Acne is mainly skin inflammation, infection, etc. caused by abnormal sebaceous glands of hair follicles, and more than 95% of people will have varying degrees of symptoms. Grade is mild (acne), moderate (inflammatory papules, pustules), severe (nodules, cysts), and is also prone to some sequelae (e.g., erythema, scarring, pigmentation).
Treatment of acne consists of oral medications and topical medications, and topical medications are usually chosen for mild to moderate acne to improve symptoms. However, moderate to severe acne requires combination therapy, mainly oral drugs, supplemented by topical drugs. At present, the first-line oral drug for the treatment of acne is isotretinoin, and its therapeutic effect can improve the four main pathological mechanisms of acne. That is, inhibit the synthesis of sebaceous gland lipids, reduce the proliferation of Propionibacterium acnes, anti-inflammatory and regulate immunity, improve excessive keratinization of hair follicle ducts, etc.
How should isotretinoin be treated orally?
First of all, let's take a look at the instructions, the dose of oral therapy varies from person to person, ranging from 0.1-1mg/kg/d, and the general recommendation is that the starting dose is 0.5mg/kg/d, divided into two oral doses. From the starting dose alone, it is necessary to convert the dose based on body weight, and if the adult male body weight is calculated at 60 kg, the starting dose is 30 mg (3 capsules). Therefore, it can be divided into 2 capsules in the morning and 1 capsule in the evening for oral administration.
Since isotretinoin is a highly lipophilic drug, it can increase the absorption rate when taken with fatty foods, and it is recommended to take it with food.
The occurrence of adverse effects may be related to efficacy:
It commonly has adverse effects similar to symptoms of vitamin A overdose and forms a dose-equivalent relationship. Mainly dry skin and mucous membranes (chapped lips, cheilitis), edema, dry eyes, eye astringency, etc., and its treatment dose is appropriate when the symptoms are tolerated. And most adverse reactions are reversible, usually after stopping the drug can gradually recover. A small number of people may also experience allergies, fatigue, weight loss, etc., which can be relieved by other methods such as diet and anti-allergic drugs.
Oral isotretinoin generally takes effect in 3~4 weeks, during which it is necessary to judge by observing the changes in acne, the degree of tolerance of adverse reactions and whether it is aggravated.
During treatment, in addition to being aware of adverse effects tolerance and acne changes, there are other issues to be aware of:
1. During the period, it was found that with the increase of dose, acne symptoms became more and more aggravated:
With the passage of treatment, many netizens may find that acne has significantly worsened. According to the feedback of clinical application of isotretinoin, about 15% of the population will have obvious aggravation of symptoms, which is commonly known as "popping acne". The intrinsic reason may be related to the dose used, and from another experimental result, higher doses may often lead to acne exacerbation in a small number of people.
However, by lowering the oral dose, the worsening symptoms will slowly subside. Therefore, if you are worried about sudden acne, you can consider oral lower dose of 0.2~0.3mg/kg. After that, slowly increase the dose, which is less prone to such problems.
2. When using anti-infective drugs, avoid taking them at the same time as tetracyclines:
Anti-infective drugs are conventional treatment drugs in the treatment of acne, but when combined with isotretinoin, pseudo-brain tumors may occur, followed by benign cerebral pressure increases, and clinical manifestations are accompanied by headache, dizziness, visual impairment, etc. Therefore, when choosing a combination of drugs, it is necessary to pay attention to the application of tetracycline (such as doxycycline, minocycline) antibacterial drugs to avoid affecting the body.
3. Most refractory acne generally requires a course of treatment for 15~20 weeks:
Treatment of severe acne usually takes a long time, so effective contraception is required to avoid fetal teratogenesis due to medications, and to prohibit blood donation for three months of discontinuation. In addition, isotretinoin has phototoxic reactions, and it is necessary to avoid sunlight or ultraviolet rays for a long time and cause solar dermatitis. If there are other problems, you can also contact your doctor or pharmacist to deal with them.
The above problems are the situations that everyone usually encounters, and the symptoms of acne are different, and the questions that arise are different. Medications are good or bad, and using them as directed can avoid most of the risks while also improving acne.
Summary:
Acne usually occurs in adolescent men and women, and at a flower-like, handsome and dashing age, it should not bear the mark of the times. The original intention of the drug treatment is to minimize the damage caused by acne, while also protecting the tender skin of youth. The emergence of isotretinoin has undoubtedly given another therapeutic idea, that is, there is no need to worry about the dependence caused by hormones, and there will be no resistance due to the abuse of antibacterial drugs. Faced with different therapeutic drugs, how do you choose? Welcome to leave a message in the comment area about your medication and randomly give you popular science answers.
Bibliography:
1. Guidelines for the treatment of acne in China (2019 revised edition), Journal of Clinical Dermatology, 2019, 48(9): 583-588.
2. Expert consensus on the clinical application of oral isotretinoin in the treatment of acne, Journal of Clinical Dermatology, 2023, 52(5): 298-307.
3、 Edileia Bagatin & Caroline Sousa Costa. The use of isotretinoin for acne - an update on optimal dosing, surveillance, and adverse effects. Expert Rev Clin Pharmacol, 2020, 13(8): 885-897.
4. Instructions for isotretinoin softgels