Acne Diagnosis and Treatment

Isotretinoin is a highly effective medication used to treat acne and, occasionally, other sebaceous gland disorders. It is available in Switzerland under various brand names (Roaccutan®, Tretinac®, Isotretinoin Mepha®, Liderma®, Curakne®, etc.).

Isotretinoin is a vitamin A acid preparation that permanently inhibits the activity of the sebaceous glands. In addition, it regulates the keratinization of the outermost layer of the skin, which plays a key role in the development of acne. Isotretinoin is used to treat forms of acne that do not respond to other common treatments or that are associated with increased scarring. In more than 80% of patients, isotretinoin completely clears up even severe acne. In most cases, the effect is long-lasting; relapses are rare. However, isotretinoin has no effect on existing scars.

The most serious side effect affects women: Isotretinoin can cause harm to the unborn child if taken during pregnancy. Women may take this medication only if a medically supervised pregnancy test has been performed prior to treatment and if they are using effective contraception throughout the course of treatment. Effective methods of contraception include the birth control pill, the intrauterine device (IUD) used in combination with condoms, and surgical sterilization. Using condoms alone is not enough! You must continue using birth control for at least two months after the end of treatment. Afterward, you’ll be able to get pregnant again without any risk. If you become pregnant while taking isotretinoin, termination of the pregnancy must be considered.

For men, taking isotretinoin has no adverse effects on fertility or on a child conceived while taking the medication. Almost all patients who take isotretinoin experience unpleasant but generally harmless side effects such as dry lips, dry skin, a dry nasal lining, and dry eyes, which can be particularly bothersome for contact lens wearers. These side effects can be alleviated by using lip balm, moisturizing lotions, nasal ointment, and eye drops. In addition, you will be slightly more sensitive to sunlight and will need to protect yourself accordingly.

Occasionally, treatment with isotretinoin may cause elevated blood lipid levels (cholesterol, etc.) and elevated liver enzyme levels, which return to normal after treatment is completed. At the start of treatment, these levels must therefore be monitored every four to six weeks through a blood test.

Less common side effects include nosebleeds, mild hair loss, and joint and muscle pain. You should report these side effects to your doctor.

Treatment is administered at a dose tailored to your weight and the severity of your acne over a period of several months, typically five to nine months. The entire daily dose of capsules can be taken at once, without chewing, with a meal.

Throughout the course of treatment, you will have follow-up visits with your doctor every four to six weeks. During these visits, your doctor will check your blood lipid levels through a blood test and discuss the treatment of any side effects with you. As part of the checkups, women always undergo a pregnancy test. Under no circumstances should you give this medication to anyone else.

If you are taking other medications at the same time, you must tell your doctor. In particular, certain antibiotics must not be combined with isotretinoin. You should also avoid taking any additional supplements containing vitamin A (such as multivitamins) on your own initiative. Topical treatments can irritate the skin and are not necessary during treatment with isotretinoin.