Isotretinoin, available as under brand names Acnotin, Roaccutane, Nimigen and Oratane in Singapore, is a powerful medication for the treatment of facial acne and body acne (bacne). It is sometimes referred to as its former brand name, Accutane. These prescription medications contain the active ingredient Isotretinoin, a derivative of Vitamin A, through which the medication exerts its beneficial effects on the skin.
Acnotin is FDA-approved for the treatment of severe acne and hormonal acne. It is able to provide remission of acne in about 70% of people who take a sufficient course of the drug. Winlevi is also another acne medication prescribed for hormonal acne, but it is not available in Singapore yet.
At SL Aesthetic Clinic, our preferred brand of Isotretinoin is Acnotin. We have been prescribing Acnotin since our clinic’s inception in 2006.
Isotretinoin works via 4 different mechanisms:
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.
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 usuallytemporary. We encourage patients to continue with the Acnotin (Isotretinoin) medication as the results usually improve with continued use. If there is no improvement, we may recommend other treatments.
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.
A box of Acnotin 20mg (30 pills) cost $110+ GST at SL Aesthetic Clinic.
In Singapore, Acnotin is available as 10mg and 20mg capsules. The prescribed dosage is dependent on your acne severity and body.
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.
2. 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.
3. 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.
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.
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.
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.
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