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Acne Scarring - Post Inflammatory Hyperpigmentation – Simplicite Skin Care |
After accutane red marks -
After accutane red marks
After accutane red marks -
Many other companies make Isotretinoin in capsules using exactly the same recipe as for Roaccutane. This is called a generic version of the medication and is identical in every way to the branded versions of Roaccutane and Accutane.
Isotretinoin is also available as a cream and gel. This article does not include further information on the cream or gel version of Isotretinoin. Isotretinoin is the most effective treatment available for acne. Isotretinoin is very good for:. Isotretinoin works by reducing grease sebum production in the skin by shrinking the sebaceous glands.
This is why dry skin is the main side effect. Grease in the hair follicles causes overgrowth of Cutibacterium acnes bacteria formerly known as Propionibacterium acnes. This leads to inflammation and acne spots. Isotretinoin also stops the hair follicle cells from being so sticky.
This means it stops hair follicles from getting clogged up by skin cells. Because cells are slightly less sticky, they are also prone to shearing with trauma. Many people will find their skin is more fragile on Isotretinoin for this reason.
This is also why waxing and threading must be avoided, as it could pull off the skin as well as hair. Isotretinoin also probably directly reduces inflammation in the skin too and helps control acne this way. What does this actually mean? Well, someone who has 20 inflamed raised and red spots on their face at the beginning of treatment may expect to have 1 or 2 inflamed spots at the end of 5 months of treatment.
Or someone who gets 20 new spots per week can expect to get 1 or 2 new spots per week after 5 months of treatment. While some people will get complete control of their spots, many people will still develop occasional spots while on Isotretinoin — but these are far fewer in number and usually much smaller and shorter-lived.
Most dermatologists agree that Isotretinoin is one of the few medications that can give prolonged control of acne even after the treatment course for many years, and in some instances, it is a permanent cure. It is hard to have an exact figure as to how many people are cured as the very long term studies to show this are lacking.
As a very general rule of thumb, in the long term, after a course of Isotretinoin in adults over the age of 18 our experience shows:. Isotretinoin is able to damage sebaceous gland cells. In fact, it can severely shrink sebaceous glands and damage the stem cells so that it takes many months or years to recover sebaceous gland activity. This is thought to be the main mechanism of how Isotretinoin produces long term relief from acne. A standard course of Isotretinoin will last between 5 to 7 months.
We usually start on a low dose to get your body used to the medication. The dose is increased every 4 weeks until the maximum dose you can manage for your body weight is reached. If you are able to reach a dose of 1mg of Isotretinoin per kg of body weight per day so if you weigh 60kgs, then a dose of 60mg of Isotretinoin per day by the 12th week, then the course will last about 5 to 7 months. The course can last longer than 7 months if:.
There is a suggestion that reaching a total dose of Isotretinoin of at least mg per kg of body weight by the end of the course will reduce the chance of the acne reoccurring. This broadly described the standard course, which is one that is licensed and officially advocated by the health care regulators in the UK and in Europe. While a standard course is very effective, the downside is that there can be more side effects compared to a low-dose course. Many studies have shown that lower doses of Isotretinoin per day can bring acne under good control as well.
Personal experience has shown that low dose Isotretinoin also causes fewer Isotretinoin-induced flares and possibly less hypertrophic scarring , especially in nodulocystic acne and acne with many macrocomedones. The big attraction for lower-dose Isotretinoin is that there are fewer side effects. Low dose Isotretinoin courses need to be longer in order to achieve enough sebaceous gland shrinkage that the chance of recurrence after stopping are reduced.
Piquero et al. Our Dermatologists are extremely experienced with Isotretinoin and understand the needs of patients who require improvement in their skin while balancing side effects. We prefer to offer a flexible dosing approach for each patient based on their personal goals, other conditions they may have such as eczema, and their proneness to develop side effects.
The aim is to control the acne as best as possible whilst keeping the side effects to their lowest levels possible. Dr Yanni Xu Aesthetic. You should definitely add differin to your regime and consider starting laser early. Best regards Dr Yanni. Similar Questions. View More. Aesthetic Medicine. What are the treatments I can go through for oily skin, large pores, acne scars, and small bumps on the face? Photo Hi there,For your skin issues as seen in the picture and described by you, there are 2 main options.
We strongly suggest avoiding Accutane at all costs as not only can it damage your skin but it can have serious psychological effects. Indented marks in the skin - this 'pitting' is caused from not extracting bacteria from breakouts and pimples; bacteria left to sit in the pore will gradually eat into skin and leave an indented mark, a hole in skin.
Improvement for this type of acne scarring can be achieved by using the gentle and effective One Step Exfoliating Cleanser nightly, with additional results found by applying Rosehip and Lavender Complexion Refiner at least twice weekly. Otherwise it is best to consult a dermatologist for specific help. Knowing the difference between acne scarring described above and post-inflammatory hyperpigmentation below is important. When you can accurately identify and then be able to treat either condition properly you'll avoid any further damage to your skin.
Post-inflammatory hyperpigmentation is the reddish, pinkish or brownish spots that are left over after a pimple heals. One study showed 1. For the first few monthly follow-ups, I reinforce this important message of taking the medication with food. The easiest way to asses if the patient is a candidate for bid dosing is to ask if they have breakfast most days. If they do, ask what they eat.
If it is a light meal or they do not regularly eat breakfast, stick with QD dosing. Although the pharmacokinetics do favor twice daily dosing, if that causes more medication to be taken in the fasting state with poor absorption, it is counterproductive. In isotretinoin-Lidose Absorica came on the market promising higher absorption both in the fed and fasting states.
While it does have a marginal edge in the fed state vs generic isotretinoin keep in mind this was tested with the 1, calorie high fat meal, which very few people eat its real advantage is in the fasting state. Its fasting absorption is 68 percent versus the fed state. This was much better than standard isotretinoin, which only reached Over the course of treatment, poor absorption could lead to lower actual cumulative doses and higher relapse rates.
Patients with low fat diets or those who have irregular meal schedules benefit most from isotretinoin-Lidose. Birth defects: This medication can cause birth defects only while you are taking it and a month after, which is explained at the last visit but does not affect long-term fertility. What this means is that if you become pregnant while taking it there are very strong odds of losing the baby or of serious birth defects. For this reason every female who is biologically capable of becoming pregnant must take monthly pregnancy tests and have a pregnancy prevention plan.
Your colleagues will almost certainly offer positive feedback and praise for this drug. Many have even prescribed it to their own children. However, when you discuss it with patients, a significant number have a negative opinion. How did this huge disconnect happen? It would take an entire article to detail the history of the bad press isotretinoin has received. This creates significant challenges reconciling our views with what the patient has heard from non-expert sources.
Great care must be taken when discussing isotretinoin as a treatment option, as it has a potential to alienate patients if not done properly. They report feeling overwhelmed and like they had little input and were not given all the treatment options. Even if the patient is open to taking isotretinoin, it is easy to understand their concern taking a medication that requires monitoring and is teratogenic.
The right approach is crucial. If our opinion is that isotretinoin is the only viable option, the conversation is straightforward. A new acne patient questionnaire is a great starting point. Isotretinoin is on that list listed as Accutane so patients recognize it. Some people circle it and some cross it out this does not necessarily mean they will never consider it, but expect resistance.
This level is very difficult to achieve for severe acne patients without isotretinoin and patients need to be educated to that reality. Many believe that there has to be something else that will get them these results, therefore, a breakdown of available treatments and expected results is often needed. If not, the patient may believe that you are just pushing one treatment option on them.
Accutane is also a good option. The patient may then offer up what they have heard about Accutane, negative or positive. Many will not say anything, which usually indicates they have not heard of it at all and need to know the basics. Even if we convince them that this is the best treatment choice, and they agree, many will not return or will return wanting to try something else.
We cannot and should not hold it against patients or look down on them that they have been exposed to misinformation that they accept it as fact. There are not experts. It is considered safe, very effective, and has never been withdrawn from the market in any country for safety concerns.
Within the dermatology community, it is not considered a controversial medication.
It is important to appreciate that there are limitations to Isotretinoin. Isotretinoin does not work for:. Isotretinoin can make you much more sensitive to the sun, and you may find that you burn very easily. It is best to stay out of bright sunlight. If you must go out, wear a hat and long sleeves, and apply a factor 50 sunscreen to the exposed areas. It is perfectly OK to apply make-up while undergoing a course of Isotretinoin. A non-comedogenic make-up is better for your skin.
Try and select a mineral-based product if possible. To remove makeup, you can consider using Micellar water and once all the make-up is off, washing the face with a moisturising lotion such as Cerave Moisturising Lotion for Dry Skin, as described above. This two-step process is sometimes called a double cleanse but it will ensure your skin remains hydrated. A mild flare in the first few weeks is very common and this is usually because your previous acne treatments have been stopped, and Isotretinoin has not yet kicked in.
Severe flares in acne are also possible from Roaccutane. One theory is that the sebaceous glands all shrink at once, causing the immune system to act strangely and start causing inflammation against them. This can be treated with steroids. You may also be advised to temporarily stop or cut down the dose of Isotretinoin for severe flares.
The other time is if you have a lot of untreated macrocomedones. It is best to get these dealt with before starting Isotretinoin treatment. It is generally best to avoid any procedure that causes trauma to the skin while taking Isotretinoin.
Therefore it is best to wait at least 3 to 6 months after you have completed the course. Ear piercing and body piercing are best avoided for 6 months until after completing your Isotretinoin course. This is because of a possible increased risk of getting thickened, raised or keloid scars.
You would be advised to avoid eyelash extensions and false eyelashes while taking Isotretinoin. There is a possibility that the glue which is used may cause irritation that can lead to blepharitis. Please contact the office so that you can be referred to a local specialist Eye clinic that is familiar with our patients on Isotretinoin for further evaluation.
Following evaluation by an eye specialist, you will be advised if you have additional reasons for your dry eyes, such as blepharitis, eyelashes irritating the eye, an unstable tear film and Meibomian gland dysfunction. You will be advised whether you require medicated eye drops, punctum plugs to help tear retention or other eye treatments. It is important to have this symptom addressed sooner rather than later in order that you may remain on Isotretinoin. If you are interested in discussing Isotretinoin as a treatment for acne, then please contact us on to organise an appointment or click here to make an enquiry.
Medications are only prescribed during a consultation once your doctor has adequate knowledge of your health and condition. A particular medication is only prescribed if the medication is suitable for a person in their current situation. We ask that you do not assume that a particular medication will be prescribed at a consultation, as this will be down to the medical assessment made by your doctor. Further, we also do not necessarily continue prescriptions for medications you may have been prescribed elsewhere, including from overseas or from online providers, as the same criteria for prescribing are applied.
Make an appointment. Making the decision to go on a course of Isotretinoin can be difficult, especially as there is a lot of opinion about this medication on the internet and on the media. It is important to consider the benefits of this medication, along side the risks and the costs. If you have had a consultation with one of our acne specialist doctors and have been advised to consider Isotretinoin, then you will be asked to read this information page before reaching the decision to take Isotretinoin so that you are fully informed.
Make an appointment Call us now. Whilst all dermatologists will be familiar with the conventional Isotretinoin doses, we have a specialist interest in all aspects of acne management. Because of this, patients are offered highly bespoke treatment regimes and combinations of therapy.
Isotretinoin is a prescription medication used for acne. It can only be prescribed by doctors who are experienced in using this drug, usually a Consultant Dermatologist. Roaccutane is the brand name for the drug Isotretinoin in tablet form. Roaccutane is made by Roche and has been available in the UK since Many other companies make Isotretinoin in capsules using exactly the same recipe as for Roaccutane.
This is called a generic version of the medication and is identical in every way to the branded versions of Roaccutane and Accutane. Isotretinoin is also available as a cream and gel.
This article does not include further information on the cream or gel version of Isotretinoin. Isotretinoin is the most effective treatment available for acne. Isotretinoin is very good for:. Isotretinoin works by reducing grease sebum production in the skin by shrinking the sebaceous glands. This is why dry skin is the main side effect. Grease in the hair follicles causes overgrowth of Cutibacterium acnes bacteria formerly known as Propionibacterium acnes.
This leads to inflammation and acne spots. Isotretinoin also stops the hair follicle cells from being so sticky. This means it stops hair follicles from getting clogged up by skin cells. Because cells are slightly less sticky, they are also prone to shearing with trauma. Many people will find their skin is more fragile on Isotretinoin for this reason.
This is also why waxing and threading must be avoided, as it could pull off the skin as well as hair. Isotretinoin also probably directly reduces inflammation in the skin too and helps control acne this way. What does this actually mean?
Well, someone who has 20 inflamed raised and red spots on their face at the beginning of treatment may expect to have 1 or 2 inflamed spots at the end of 5 months of treatment. Or someone who gets 20 new spots per week can expect to get 1 or 2 new spots per week after 5 months of treatment. While some people will get complete control of their spots, many people will still develop occasional spots while on Isotretinoin — but these are far fewer in number and usually much smaller and shorter-lived.
Most dermatologists agree that Isotretinoin is one of the few medications that can give prolonged control of acne even after the treatment course for many years, and in some instances, it is a permanent cure. It is hard to have an exact figure as to how many people are cured as the very long term studies to show this are lacking. As a very general rule of thumb, in the long term, after a course of Isotretinoin in adults over the age of 18 our experience shows:. Isotretinoin is able to damage sebaceous gland cells.
In fact, it can severely shrink sebaceous glands and damage the stem cells so that it takes many months or years to recover sebaceous gland activity.
This is thought to be the main mechanism of how Isotretinoin produces long term relief from acne. A standard course of Isotretinoin will last between 5 to 7 months. We usually start on a low dose to get your body used to the medication. The dose is increased every 4 weeks until the maximum dose you can manage for your body weight is reached. If you are able to reach a dose of 1mg of Isotretinoin per kg of body weight per day so if you weigh 60kgs, then a dose of 60mg of Isotretinoin per day by the 12th week, then the course will last about 5 to 7 months.
The course can last longer than 7 months if:. There is a suggestion that reaching a total dose of Isotretinoin of at least mg per kg of body weight by the end of the course will reduce the chance of the acne reoccurring. This broadly described the standard course, which is one that is licensed and officially advocated by the health care regulators in the UK and in Europe.
While a standard course is very effective, the downside is that there can be more side effects compared to a low-dose course. Many studies have shown that lower doses of Isotretinoin per day can bring acne under good control as well. Personal experience has shown that low dose Isotretinoin also causes fewer Isotretinoin-induced flares and possibly less hypertrophic scarringespecially in nodulocystic acne and acne with many macrocomedones.
The big attraction for lower-dose Isotretinoin is that there are fewer side effects. Low dose Isotretinoin courses need to be longer in order to achieve enough sebaceous gland shrinkage that the chance of recurrence after stopping are reduced.
Piquero et al. Our Dermatologists are extremely experienced with Isotretinoin and understand the needs of patients who require improvement in their skin while balancing side effects. We prefer to offer a flexible dosing approach for each patient based on their personal goals, other conditions they may have such as eczema, and their proneness to develop side effects. The aim is to control the acne as best as possible whilst keeping the side effects to their lowest levels possible.
For some, this will mean a dose of 10mg three times per week, and for others, this will mean more conventional dosing, with many variations in between. When using low-dose Isotretinoin, treatment is continued until the acne has become controlled and is extended to 3 or 4 months beyond that.
A flexible dosed course may last anywhere from 4 months to 18 months. It is important to note that low dose and personalised dosing is not in the product licence for Isotretinoin, and so it is provided for on a case-by-case basis after consultation with a doctor.
These are the costs to consider when embarking on a course of Isotretinoin. The following can provide a rough idea of the costings:. Blood tests can be done at the Clinic. We are unable to instruct your GP to carry out blood tests while you are receiving private care. We let all our patients know that if there are interruptions in the monitoring plan that you have been given, then we cease treatment and further prescriptions of Isotretinoin are not offered.
Isotretinoin can cause side effects and these are greater as the dose is increased. With our Personalised Dosing Plan, the goal is to keep side effects minimal and under control whilst improving acne. The key here is to prevent side effects as much as possible right from the beginning. With good management, out of people starting Isotretinoin, only 1 or 2 may need to discontinue it.
You should take Isotretinoin at the same time every day with a meal, preferably a meal that has 20g or more of fat.
localhost › Q&A › Accutane Questions. If you still have red marks two years post-Accutane, you may need an additional treatment other than Accutane. While Accutane is exceptionally helpful for. Post-inflammatory hyperpigmentation is the reddish, pinkish or brownish spots that are left over after a pimple heals. These is not true scarring as such, more. Treatments will result in progressively smoother skin with scar lifting, even-colored skin, improved hydration and elasticity. No downtime laser toning can. Some of the red marks and brown spots will clear up as your acne clears. The scars will not be affected by isotretinoin. A few months after you finish. Indented marks in the skin - this 'pitting' is caused from not extracting bacteria from breakouts and pimples; bacteria left to sit in the pore will gradually eat into skin and leave an indented mark, a hole in skin. To remove makeup, you can consider using Micellar water and once all the make-up is off, washing the face with a moisturising lotion such as Cerave Moisturising Lotion for Dry Skin, as described above.Isotretinoin, the drug that revolutionized acne treatment, is the only medication that can clear acne and produce long-term remissions. Since its introduction in , it continues to be a vital and widely used acne medication worldwide.
It is used mainly for severe, recalcitrant nodulocystic acne as well as recalcitrant moderate acne. Abroad, isotretinoin tends to be dispensed more liberally than in the US and with a trend toward lower doses. This article will not cover the well known pharmacology, dosing, and side effects of this medication. The goal is to have the patient very well educated and for the provider to have all the tools and knowledge to guide the patient through a successful treatment.
Educating patients about isotretinoin and how it differs from other treatments is no easy task. Isotretinoin is a unique drug and is completely different than any other acne medication. Below are the topics that are essential to cover during the patient visit and information on how I explain them to patients. Much of this information is included in the Isotretinoin Fact Sheet to be discussed later that I routinely hand out. Q: What is isotretinoin?
Isotretinoin is a pill you take for four to five months. Your acne will start to improve in one to two months, and the vast majority of people are clear at the end of treatment. It is the only acne medication that permanently reduces acne an average of 80 percent—some people a little more and some a little less. It also makes our skin less oily long-term. Twenty percent of patients take the medication a second time if they still have significant acne.
Some blood tests are required. After hearing so much about how effective isotretinoin is, patients expect dramatic results the first month and need to have their expectations managed. Temporary improvement vs. Isotretinoin is the only medication to produce a substantial permanent reduction in acne after you stop taking it. Isotretinoin is the only medication where these expectations can largely be met. For some people, it is quite a shock that at age 14 for example, without isotretinoin and sometimes with it if they do not get full clearance they will be treating their acne at least another five years.
This stark contrast between isotretinoin and non-isotretinoin treatment should be made crystal clear. How does it work? Isotretinoin works by shrinking your oil glands and normalizing the way your skin grows, which prevents pimples and clogged pores. Because your lips have a lot of oil glands they will become dry first, followed by your face and possibly other areas.
Using lip balm frequently and moisturizing creams can manage these symptoms quite well. You will also sunburn faster. We expect the medication to do this—this is how it works. Isotretinoin does not make scars or PIH post inflammatory hyperpigmentation , or post inflammatory erythema disappear.
Some of the red marks and brown spots will clear up as your acne clears. The scars will not be affected by isotretinoin. A few months after you finish treatment, we can see what red marks and brown marks remain, assess your scarring, and review your treatment options for clearing those up. Some treatments, like hydroquinone blend bleaching creams, can be initiated immediately after isotretinoin is finished or even during treatment if the skin can tolerate it.
For some treatments lasers, chemical peels, etc. Initial flare is not therapeutic! I f your acne gets worse in the first month or two, let us know so we can treat it! Initial flare is a common but preventable side effect. The more severe, inflammatory, widespread and cystic the acne is, the more common initial flare is.
Strategies to prevent initial flare include lower initial dose and concurrent use of prednisone the first month. Acne can also get worse the first month simply because all other acne medications have been discontinued and isotretinoin may take a month or two to begin working, causing a treatment gap. Keep in mind that non-drying topical medications can be continued as can spironolactone for female patients and any antibiotic except tetracyclines due to the increased risk of Pseudotumor Cerebri.
Take with food: Isotretinoin absorbs twice as well if you take it with meals. Isotretinoin is a lipophilic medication. One study showed 1. For the first few monthly follow-ups, I reinforce this important message of taking the medication with food. The easiest way to asses if the patient is a candidate for bid dosing is to ask if they have breakfast most days.
If they do, ask what they eat. If it is a light meal or they do not regularly eat breakfast, stick with QD dosing. Although the pharmacokinetics do favor twice daily dosing, if that causes more medication to be taken in the fasting state with poor absorption, it is counterproductive.
In isotretinoin-Lidose Absorica came on the market promising higher absorption both in the fed and fasting states. While it does have a marginal edge in the fed state vs generic isotretinoin keep in mind this was tested with the 1, calorie high fat meal, which very few people eat its real advantage is in the fasting state. Its fasting absorption is 68 percent versus the fed state.
This was much better than standard isotretinoin, which only reached Over the course of treatment, poor absorption could lead to lower actual cumulative doses and higher relapse rates. Patients with low fat diets or those who have irregular meal schedules benefit most from isotretinoin-Lidose. Birth defects: This medication can cause birth defects only while you are taking it and a month after, which is explained at the last visit but does not affect long-term fertility.
What this means is that if you become pregnant while taking it there are very strong odds of losing the baby or of serious birth defects. For this reason every female who is biologically capable of becoming pregnant must take monthly pregnancy tests and have a pregnancy prevention plan. Your colleagues will almost certainly offer positive feedback and praise for this drug. Many have even prescribed it to their own children.
However, when you discuss it with patients, a significant number have a negative opinion. How did this huge disconnect happen? It would take an entire article to detail the history of the bad press isotretinoin has received. This creates significant challenges reconciling our views with what the patient has heard from non-expert sources.
Great care must be taken when discussing isotretinoin as a treatment option, as it has a potential to alienate patients if not done properly. They report feeling overwhelmed and like they had little input and were not given all the treatment options. Even if the patient is open to taking isotretinoin, it is easy to understand their concern taking a medication that requires monitoring and is teratogenic. The right approach is crucial. If our opinion is that isotretinoin is the only viable option, the conversation is straightforward.
A new acne patient questionnaire is a great starting point. Isotretinoin is on that list listed as Accutane so patients recognize it. Some people circle it and some cross it out this does not necessarily mean they will never consider it, but expect resistance.
This level is very difficult to achieve for severe acne patients without isotretinoin and patients need to be educated to that reality.
Many believe that there has to be something else that will get them these results, therefore, a breakdown of available treatments and expected results is often needed. If not, the patient may believe that you are just pushing one treatment option on them.
Accutane is also a good option. The patient may then offer up what they have heard about Accutane, negative or positive. Many will not say anything, which usually indicates they have not heard of it at all and need to know the basics. Even if we convince them that this is the best treatment choice, and they agree, many will not return or will return wanting to try something else.
We cannot and should not hold it against patients or look down on them that they have been exposed to misinformation that they accept it as fact. There are not experts. It is considered safe, very effective, and has never been withdrawn from the market in any country for safety concerns. Within the dermatology community, it is not considered a controversial medication.
Dermatologists are very comfortable with its use, so much so that many prescribe it to their own children or relatives I usually add here that my brother took it on my recommendation. But the most important thing is that you have to be comfortable with it. If the patient wants to consider it as an option right then and there they will pursue that conversation, if not I pivot to other treatments.
If the patient chooses other treatments, at least you have set the stage for more informative discussion down the road if they are not getting the results they want. We have become very comfortable with using isotretinoin but must remember that for a patient, parent or teen, to consider taking a medication that is teratogenic and needs monitoring may just be too scary to consider, even if it is the only thing that will help.
Often times our failure to navigate it and guide patients through it prevents patients from getting their medication. Prescribers should not delegate iPLEDGE responsibilities to medical assistants without first mastering the system ourselves. For me this required several months of clearing people and making multiple calls to iPLEDGE, but it was a worthwhile investment. Going through this process, I concluded that it is unrealistic to expect a person with a medical assistant level education to master iPLEDGE on their own.
We have to register them and clear them every month but they do absolutely nothing. Whether these patients had blood tests is not a criteria for clearing them. They have a day window to pick up their medication. Registration cannot take place without a pregnancy test and even if the pregnancy test date precedes the registration date, the day window starts on the registration date. This is why it is important to register patients the day the pregnancy test results come in to avoid delays.
Schedule a four and a half to five week follow-up rather than four weeks follow-up for the second visit.
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