Rosacea - Patient's guide

Isotretinoin - Side Effects And Treatment Of Side Effects

View the A-Detail™ on Accutane®.

Most people have minor Isotretinoin (Accutane®) side-effects that disappear within 2 weeks after stopping the medication. Almost everybody gets dry lips. Blood work to monitor your liver and your blood fats (lipids) must be done periodically. Possible side-effects are numerous and well documented. Most side-effects are dose related, which means they get worse as the dose gets higher.

You may experience some side-effects from Isotretinoin, that will require some medical attention while on this acne treatment. The side-effects that typically require treatment are aggravated skin, dry eyes, dry nose, and sun damage on your lips.

Side Effects That May Be Noticed By The Patient:

Aggravated skin:

Overcleansing your skin can cause irritation that may aggravate your acne as well as encourage you to use other products that will grease up your skin. This may then complicate your skin care, in that you will need to use a toner to remove the oil, which in turn may irritate your skin further.

Skin Cleansers Can Be Grouped As:

• Wipe-off cleansers (cold creams and makeup removers)
• Soaps (for example, Dove® unscented soap)
• Cosmetics
• Water soluble cleansers (soap substitutes), these are most gentle
• (These should be non-irritating, non greasy, unscented, and able to remove some excess)

Examples:

• Cetaphil® gentle skin cleanser
• Spectrojel®
• Dormer® cleanser
• Aquanil®
• Dove®, by Unilever

Dry Lips And Skin:

Dry lips are the most common side-effect of Isotretinoin (Accutane). If you are on a course of Accutane® and your lips are not dry, then you are either not using the drug, or you are not taking the medication with fatty food.

Sticky ointments are best for relieving this dryness and may prevent cracking, these products must be used multiple times a day. Occasionally, you may get a secondary bacterial infection on your lips, this will usually respond to topical antibiotics.

Some doctors will advise a few days of mild cortisone ointment for you if you have significant inflammation on and around your lips.

With dry skin, you may see this most often on the back of your hands and forearms. Dryness may cause a secondary bacterial infection in your skin, your skin may become fragile and the healing of your skin may slow down.

We often forget about protecting our lips from chronic sun damage, long term exposure will often produce "actinic cheilitis", which describes changes such a loss of a distinct lip line, and white patches on the lower lip called leucoplakia.

These changes are precancerous and you should take care to protect your lips to reduce this occurrence. Those who are prone to cold sores may get them more frequently after sunexposure. Those taking Accutane® will have dry lips that are more sensitive to sunburn.

Regular sunscreens are not entirely satisfactory for lip protection, and a number of lipsunscreens have been developed.

Examples:

• Antherpos-Ceralip Solaire® (Cosmair)
• Artistry Lip Colors® (Amway)
• Banana Boat Aloe Vera Lip Balm Sunblock® (Banana Boat)
• Blistex Ultra Lip Balm® (Blistex)
• Chapstick Lip Balm® (Blistex)
• Ombrelle Stick® (Cosmair)
• Shiseido Sun Block Stick® (Shisedo)
• Sun Buffer Lipstick® (Clinique)
• Sunseekers Protective Lip Balm® (Avon)
• Vaseline Lip Therapy® (Lever Ponds)

Dry Eyes And Vision:

Rarely, night vision problems have been reported. They are mostly transient, but could be permanent. Loss of visual acuity is uncommon but, if you experience this, an ophthalmologist should assess you.

For dry gritty eyes, contact lenses may have to be discontinued, but the use of artificial tears is encouraged and in most cases can be very helpful.

Dry eyes are a common problem. There are multiple contributing factors and a spectrum of severity. The film of tears over your eyes is composed of oil, water and mucin. These are produced in the meibomian glands, lacrimal glands and goblet cells.

Your tears are then spread by your eyelids to coat your eyeballs, which helps to moisten them. The tears drain away through a tear duct that is found in the inner part of your lower eyelid. If this is blocked it will produce excess tears and lead to watery eyes.

Many disease conditions, trauma, and/or environmental conditions may play a part in causing symptoms of dry eyes such as burning, grittiness and blurry vision. It is also known that a low level of inflammation that is often not seen (subclinical) can produce dry eyes.

Accutane® (isotretinoin) will cause dry eyes in some individuals. You may find this to be a problem, particularly if you wear contact lenses. You may need to stop wearing them temporarily, but frequent use of artificial tears may allow you to continue using your lenses.

Artificial tears have active ingredients that may contain various methylcellulose compounds, polyvinyl alcohol and polyethylene glycol.

Examples:

• Refresh tears® (Allergan)
• Artificial tears
• Bion tears® (Alcon)
• Cellufresh® (Allergan)
• Celluvisc® (Allergan)
• Isopto tears® (Alcon)
• Liquidfilm tears® (Allergan)
• Tears naturale® (Alcon)
• Visine true tears® (Pfizer Consumer)

Nasal Dryness:

You may have a dry nose, or nose bleeds due to dryness and subsequent cracking of the inner lining of your nose. Frequent use of lubricants is recommended. Dryness of the inner linings of your nose can be caused by a variety of factors. Allergic conditions, viral infections, chronic irritation, sinus inflammation, dry climates, and postnasal discharge, as well as oxygen therapy, can change the moisture content of the nasal lining. Accutane® (isotretinoin) will often cause dry nose, which may in turn produce cracking and consequent nosebleeds. Lubricating your nose can minimize or prevent this side effect. Nose lubricants that are most often used are in the form of a gel. These will often contain polyethylene glycol and propylene glycol.

Examples:

• Rhinaris Lubricating Nasal Gel® (Pharmascience)
• Secaris® (Pharmascience)

Hair:

Thirteen pecent of people taking Accutane® experience thinning hair, though this is usually temporary.

Photosensitivity:

You may sunburn more easily. This can be a problem, particularly during vacations and recreational activities. While taking Accutane® alcohol based sunscreens may be too drying.

Fatigue: (15-20%)

This may be confused with depressive symptoms.

Headaches: (5-16%)

A rare side-effect of this drug is benign intracranial hypertension, which is an increase in pressure of the fluid surrounding your brain. If you have persistant headaches that are present in the morning on waking and ware off through the day, your doctor should evaluate you.

Minocycline (Minocin®, Dynacin®, Vectrin®)

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• INTRODUCTION
  Minocycline inhibits the growth of Propionibacterium acnes. Anti-inflammatory actions. Drug Class: Antibiotic, Anti-inflammatory-long acting tetracycline...   |   Read more ...



• CLININCAL EXPERIENCE
  Oral antibiotics have had a significant role in the treatment of inflammatory disease such as acne, rosacea, perioral dermatitis and others. Tetracycline has long been the first line antibiotic for acneform eruptions because of its efficacy and affordability although in inconvenience of divides doses on an empty stomach has compromised compliance in some. P. acnes resistance to Tetracycline and Erythromycin has meant looking elsewhere for an alternative antibiotic. Bacterial resistance to Minocycline has been much slower to develop...   |   Read more ...



• INDICATIONS
  Labeled Indications: Dermatologic Dermatologic: Acne vulgaris, Inflammatory acne, Anthrax, Chancroid, Granuloma inguinale, Lymphogranuloma venerum, Skin and soft tissue infections , Syphilis, Yaws...   |   Read more ...



• PATIENT PROFILE
  Any inflammatory acne or rosacea patient who is not likely to respond to topical therapy alone. If scarring present or nodulocystic acne a more aggressive approach may be necessary...   |   Read more ...



• DOSING
  Capsules: Minocycline 50 and 100mg (Minocin* Dynacin*) Suspension: Minocycline 50mg (Minocin* Dynacin*) Parenteral: Minocycline 100mg (Minocin IV*) ...   |   Read more ...



• EFFICACY
  Improvement in inflammatory lesion in acne is about a 20% reduction a month. It may take 1-2 months to see initial benefit. After 6 months there is an approximate 60-70% improvement in inflammatory acne counts. Studies over the last 20 years have shown that tetracycline, erythromycin, doxycycline and minocycline have about the same efficacy in acne...   |   Read more ...



• COMPLIANCE
  All tetracyclines are broad-spectrum bacteriostatic agents. They are well absorbed, although oxytetracycline and tetracycline should not be taken with food. Minocycline as well as Doxycycline are absorbed almost as well on an empty as full stomach...   |   Read more ...



• SIDE EFFECTS, SAFETY AND RISKS
  Discard outdated tetracyclines as degradation products may be toxic. Not recommended in pregnancy and in children under 8 years of age as permanent enamel hyperplasia, discoloration of teeth, and inhibition of fetal skeletal growth may occur...   |   Read more ...



• COST OF TREATMENT
  Cost of treatment of 1 month of standard dose for acne: Minocycline 100 mg daily for 1 month $42. Tetracycline 1gm daily for 1 month ...   |   Read more ...

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