For patients with severe acne, Accutane (isotretinoin) is the most effective solution. However, this is a potent medication that can come along with unwanted side effects and is highly regulated in the USA. In other countries, it is sold over the counter! In Miami, many patients come in after self-prescribing this medication that they purchased in Mexico or Venezuela or other South American countries. It is important that you understand the risks and regulatory requirements for isotretinoin, even if you are not the prescriber. This is important because patients who have had isotretinoin in the previous six months are at a higher risk for scarring after a procedure. I was recently at a Cosmetic Surgery Conference where a dermatologist showed data that it is safe to do surgery a month after isotretinoin. I tend to believe she was just lucky, because I have seen many patients treated by other doctors with laser resurfacing and dermabrasion who have had excessive scarring, especially along the jawline. I believe this was due to the fact that they had been recently treated with isotretinoin.
If your patients are on isotretinoin, you will need to educate them to help reduce side effects and improve compliance. Before starting a patient on an Accutane regimen, you are required by iPledge to outline the risks involved, check routine blood tests, and begin a birth control method in females with child bearing potential. You must register with iPledge before you can prescribe this medication. iPledge provides a consent booklet that discusses, risks including the possibility of birth defects if taken during pregnancy. Patients on Accutane should also avoid giving blood while on this medication.
Despite the risks, isotretinoin is often the best solution for patients who have been struggling with moderate to severe acne and have not responded to other treatment options. It is life-changing and safe when closely monitored! To help your patients see the best results, share with them these important tips while taking Accutane.
Start with a Smaller Dosage
Because Accutane can cause skin dryness, flaking, and rashes, it is best to start with a smaller dosage and gradually increase it over time. I use 0.5mg/kg once per day for the first month to see how they react. At the one-month follow up visit, I increase to 0.75mg/kg per day and eventually to 1mg/kg per day. Starting with a lower dose will help with compliance, as many patients (especially boys) have an initial acne flare when starting isotretinoin. Most patients begin to see their skin improve after the first four to eight weeks of following their prescribed isotretinoin treatment.
Best Skincare for Patients on Accutane Isotretinoin
Another way to help increase compliance and minimize side effects is to recommend a skincare regimen that will counteract the dryness and flaking that result from isotretinoin. Even for patients with oily skin types, dryness and irritation can be a concern while on this medication. To counteract these symptoms, recommend a creamy moisturizing cleanser such as PCA Creamy Cleanser or VMV Hypoallergenic Creammmy Rich Intensive Moisturizer Milk or NIA 24 Gentle Cleansing Cream. Patients should avoid using foaming cleansers, physical exfoliants and topical retinoids while using isotretinoin.
You should also recommend a barrier repair moisturizer such as Zerafite Barrier Repair Moisturizer for the face and Zerafite Body cream for the body. These contain a multi lamellar emulsion (MLE Technology) designed for atopic dermatitis patients that helps decrease the side effects of isotretinoin. Zerafite is only sold by physicians who use the Skin Type Solutions System. You can find out more about how to sell it in your practice at this link.
In my practice, we also sell healing lip balm to help with lip dryness. Many isotretinoin patients have nose bleeds because the inside of the nose becomes excessively dry. Dabbing a small amount of petroleum jelly can help to seal in moisture. Saline eye drops can help to lubricate dry, uncomfortable eyes.
Encourage Sunscreen Use in Isotretinoin Patients- Especially Teens
Isotretinoin increases sun sensitivity, so it is crucial that patients wear sunscreen and avoid prolonged sun exposure every day. Recommend a non-comedogenic physical sunscreen like EltaMD Physical to avoid exacerbating acne breakouts. Sun protective clothing like a sun hat, sunglasses, and cover-ups are also helpful. Remind patients that the sun can reach their skin through their car windows while driving, so daily sunscreen use is imperative.
Suggest Alternatives to Waxing
Waxing can burn or irritate the skin because the outer layer of skin, the stratum corneum, becomes thinner while taking isotretinoin. Instruct your patients to avoid waxing their face or eyebrows while on this medication. Plucking, shaving, or threading are better hair removal solutions during this time. Laser hair removal is safe while on isotretinoin. However, ablative laser procedures should be avoided.
Recommend Diet Adjustments
Isotretinoin can increase cholesterol and triglyceride levels, so encourage your patients to eat a low fat, high fiber diet while on this medication. Eating foods rich in omega-3 fatty acids like wild salmon, flax seeds, walnuts, and dark, leafy vegetables can help to lower the dryness and inflammation caused by isotretinoin.
Provide a “Do & Don’t” List While Taking Accutane
With so much information available — often from unreliable sources online — some patients may be reluctant to follow an isotretinoin regimen. You can help to ease their minds and increase compliance by providing as much written information as you can. Additionally, providing a written list of “dos and don’ts” for your patients will help them to follow your guidelines for reducing side effects, thus increasing the likelihood that they will stick to their regimen.
Isotretinoin can help patients with severe acne finally get clear, healthy-looking skin. By discussing skincare guidelines with patients prior to starting their regimen, you can help them to reduce associated side effects, increase compliance, and see the best possible outcome.
To learn about how to carry Zerafite and other exclusive brands in your practice and utilize the Skin Type Solutions software