I suggest we start with a brief explanation of what isotretinoin is. He is 13-cis retinoic acid, a derivative of vitamin A. Its effect on acne was discovered accidentally when a group of scientists (Peck et al) treat kertinization disease such as Darie's disease, pityriasis rubra pilaris and ichthyosis (I will talk about them in another article). It turns out that one of the patients has severe acne conglobata and the response to isotretinoin therapy was phenomenal. Subsequently, the FDA (Food and Drug Administration in the United States) approved its use for very severe, unresponsive acne. In Germany, the spectrum is a bit wider. The truth is that worldwide sales of the drug far exceed the needs of patients, if it was prescribed only to those with a specific indication.
What is the mechanism of action of isotretinoin?
The drug has an effect on the basic mechanisms, which cause acne.
One of the most impressive effects is drastic decrease of sebum production. It occurs rapidly within the first two weeks and depends on the dose. This is due to isotretinoin-induced apoptosis of sebocytes. Or to put it simply - the drug triggers the occurrence of controlled destruction and respectively reduction of the number of sebaceous gland cells. And less cells means less sebum. This also leads to a reduction in the size of the gland.
Comedolytic and anticomedogenic effect, which means that isotretinoin destroys both already formed comedones and prevents the formation of new ones. In practice, the drug "does not allow" the formation of corneodesmosomes, which stick together keratinocytes from the stratum corneum. It also helps to form special structures called lamellar bodies that carry out normal desquamation. This means that the connection between the horn cells improves.
Isotretinoin has a direct suppressive effect on some proinflammatory mediators such as IL-17, IL-1β, TLR2. In this way he exerts his own anti-inflammatory effect.
№1 Isotretinoin leads to infertility, impotence, etc.
The reason for this misinformation is the misinterpretation of one of the side effects called teratogenicity. This means that there is a risk of embryonic malformation if the medicine is taken DURING pregnancy. This is the reason why it is prescribed in combination with contraceptives in women and in men with barrier contraception (condom and spermicidal gel). This means that taking isotretinoin OUTSIDE pregnancy does not pose a risk of malformations. It is important that contraception continues for 1 month after stopping the medicine. Pregnancy after this period is considered risk-free.
№2 Isotretinoin triggers depression and suicidal thoughts
The reason for not having a definite opinion on this issue is that it is difficult to distinguish whether the patient's depression was triggered after taking the drug or existed before. That is why it is very important to have a careful conversation with anyone who is about to have such therapy.
In fact, the most common and expected side effect is dry skin and mucous membranes. This is observed on the skin of the whole body. The lips are dry and cracked, the eyes are dry, and artificial tears are often required. The mucous membrane in the nose also dries out, which sometimes leads to bleeding. It also needs to be lubricated further. Most often by basic vaseline.
As I wrote above, in Bulgaria isotretinoin is under the trade name Roaccutane® 20 mg. The dose in each patient is determined by the severity of his acne and his weight. The duration of treatment varies between 4 and 9 months.
Isotretinoin (roaccutane) treatment requires you to be in very good communication with your dermatologist. You should meet at least once a month to monitor the effects of therapy and prevent side effects. Before the first intake, a complete blood count, lipid profile, liver enzymes, blood sugar and other indicators must be tested. Do not self-administer isotretinoin therapy.