lip balm and moisturisers.
  2. Increased skin photosensitivity – skin reacts to the sun more than usual. We recommend limiting sun exposure and to always apply sunscreen.
  3. Nose bleeds can occasionally happen due to the drying of the inner nose walls in the. This can be improved by applying vaseline to the walls in between the nostrils.
  4. Rarer side effects include dry eyes, fatigue, headaches and joint aches. The use of eyedrops can alleviate dry eyes and reduction of strenuous exercises will reduce joint and muscle aches.
  5. Raised fat levels and liver enzymes. The doctor may conduct blood tests for you before and during the treatment period.
  6. Mood changes. These are very rare and have not been conclusively linked to Isotretinoin.

What are the risks?

Although rare, some risks may include:

  • An extended period of skin irritation and redness.
  • Damage and potential scarring of sensitive skin areas if TCA is accidentally deposited.
  • Temporary hyperpigmentation (PIH) or permanent hypopigmentation.
  • Scars coalescing into larger scars.
  • Skin discolouration, mainly in darker-skinned individuals.

Pregnancy and Isotretinoin

Isotretinoin is a Class X medication. This means that there is a high chance that it will cause birth deformities in the developing foetus.

Women seeking Isotretinoin to treat acne must ensure that they are not with child, and confirmed as such with at least 2 pregnancy tests, before commencing treatment. Ideally, female patients should also use at least 2 forms of birth control while on Isotretinoin.

However, Isotretinoin does not affect overall fertility. A female patient can safely resume family planning and conceiving 1 month after stopping the last pill of Isotretinoin.

What If I Forgot or Skipped A Dose of Accutane (Isotretinoin)?

You may take the medication at the next meal time on the same, or just continue the same dose the next day. There is no need to double the dose of medication the next day if you forget to take during the previous day.

Can I Have Laser Treatments Done While On Accutane?

Yes, you may continue doing laser treatments while taking Isotretinoin. Clinical studies have shown that laser treatments, including ablative laser treatments, are safe to do while on a course of low dose Isotretinoin.

What Precautions Should I Take For Accutane?

  • DO NOT buy Isotretinoin online or from non-trusted sources. You will never be certain of what chemicals there are inside the pills. Only purchase Isotretinoin from certified doctors.
  • Inform your doctor if you have other medical conditions such as diabetes, liver or kidney disease and high fat levels in your blood.
  • Do not donate blood while on Isotretinoin and for at least 1 month after stopping. This is to prevent your blood from being transfused to a pregnant woman.
  • Isotretinoin can increase the levels of triglycerides (fats) in your blood. Limit your intake of alcoholic drinks, as alcohol also increases the triglycerides in the blood.
  • Do not share your Isotretinoin medication with anyone else.

Price/Cost of Accutane (Isotretinoin) in Singapore

A box of Acnotin 20mg (30 pills) cost $117.70 at SL Aesthetic Clinic.

[12 Jun 2021] Written by Dr. Wei Xiang
Dr Ko Wei Xiang

Dr Wei Xiang – The Artist
MBBS, Singapore; MRCS, Edinburgh

Dr Wei Xiang has been heavily involved in the arts throughout his life. During his formative school years, he studied fine arts under the prestigious Art Elective Programme, where he developed his artistic talent and creative expression across various media, including painting, charcoal, digital media and photography.

After graduating from the Yong Loo Lin School of Medicine in 2014, Wei Xiang pursued postgraduate surgical training in a residency programme, where he honed his surgical skills over the years. His artistic side remained strong, and he constantly yearned to express a greater aesthetic element in his work. In 2019, he left his surgical career in search of his calling.

A fateful encounter with Dr Kelvin Chua brought Wei Xiang into the world of Aesthetic Medicine. It was in Aesthetic Medicine where Wei Xiang found his “ikigai” of sorts. Under Kelvin’s mentorship, Wei Xiang grew steadily and became adept at a wide range of aesthetic procedures including Botox, fillers, lasers, HIFU, Thermage, Ultherapy and PicoCare Laser. His keen eye for beauty, coupled with his steady hands, allows him to bring out the best in his patients.

Wei Xiang occasionally still creates artwork in his free time, when he is not spending time with his wife and daughter, or jamming and making music.

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