Isotretinoin

Isotretinoin_Drug Images

Accutane is a product name, and its common name is isotretinoin. In addition to Accutane, isotretinoin’s product names are Roaccutane, Isotroin, Absorica, Amnesteem, Claravis, Myorisan, Sotret, Zenatane and others.

In our clinic, we have performed acne treatment with isotretinoin for over 12 years. Our clinic has the largest number of patients receiving the accutane treatment in Japan.

Isotretinoin is a treatment which is most effective and has the lowest recurrence rate among acne treatments that are used worldwide. The effective rate of isotretinoin treatment for acne is 98% or higher and the recurrence rate is only 30% (*).

Transient acne exacerbation is seen in about 30% of patients during the first month. Patients should see a dramatic improvement within 2 to 3 months if they take the adequate dosage of medicine consistently. Even after the acne improve, it is necessary to continue the treatment to prevent recurrence. A regular course of treatment is 6 months. If there is little improvement, it can be extended to 8 months.

* Regarding the recurrence rate, compared with the condition before the treatment, the case where the number of acne recurs more than one-third is called recurrence.

Isotretinoin

Isotretinoin_Drug Images

Isotretinoin is a drinking pill for the treatment of acne. It is a medicine belonging to the “retinoid” of vitamin A derivative.

Isotretinoin is the original medicine under the product name “Accutane”, and it has now been replaced by all generic medicines. Generic medicines of Accutane include “isotroin”, “roaccutane (roacquatan)”, “sotoretto” and “clarabis”.

For moderate ~ severe acne, it is recommended at a high level in the treatment guidelines of Europe and the United States and has been used worldwide for more than 30 years 1 , 2.

The reason why isotretinoin is Japan and unlicensed is that acne is not a disease that causes physical problems, so it is often interpreted as “cosmetic purposes” rather than “for the treatment of diseases”, and in particular, medicines with serious side effects such as teratogenic properties such as isotretinoin are difficult to be approved.

Our hospital, including the previous hospital, has treated more than 10,000 patients for more than 14 years. We are proud to be a dermatologist who has experienced many cases since ancient times, mainly for patients with severe acne that do not improve in dermatology.

Effects of isotretinoin on acne

The outcome of isotretinoin treatment for our patients is more than 98% for patients with moderate or better improvement, and the recurrence rate* is 30% or less.

This is not significantly different from the efficacy rate and improvement rate of isotretinoin in the literature. In a study that treated patients with moderate acne with isotretinoin at 20 mg/day over a period of about 6 months, 98.99% of patients reported improvement, and 98.3% of patients reported a dramatic improvement in 98.3% of patients, a very high efficacy rate 3.

In a study that treated patients with severe acne with isotretinoin of 1 mg/kg/day over a period of approximately 5 months, 90% of patients showed a reduction in inflammatory acne of 95% or more, and the efficacy rate increased in a dose-dependent manner 4.

Considering that most patients treated at our hospital had already received insurance treatment such as antibiotics and topical creams and no improvement was observed, it can be said that the effect of isotretinoin is very high and the recurrence rate is low.

For moderate or less acne, insurance treatment is ineffective and only prescribed for those who repeatedly relapse. For moderate or sub-acne, low-dose therapy of isotretinoin of 0.5 mg/kg/day or less is often effective 5 , 6.

For acne of moderate disease or above, we aim for early improvement in order to leave scars and marks as little as possible.

*The recurrence rate according to our statistics is relapsed when the number of new acne returns to 1/3 or more of the state before treatment after the treatment is completed.

Action of isotretinoin

Isotretinoin does not contain ingredients such as antibiotics, hormonal medicines, or steroids that have the effect of sterilizing acne bacteria.

There are still many unknown parts of the action of isotretinoin, but the following three main things are known.

Involutes sebaceous lines

Oral isotretinoin does not have a direct antibacterial effect, but it does have the effect of involving the sebaceous glands and greatly reducing sebum secretion 7 20. This action prevents acne bacteria, which are the causative bacteria of acne, from colonizing, and can reduce the number of acne bacteria compared to antibiotics 21.

Isotretinoin promotes apoptosis of the sebaceous glands8, and even after treatment, a decrease in the amount of sebum is observed to some extent. However, since the size of the contracted sebaceous glands without causing apoptosis returns to the original, sebum also returns for the most part.

Normalizes cells

Isotretinoin works on cells to normalize sebaceous gland cells and epidermal cells 9. Although the pathological condition is different from acne, the therapeutic effect in “sebaceous gland hyperplasia” in which the sebaceous gland develops too much and becomes enlarged has also been recognized, and it has also been reported that the rate of normalization of the sebaceous glands even after completion of treatment is high 10.

When the cells of the skin become working normally, abnormal keratinization (thickening of the skin and clogging of pores) does not occur, and if the pores become boring, the inflammation of acne does not occur.

Anti-inflammatory properties

It has also been reported that isotretinoin has an “immunomodulating effect” that normalizes the immune response of cells to acne bacteria, which are the cause of acne.

In other words, it has the effect of preventing inflammation from occurring due to excessive immune response, which makes acne inflammation less likely to occur 11, 12.

Isotretinoin treatment at our hospital

About 30% of patients have a transient exacne exacerbation (upturn reaction) for one month after the start of treatment, but on average acne improves in 2 months ~ 3 months. Even after the acne improves, treatment should be continued to prevent recurrence. The duration of treatment for 1 cool is about 6 months.

We will examine the condition of the skin and the presence or absence of side effects, and if the improvement of acne is poor, the dose will be increased. The recommended dose is 0.5mg~1.0mg/kg/day, and the maximum dose is 2mg/kg/day 13.

Prescriptions from inexperienced beauty clinics often have problems where proper dosage and administration are not adhered to, side effects are not properly managed, and the rate of improvement is not high even with the use of isotretinoin.

At our hospital, we are striving to minimize the recurrence rate by devising treatment methods, but about 30% of patients recognize relapse. Unfortunately, for 1 to 2% of patients, increasing the dose may not have any effect at all.

Duration of treatment

Treatment is carried out for 6 months, but fluctuates in the condition of individual acne. If the acne healing is bad, it may be extended to 8 months.

After the end of treatment of 1 cool, take a leave period of at least 2 months (preferably 4 months). If the recurrence of acne is mild, treatment is finished.

If you have a recurrence that you are worried about, take a break of more than 2 months, and then consult again to consider whether to treat the second cool.

Even if acne recurs, it is almost always difficult to form than before, so by repeating treatment with 2 cools and 3 cools, it is possible to bring it to a state where acne is not bothered in most cases.

Case Photos

If you would like to see case photos of acne treatment with isotretinoin, please click below.

Treatment Case 1 (acne conglobata)

How did you come to the hospital?

A man in his 20s. I began to suffer from acne on my face from the age of 15, and although I had been receiving almost all the insurance treatment including antibiotics, topical preparations, vitamins, and herbal medicines at the dermatologist of the doctor nearby, it did not improve and came to our hospital.

Photos before treatment

A large number of acne with strong inflammation are formed on the entire face. Multiple acnes gather together into one large mass, which is strongly swollen. It is a severe type of acne called “acne concentrated” in a state where many nodules are connected.

1 before severe acne treatment
3 Before Severe Acne Treatment

Since large acne has been forming repeatedly for many years, I fully explained the risk of dents and crater marks, and started treatment with isotretinoin.

Photos 5 months later

This is a photograph taken at the time when 5 months have passed since the start of treatment. Pustules and nodules are gone, papules and comedo are almost gone.

1 after severe acne treatment
3 After Severe Acne Treatment

Commentary

For acne with severe symptoms, if treatment continues for many years without healing, it is often a problem that atrophic scars (dents) that will not heal for a lifetime remain.

In addition, when acne is on the entire face, it is difficult to notice acne scars because the face is swollen due to inflammation, but when acne disappears, the marks that were hidden under the acne will appear.

Many patients have already formed scars at the time of their visit to our hospital, but early treatment of severe acne is important in order not to leave scars.

How did you come to the hospital?

I am a patient with severe acne in my late teens. Acne began to form four years ago, and I had been treating oral antibiotics, topical preparations (including steroids), herbal medicines, etc. for 3 years at the dermatologist near me, but although it temporarily got a little better, it was far from cured. Two months ago, the inflammation became stronger and stronger, and as the indicular cysts became more frequent, it became unmanageable with the nearest doctor, and I was referred to a university hospital. However, at the university hospital, the same treatment as that of the doctor (oral use of antibiotics, external use of antibiotics, Bepiogel, oral vitamin supplements) was carried out, and no change was observed in two months, and the parents requested to be transferred to our hospital.

【Past treatment history】Over-the-counter acne treatment drugs (multiple types), oral vitamins, antibiotics (such as minocycline), herbal medicines (multiple types, details unknown), topical preparations (aquachim cream, dalacin gel, differin gel, bepiogel, convec ointment, staderm ointment, delmosol G ointment)

Photos before treatment

A large number of pustules with hardening are formed, and the entire face is swollen. Acne also formed on the skin around the eyes, and the face was deformed with a large swelling. It is a severe acne called “acne collective” that becomes a lump when the abscess is combined.

4 Before Severe Acne Treatment
6 Before Severe Acne Treatment
5 Before Severe Acne Treatment

At the time of the first consultation, it was accompanied by fever, and blood data showed WBC16400 CRP4.17 and systemic inflammation. Differential diagnoses were made for systemic lupus lepus (SLE), sarcoidosis, γ globulinemia, rheumatism, viral hepatitis, malignant lymphoma, etc. as underlying diseases that cause pyoderma, but all were negative.

Since acne collecting has a high risk of leaving a large scar, treatment with isotretinoin was immediately performed.

Photos 5 months later

Two weeks after I started taking isotretinoin, and although there were many more abscesses, it gradually improved from 1 month later, and after 5 months the inflammation completely subsided. The redness of the acne scar still remains strong, and irregularities are also noted, but the new acne is gone, and the swelling of the entire face is receding.

4 After Severe Acne Treatment
5 After Severe Acne Treatment

Photos after 8 months

Since it was the most severe form, maintenance therapy was performed after completing the treatment period of 1 cool. In addition, during treatment, we thoroughly moisturized with in-hospital dispensing and performed acne scar care by peeling.

6 After Severe Acne Treatment
8 After Severe Acne Treatment
7 After Severe Acne Treatment

* Because I changed to a new camera, I can shoot pale due to the setting.

Commentary

The patient pictured had been on antibiotics for three years at the dermatologist but showed no improvement. Treatment of acne in Japan is delayed by more than 40 years compared to Europe and the United States, and the more severe the disease, the more likely it is that acne scars (pigmentation and irregularities) will remain for a lifetime if treatment is not performed at an early stage.

Treatment with isotretinoin is not the “last resort = last treatment” of acne treatment. In the case of severe acne, it is necessary to treat it as early as possible in order not to leave scars.

How did you come to the hospital?

I am a woman in her 20s. I have been suffering from acne for 10 years, and I have been continuing insurance treatment such as antibiotics, vitamins, and Chinese medicine for internal use at a dermatologist for many years, but I did not find any improvement. I had cosmetic surgery a year ago, had 6 photo facials, chemical peeling and iontophoresis 12 times, but it got worse from half a year ago, so I went to the esthetic salon and received treatments such as sedation pack and exfoliation, but it did not improve so I came to our hospital.

【Past treatment history】Oral vitamin pills, antibiotics (details unknown, multiple oral doses), herbal medicines (Tomi Septic Yu, Katsuraeda Kinen Maru Yokuinin, etc.), Topical preparations (details unknown, but multiple uses), vitamin C iontophoresis (cosmetic surgery), Photo facial (cosmetic surgery), glycolic acid chemical peeling (cosmetic surgery), sedation pack (esthetic treatment), exfoliation (esthetic treatment)

Photos before treatment

Papules throughout the face, face line, neck upset, nodules, pustules are frequent, and pigmentation and irregularities of acne scars are also often observed.

Severe Acne in Women 1
Severe Acne 2 in Women
Women Severe Acne 3

Photos 1 month later

There are places where acne is healed, but nodules that were not present at the time of initial examination appear on the face line and neck, and the overall situation is deteriorating.

Accutaneous deterioration

Photos 5 months later

At this point, the new acne was almost gone. In parallel with isotretinoin treatment, dispensing cosmetics and peeling are performed, and the strong reddish acne scars are gradually turning a pale pink color.

Women after Accutane treatment
Women after Accutane treatment
Women after Accutane treatment

Commentary

Acne worsens one month after treatment, but when isotretinoin is taken internally, transient exacerbations are observed in about 30% of patients for the first month.

Temporary exacerbations are not uncommon, but if the degree of aggravation is severe, we will increase the dose early or prescribe medication to quell the inflammation.

This patient received various treatments and did not improve, so he took a long detour until he came to our hospital. Although he had formed a large number of scars (hankon, acne scars) at the time of the first consultation, the person himself was always cheerful and positively engaged in treatment.

Background of the visit

I have been suffering from acne for 15 years and have been receiving sulfur camphor lotion, antibiotic oral medicine, herbal medicine, vitamins, etc. at the dermatologist for many years. After that, treatment with the pill continued at another hospital for more than a year, but it got worse, and from 2 years ago it became impossible to walk without a mask, so he came to our hospital.

Photograph taken at the time of the first consultation

Papula-like red acne is frequented around the chin, face line, and neck. In the case of women, during puberty, acne tends to form in the T-zone and cheeks, and adult acne tends to form on the chin, face line, neck, etc.

Jaw acne

Skin care with isotretinoin treatment and dispensing cosmetics was performed.

Photos 4 months later

The red inflammation of acne has subsided, and new acne including comedo can no longer be done. The pigmentation of acne scars has become less noticeable, and the skin quality has also improved. It seems that he lost weight during the treatment, and although it looks like a different person in the photo, it is the same patient.

After jaw acne treatment

Commentary

Isotretinoin has the effect of enhancing skin turnover, so it can also be expected to expel pigmentation of acne scars quickly. By using preventive skin lightening and dispensing cosmetics with moisturizing effects in combination, further improvements are promoted.

Background of the visit

A man in his 20s. Because of the acne on the entire face ~ neck, he consulted a dermatologist and received insurance treatment (internal and topical use, details unknown) for more than half a year, but because it continued to deteriorate, he was examined at our hospital.

Photograph taken at the time of the first consultation

Erythema and papules occur frequently on the entire face, neck and face line, and some nodules are observed. Pigmentation and atrophic scarring of acne scars are also noted.

Severe acne
Severe acne
Severe acne

In conjunction with isotretinoin treatment, we started macrogol peeling salicylate.

Photos 4 months later

Improvement was observed 1 month after the prescription of isotretinoin, and by the time 4 months had passed, the new acne and active acne were almost gone.

After treatment of severe acne
After treatment of severe acne
After treatment of severe acne

Commentary

This patient seems to have had some acne than before, but it seems that it suddenly worsened from 7 months before coming to our hospital to the entire face ~ neck.

Genetic factors account for the majority of acne causes, but environmental changes and stress can also be triggers.

The response to isotretinoin was good, and the acne improved in 1 month, but continued for 6 months to prevent recurrence.

Background of the visit

A man in his 20s. I developed puberty acne 15 years ago and it spread to my entire face before taking the university entrance exam. After that, although the acne gradually calmed down after becoming a member of society, I always had multiple red acne all over my face. I had been receiving insurance treatment such as antibiotics at a dermatologist near me for several years, but I did not improve, so I visited our hospital.

Photograph taken at the time of the first consultation

There are many cases of red acne with inflammation all over the face.

Red Acne
Red Acne

We explain the initial deterioration at the time of isotretinoin treatment to all patients, but 2 weeks after the start of treatment, the acne worsened, and I became worried and called our hospital. I explained that it would continue as it is, and in the second month it became an improving trend.

Photos 5 months later

The new acne and active acne are gone, and the pigmentation and irregularities of the acne scar have healed without leaving much.

After red acne treatment
After red acne treatment

Commentary

In the case of isotretinoin treatment for one month, millet may worsen transiently in about 30% of patients.

If it worsens, try not to irritate the acne as much as possible and continue the medicine as it is. In addition, antibiotics may be prescribed if the symptoms are severe, but most patients take multiple antibiotics for a long period of time before visiting our hospital, and there are many cases where the effect does not come out due to problems such as resistant bacteria.

Background of the visit

Acne began to form 7 years ago, and from 4 years ago to the present, papules and pustules (white acne) began to occur frequently throughout the face. I have received various treatments such as over-the-counter acne treatment drugs, peeling soaps, antibiotics of health insurance treatment, vitamin supplements, herbal medicines, topical preparations such as differin gel and Bepiogel, clear touch (light treatment), etc., but it could not be cured, so I visited our hospital.

【Past treatment history】Over-the-counter acne treatment drugs (multiple types), peeling soap, vitamin supplements, antibiotics (cefuroxime, roxisulomycin), herbal medicines (Katsuraeda Kinen Maruka yokuinin, Toki Peony Medicine Powder, Chu Chu Renyu Yu), external preparations (Aqua Chim Cream, Dallaxin Lotion, Differin Gel, Bepiogel), Light Treatment (Clear Touch)

Photograph taken at the time of the first consultation

There are many cases of papules on the entire face, especially on the cheeks and chin, and white acne with some pus. Many acne scars (atrophic scars) are also observed.

Red Acne and White Acne
Red Acne and White Acne
Red Acne and White Acne

Started treatment with isotretinoin.

Photos 1 month later

Early deterioration is noted throughout the face. A large number of pustules appeared, increased the dose of isotretinoin.

Worsening of red and white acne
Worsening of red and white acne
Worsening of red and white acne

Even though the acne has worsened, “It has worsened, but I don’t care because I was briefed at the beginning.”

Photos 5 months later

After 3 months there was little improvement, so I increased the dose of isotretinoin further, and at 5 months both red inflammatory acne and white acne with pus disappeared.

After red acne and white acne treatment
After red acne and white acne treatment
After red acne and white acne treatment

Commentary

Red acne is a colloquial name for acne with red and swollen inflammation. White acne refers to acne with pus. Black acne is a condition in which the sebum in the head part of the acne has oxidized and turned black. Also called blackheads (blackheads = black heads).

There are pages that classify acne by color difference and explain each treatment, but it is meaningless at all. The cause of acne is the sebaceous gland, and the color is only a wording of the subsequent condition.

Whether it is red acne or white acne, there is no difference in the treatment method. However, in the case of black acne, there are cases where it is simply a clogging of sebum causing oxidation, so if inflammation is not recognized, it may be cured even with ordinary skin care and peeling.

If the reaction to isotretinoin is poor, the dose of the drug must be increased.

There are many patients who are reluctant to get worse in the early stages, but since we explain it first on the sheet, there are very few patients who quit halfway. Because the patient was also positive about treatment, we were able to cure acne. If he had thrown out the treatment in the middle, he would not have been able to make a complete cure.

Background of the visit

Male teenager. This is a patient who has been visiting a dermatologist for several years since the age of 16 to receive insurance treatment. I was prescribed and drank antibiotics for a total of 2 to 3 years, but it did not improve and I was examined at our hospital.

Photos before treatment

Inside the scalp ~ nape ~ back ~ waist, papules, nodules and pustules are observed throughout. Because it was repeated for many years, many red and red-black acne scars remain.

Severe acne on the back

Started treatment with isotretinoin.

Photos after 6 months

This is a photo taken 6 months after the start of treatment. Although many pigmentation of acne scars remained, the inflammation receded and the pustular acne was cured.

After treatment of severe acne on the back

Commentary

At the time of the first consultation, it is explained that isotretinoin is a treatment for acne and has little effect on improving acne scars, but in fact it has the effect of enhancing skin turnover, so you can expect the effect of improving the redness of acne scars.

This patient was satisfied with the condition of his skin after 6 months, so he did not want acne scar treatment such as laser or peeling. After the acne is cured, it is decided whether to treat the scar or not in consideration of the wishes of the person.

Background of the visit

A man in his 20s. Since the age of 12, I have been suffering from acne not only on my face, but also on my body such as my back and chest. He continued to receive insurance treatment for a long period of 9 years, and regularly used antibiotics such as minomycin and rurid, vitamins B and C, pantothenic acid, epiduogel, differin gel, and Bepiogel, but according to the person himself, there was no improvement at all, so he came to our hospital.

Photos before treatment

At the time of the first visit, I had erythema and papules all over my back, and they were also scattered on my chest. There were also many redness and pigmentation of acne scars, some of which were hypertrophic scars (swelling).

Breast Acne
Back Acne

Started treatment with isotretinoin.

Photos 5 months later

Both the chest and back are inflamed and the acne is improving.

On the chest there are several raised acne scars called “hypertrophic scars”. The back looks mottled due to the red pigmentation of the acne scars.

After breast acne treatment
After Back Acne Treatment

Acne scar pigmentation and hypertrophic scarring

Like this patient, if acne continues to form repeatedly for a long period of 9 years, acne scars will remain.

With the right treatment, it is not difficult to cure acne, but acne scars may remain for a lifetime. The important thing is to treat severe acne at an early stage. If it can be cured early, it can only prevent the risk of leaving keloids and scars.

Patients who post photos have received consent forms for publication. The photographs taken at the time of examination are for medical records and are protected by the Personal Information Protection Act. Please be assured that we will not post it without your consent.

Side effects of Isotretinoin

It is also true that isotretinoin has various side effects and risks. It is essential to thoroughly explain side effects and risks, and to check for side effects such as regular blood sampling tests.

The side effects of isotretinoin are wide-ranging, but the most common is dryness of the skin, mouth, nose and mucous membranes of the eyes. This side effect occurs in almost 100% of patients. Dryness can cause dermatitis, angular cheilitis, cheilitis, nose bleeds, dry eyes, etc. Along with that, reddening and nosebleeds are also common side effects 13.

In addition to liver dysfunction, various abnormalities may be observed in the examination, so our hospital conducts detailed blood tests and urinalysis tests every month.

Although very rare, serious side effects such as blurred vision, visual field disturbances such as eye abnormalities, acute pancreatitis, acute hepatitis, ulcerative colitis, Crohn’s disease, anaphylactic shock, Stevens-Johnson syndrome, and suicidal impulses have been reported.

As a serious side effect, due to teratogenic properties of the fetus, contraception must be performed during oral administration and for 6 months after discontinuation of oral use. In compliance with the American iPLEDGE program, prescribing requires a pregnancy response test before oral administration and once a month 14.

Side effects are described in detail in the side effect sheet at the time of examination. If you have any concerns, please do not hesitate to consult a doctor.

Prices for Isotretinoin Treatment

Since this is a treatment that insurance does not work, please confirm the fee in advance.

  1. Prescribing medication always requires medical examination and examination.
  2. The price of the medicine will fluctuate depending on the dose.
  3. Since it is an unapproved medicine in Japan, it is not eligible for the Pharmaceutical Side Effect Damage Relief System.
項目料金(税込)
イソトレチノイン 10 mg1錠 308円
イソトレチノイン 20 mg1錠 418円

Treatment cost of Isotretinoin 10 mg for 1 month (tax included)

診察料初診料 3,850円
再診料 1,650円
薬代イソトレチノイン10 mg
30日分 9,240円
検査料血液検査 3,608円
尿検査 1,056円(女性)
合計(30日)
初診時 16,698円~17,754円
再診時 14,498円~15,554円

Treatment cost of Isotretinoin 20 mg for 1 month (tax included)

診察料
初診料 3,850円
再診料 1,650円
薬代イソトレチノイン 20 mg
30日分 12,540円
検査料血液検査 3,608円
尿検査 1,056円(女性)
合計(30日)
初診時 19,998円~21,054円
再診時 17,798円~18,854円

Treatment cost of Isotretinoin 40 mg for 1 month (tax included)

診察料初診料 3,850円
再診料 1,650円
薬代イソトレチノイン40 mg
30日分 25,080円
検査料血液検査 3,608円
尿検査 1,056円(女性)
合計(30日)初診時 32,538円~33,594円
再診時 30,338円~31,394円

Treatment cost of Isotretinoin 60 mg for 1 month (tax included)

診察料初診料 3,850円
再診料 1,650円
薬代イソトレチノイン60 mg
30日分 37,620円
検査料血液検査 3,608円
尿検査 1,056円(女性)
合計(30日)
初診時 45,078円~46,134円
再診時 42,878円~43,934円

Treatment cost of Isotretinoin 80 mg for 1 month (tax included)

診察料初診料 3,850円
再診料 1,650円
薬代イソトレチノイン80 mg
30日分 50,160円
検査料血液検査 3,608円
尿検査 1,056円(女性)
合計(30日)
初診時 57,618円~58,674円
再診時 55,418円~56,474円

Those who are unable to receive treatment

The following persons may not be able to receive “acne treatment with isotretinoin”. Consult your doctor.

  1. Private
    imports of isotretinoin are prohibited overseas unless prescribed by a doctor.15 Please note that our clinic only treats patients who are able to receive prescription and treatment of medicines under the responsibility of a doctor.
  2. There are cases where it is prescribed for those who have mild acne self-funded medical care, but in principle, it is indicated only for “refractory acne” that could not be cured by insurance treatment and “acne
    of moderate or more”.
  3. The calcantal
    line under the age of 15 may be closed, making it difficult to grow in height.
  4. If
    you are under the age of 18 or under the age of 18, you cannot prescribe medication unless you are accompanied by a guardian at the time of the first consultation. At the time of re-examination, it is possible to examine only the person himself.
  5. Those who have a history of ulcerative colitis, Crohn’s disease, serious liver damage, etc.
  6. Those
    who suffer from mental illness or mental illness such as depression or schizophrenia cannot receive treatment in principle. Patients who have a history and are currently fully cured should consult a doctor at the time of examination.
  7. If you are pregnant, breastfeeding, pregnant, or planning to become pregnant within one year, such as
    pregnant persons, you cannot take isotretinoin internally.
  8. If you are
    undergoing laser hair removal or photoepilation, you will be asked to suspend hair removal during treatment and for 1 month after discontinuation of treatment.
  9. Those
    who have allergies, those who have caused allergies to isotretinoin preparations, those who have aspirin asthma, those who are allergic to parabens, soybeans, and peanuts can not take it.
  10. Those who
    have not received LASIK for 6 months before and after LASIK surgery can not take isotretinoin 22.
  11. The importance of
    regular checkups requires one inspection per month for six months. It is also possible to prescribe a longer prescription for people who are far away, so please consult us at the time of examination. If you are unable to visit our clinic regularly, we recommend treatment at another hospital near you.

Frequently Asked Questions

Accutane and isotretinoin are the same medicine. Accutane is the product name and isotretinoin is the ingredient name.

In the treatment of acne with isotretinoin, 98% of patients are cured or improved in 1 cool (about 6 months) by using the appropriate dosage. It is considered to be the most effective and low recurrence rate of acne currently prescribed all over the world.

The effect of isotretinoin can worsen in the first month, but then appears in 2~3 months.

If there is no improvement, you will need to adjust the amount of medication, so consult your doctor.

Isotretinoin has the effect of increasing skin turnover and speeds up the replacement speed of new skin. Therefore, it can be expected to have the effect of improving the erythema (redness) of acne scars.

As for the crater (dent) of acne scars, scar tissue (scar) has formed in the deep part of the skin called the dermis, so the effect of isotretinoin can not be expected.

In principle, laser treatment cannot be performed during isotretinoin oral administration, but in our hospital, there are many cases where laser is irradiated against the redness of acne scars during isotretinoin oral administration.

By adjusting the type and power of the laser, it is possible to safely treat even during isotretinoin oral administration, and by taking advantage of the increased turnover of the skin during treatment, the laser reaches deep into the dermis and redness can be efficiently removed.

It is recommended to prescribe in a clinic that is familiar with how to use isotretinoin. At our hospital, we have a track record of completely curing and remitting more than 10,000 severe acne that did not improve with insurance treatment, and patients who were prescribed isotretinoin at other hospitals and did not improve are also visited.

In our hospital, doctors who are familiar with the following matters will prescribe.

  • Prevent initial deterioration as much as possible and leave as few acne scars as possible of initial deterioration
  • Use appropriate laser treatment in combination during oral administration to quickly cure acne scars
  • Minimize recurrence as much as possible
  • Even for intractable cases that have not improved at other hospitals, we will treat them appropriately and make improvements.
  • Prevent side effects as much as possible and take appropriate measures when they occur.
  • Explain possible risks, including serious side effects, and conduct treatment

One of the serious side effects of isotretinoin is that it causes miscarriage and fetal malformations when administered to pregnant women.

Specific reports include malformations of the central nervous system, ear defects and malformations, eye abnormalities, cardiac malformations, cleft palates, and malformations of the thymus and parathyroid glands. For women, a pregnancy response test is always performed before taking the medicine (if possible, a test one month before the start of taking the medicine is more reliable), and a pregnancy reaction test is always performed at the time of the monthly regular checkup 14.

Of course, during the course of taking the medicine, you will be required to use contraception (preferably two or more types of contraception) for 6 months after discontinuation of the dose. If a man takes it, the male side also takes contraception during the dose and for one month after discontinuation.

On the package insert, contraception for 1 month is required, but at our hospital we take the margin of safety and set it to 6 months.

In addition, there is a treatment for psoriasis called etretinate (tigason), but this one has a stronger lipophilic property and a very long half-life of 120 days, so contraception for 2 years is required after taking it. The half-life of isotretinoin (Accutane) is 15 hours ~ 20 hours, so the persistence in the body is different from Chigason.

If you use contraception properly for a predetermined period of time, the rate of fetal malformations will not increase compared to normal pregnancy. In the 14 years of treatment, there has not been a single report of fetal malformations from our patients.

If you have any concerns about any of the above, please do not hesitate to consult your doctor at the time of examination.

Treatment of acne with isotretinoin requires an outpatient visit approximately once a month. The duration of treatment is 1 cool, 6 months. If the effect of the treatment is weak, the duration of 1 cool may be extended to 8 months.

For those who can not visit the hospital easily or those who are far away, we prescribe as much as possible, but since it is necessary to check side effects such as blood collection, please check in advance whether you can visit the hospital regularly.

The maximum amount prescribed is limited to 2 months, but if you have special circumstances, please consult us at the time of examination.

At our hospital, during isotretinoin treatment, blood collection tests are always performed regularly.

Side effects confirmed by blood tests are wide-ranging, including liver dysfunction, renal dysfunction, pancreatic dysfunction, triglycerides, cholesterol, blood glucose levels, and uric acid levels, decreased or increased blood cell components, and increased CPK. Even if there is no problem with the first or second blood collection, it may appear in the middle of treatment, so monthly blood collection examination is necessary.

For female patients, a urinalysis test (pregnancy reaction test) is always performed before taking the medicine, and pregnancy response is always tested at the time of regular monthly checkup.

Please note that if you do not perform the necessary tests, we will not be able to prescribe medicines at our hospital.

Isotretinoin is a medicine with a low recurrence rate, but even so, about 30% of patients relapse and there are cases where they have to receive treatment with 2 ~ 4 cool. In order to minimize the recurrence rate as much as possible, it is important to take the medicine at the “right time” and adhere to the “appropriate dose and duration”.

When to drink

The right time to drink isotretinoin is “immediately after eating.” Because it is fat-soluble, it is absorbed together with fat. If you drink it on an empty stomach, absorption will be poor, so the effect will be weak. Of course, you will also be careful not to forget to drink.

There is also a medicine called Absorica, which has been improved as an isotretinoin preparation that is not affected by the diet. Absolica is an improved isotretinoin developed by Lambaxy Laboratories in India and approved by the US FDA in 2012. Since it is not affected by meals, it is a suitable medicine for patients who have difficulty drinking isotretinoin after eating.

However, in previous controlled trials, although there was no statistically significant difference, the results showed that conventional isotretinoin performed better than absolica. Since the price of absolica is also high, I think that it is not necessary except for those who can not drink isotretinoin after eating.

Appropriate Dosage and Period

The appropriate dose of isotretinoin is judged from the severity of the acne and the patient’s body weight. In our hospital, treatment is generally between 20 ~ 60 mg.

In Western patients, the dose starts at 0.5~1 mg per kg of body weight and increases to a maximum of 2 mg per 1 kg of body weight (120 mg/day for those weighing 60 kg), but in the case of Japan people, it is rare to need such a high dose.

The appropriate period is usually 4 months ~ 5 months, but in recent years in Europe and the United States, in order to prevent recurrence, the treatment period per cool is about 6 months, and some hospitals set it to 8 months ~ 10 months. In our hospital, 1 cool is about 6 months, and if necessary, it is extended to 8 months.

Studies in the United States and Germany have reported that taking doses of 1 mg or more per kg of cumulative body weight during a period of 120 cool conditions is important to reduce the rate of relapse. In other words, for patients with severe acne weighing 60 kg, if the duration of 1 cool is 6 months, about 40 mg per day is required 17.

There are also reports that higher doses further reduce the rate of recurrence. In a German trial, taking doses of 220 mg/kg or more during a period of 1 cool significantly reduced the rate of recurrence 18.

In the case of mild to moderate acne, even low doses do not significantly change the recurrence rate, so it is often prescribed at low doses. There are many reports that the rate of recurrence is related to cumulative doses, but there are also views that deny 19.

Since many people with severe acne visit our hospital, there are not a few cases where we prescribe 40 mg ~ 80 mg per day. The maximum amount prescribed in the past at our clinic is 140 mg per day.

Increasing the dose and prolonging the duration of taking the medicine can reduce the rate of recurrence and the degree of relapse, but increase the rate of occurrence of side effects. In order to reduce the recurrence rate, it is necessary to gradually increase the amount of medication until the new acne can no longer be performed, while monitoring the degree of side effects.

In some cases, even a short-term treatment of about 3 months at a low dose of 10 mg per day may be effective. In the case of low-dose short-term therapy, the occurrence of side effects is small and easy to treat, but the recurrence rate is very high. This should also be taken into account when treatment.

Isotretinoin increases light sensitivity, so exposure to light or laser during oral use may cause blemishes, pigmentation, and scarring.

However, there are some that can be done during treatment depending on the type and output of the laser, and our hospital has determined the period of time to be free based on past treatment experience and literature.

For more information, see Treatment Interval.

Isotretinoin is a medicine that increases the sensitivity to light, so it may become hypersensitive to sunlight. Therefore, avoid sunburn during treatment and for at least 2 months after the end of treatment.

Isotretinoin is combined with several medications and has interactions. Do not take together with the following medications:

● Tetracycline antibiotics

Typical product names: vibramycin, minomycin, minocycline, minopen

Side effects of increasing intracranial pressure, which causes headaches in interactions, may be stronger.

●Corticosteroids

Typical product names: Predonin, Prednisolone, Celestamine

Side effects that weaken the bones may appear strongly in the interaction.

Inhaled steroids used in the treatment of asthma and topical steroids used in the treatment of atopic dermatitis can be used in combination. Short-term steroid drips performed in treatment such as asthma attacks are no problem.

● Antiepileptic medicines

Typical product names: Aleviatine, Hydantol

Antiepileptic medicines (phenytoin, carbamazepine, phenobarbital, primidone, valproic acid, etc.) have the effect of making the bones brittle (osteoporosis risk) in the medicine itself. The interaction with isotretinoin is not clear, but there is a concern that the side effects of weakening the bones may be enhanced, so regular bone density checks are recommended.

●Vitamin A

Interactions may enhance overall side effects. Many multivitamins contain vitamin A, so be sure to check the packaging. There are no interactions with vitamins other than vitamin A. β carotene is safe to consume. If you take vitamin A for a short period of time without noticing it, you will not have any problems, so do not worry.

* For other medications that are taken together, we explain in the side effect sheet at the time of examination.

The interaction between vaccination and isotretinoin has not been tested for safety. Therefore, in principle, vaccination should be refrained from during oral administration for one month after the end of oral administration.

If the health benefits outweigh the risks (e.g. for travel to the tropics or hepatitis B vaccines for health care workers) and vaccination is absolutely necessary, wait at least 2 weeks before vaccination, and resume your medication 24 hours after vaccination and 3 weeks for live vaccines.

As for the influenza vaccine, there is no side effect or side reaction in one case according to the data of our hospital, and there is no problem to receive it in view of the situation in other countries.

There is no interaction with alcohol, so it is okay to take it together, but when taking medicine, please drink it with water. If you consume a large amount of alcohol while taking isotretinoin, liver dysfunction is likely to occur, so please refrain from excessive drinking.

If you forget to take isotretinoin, it is ideal to take it immediately after eating, so if it is on the day, be sure to take it after the next meal. If you do not eat the next meal, please drink it at the timing you notice.

Example 1) If you take 1 tablet every day after lunch and notice that you forgot to take it before dinner, take 1 tablet after dinner

Example 2) If you take 1 tablet every day after dinner and notice that you forgot to take it before going to bed, take 1 tablet at that time

Example 3) If you take 1 tablet after breakfast and 1 tablet after dinner every day and forget to drink after breakfast, take 2 tablets at a time after dinner

If you forgot to drink the day before, you do not have to ignore it as it is and drink it. For example, if you take 1 tablet a day and you forgot to take the previous day, do not take 2 tablets on the same day. In order to prevent recurrence, try not to forget to drink as much as possible.

Accutane was the first isotretinoin formulation introduced by the Swiss company Roche in the 1980s, but its patent expired in 2002 and it has since been lost to generic medicines such as Amnesteen, Claravis, and Sotret. Accutane sales fell to less than 5% of all isotretinoin formulations, and Roche discontinued Accutane production in 2009. In the United States, we withdrew due to the loss of the market, but later changed the name to Roaccutane and expanded into other countries.

The medicine Accutane is not currently on the market, and everything on the market is generics (generic medicines). Roaccutane is a generic medicine manufactured by the manufacturer, Roche in Switzerland.

You may think it’s weird for a first-mover medicine manufacturer to make generics, but it’s not uncommon to rethink packaging and manufacturing methods to reduce costs and launch them under different names.

In our hospital, Cipla’s Isotoroin is mainly used as an isotretinoin preparation. We may also use Roaccutane.

Please note that many patients recognize the name of the original Accutane instead of the name isotretinoin, so for convenience, treatment with isotretinoin preparations is referred to as Accutane treatment.

Pantothenic acid is one of the water-soluble vitamins, also called vitamin B5. It has a role as a coenzyme that activates the metabolism of sugars, fats, proteins, etc., and also has a role of helping the work of B vitamins and C, so it is an important ingredient for the skin.

Although it is a weak action, pantothenic acid has the function of reducing sebum, so it seems that some patients use it for the purpose of suppressing sebum.

The daily requirement of pantothenic acid is 5 mg, but there has been a folk remedy for a long time that suppresses sebum by taking a dose more than 1000 times that amount, but there is a lack of medical evidence that pantothenic acid alone improves acne.

Pantothenic acid is also used as a laxative, and if you drink it in large quantities, it will cause digestive symptoms such as diarrhea and abdominal bloating, so even though it is a water-soluble vitamin, if you take a large amount exceeding the necessary amount, problems may occur.

Recently, it seems to have replaced the folk remedy of pantothenic acid and lactic acid bacteria in combination. Pantothenic acid is commercially available as a supplement, so we believe that there is no problem at all as long as it is not used in excess of the recommended dose.

In the questionnaire at the time of consultation, many patients who have performed the treatment in the past are examined, but almost no patients say that it has been effective.

If there is an effect, you should not visit our hospital, so it cannot be denied that there is bias, but since the effect of isotretinoin is recognized in all patients who did not have pantothenic acid effective, it is not as effective as replacing isotretinoin.

Bibliography

  1. A. Nast, (2012) “European evidence-based (S3) guidelines for the treatment of acne.” J Eur Acad Dermatol Venereol. GUIDELINES 2012
  2. Andrea L. Zaenglein, (2016) “Guidelines of care for the management of acne vulgaris. ” J Am Acad Dermatol. May 2016Volume 74, Issue 5, Pages 945–973.e33
  3. Dhaked DR, (2016) “A randomized comparative trial of two low-dose oral isotretinoin regimens in moderate to severe acne vulgaris. ” Indian Dermatol Online J. 2016 Sep-Oct;7(5):378-385. PMID: 27730033
  4. Costa CS, (2018) “Oral isotretinoin for acne. ” Cochrane Database Syst Rev. 2018 Nov 24;11:CD009435. doi: 10.1002/14651858.CD009435.pub2. PMID: 30484286
  5. Sardana K, (2010) “Efficacy of low-dose isotretinoin in acne vulgaris. ” Indian J Dermatol Venereol Leprol. 2010 Jan-Feb;76(1):7-13. doi: 10.4103/0378-6323.58672. PMID: 20061724
  6. Amichai B, (2006) “Low-dose isotretinoin in the treatment of acne vulgaris. ” J Am Acad Dermatol. 2006 Apr;54(4):644-6. PMID: 16546586
  7. Orfanos CE, (1998) “Oral retinoids in the treatment of seborrhoea and acne. ” Dermatology. 1998;196(1):140-7. PMID: 9557249
  8. Nelson AM, (2008) “Neutrophil gelatinase-associated lipocalin mediates 13-cis retinoic acid-induced apoptosis of human sebaceous gland cells.” J Clin Invest. 2008 Apr;118(4):1468-78. doi: 10.1172/JCI33869. PMID: 18317594
  9. Eichenfield LF, (1991) “Acne: current concepts of pathogenesis and approach to rational treatment. ” Pediatrician. 1991;18(3):218-23. PMID: 1835004
  10. Sandra Tagliolatto, (2015) “Sebaceous hyperplasia: systemic treatment with isotretinoin” An Bras Dermatol. 2015 Mar-Apr; 90(2): 211–215. doi: 10.1590/abd1806-4841.20153192 PMID: 25830991
  11. Orfanos CE, (1983) “Evidence for anti-inflammatory activities of oral synthetic retinoids: experimental findings and clinical experience. ” Br J Dermatol. 1983 Jul;109 Suppl 25:55-60. PMID: 6222758
  12. Dispenza MC, (2012) “Systemic isotretinoin therapy normalizes exaggerated TLR-2-mediated innate immune responses in acne patients. ” J Invest Dermatol. 2012 Sep;132(9):2198-205. doi: 10.1038/jid.2012.111. Epub 2012 Apr 19. PMID: 22513780
  13. Roche “Accutane (isotretinoin) Capsules Label” https://www.accessdata.fda.gov/drugsatfda_docs/label/2002/18662s051lbl.pdf 2019.05.07 Access
  14. iPLEDGE program” https://www.ipledgeprogram.com/iPledgeUI/home.u 2019.05.07 Access
  15. Ministry of Health, Labour and Welfare “Alert on ACCUTANE (an unapproved intractable acne treatment medicine in Japan)” https://www.mhlw.go.jp/topics/bukyoku/iyaku/kojinyunyu/050609-1b.html 2019.05.07 Access
  16. Lee SY, (2016) “Does exposure to isotretinoin increase the risk for the development of inflammatory bowel disease? A meta-analysis. ” Eur J Gastroenterol Hepatol. 2016 Feb;28(2):210-6. doi: 10.1097/MEG.0000000000000496. PMID: 26545085
  17. Layton AM, (1993) “Isotretinoin for acne vulgaris–10 years later: a safe and successful treatment. ” Br J Dermatol. 1993 Sep;129(3):292-6. PMID: 8286227
  18. Blasiak RC, (2013) “High-dose isotretinoin treatment and the rate of retrial, relapse, and adverse effects in patients with acne vulgaris. ” JAMA Dermatol. 2013 Dec;149(12):1392-8. doi: 10.1001/jamadermatol.2013.6746. PMID: 24173086
  19. Rademaker M, (2016) “Making sense of the effects of the cumulative dose of isotretinoin in acne vulgaris. ” Int J Dermatol. 2016 May;55(5):518-23. doi: 10.1111/ijd.12942. Epub 2015 Oct 15. PMID: 26471145
  20. King K, (1982) “A double-blind study of the effects of 13-cis-retinoic acid on acne, sebum excretion rate and microbial population. ” Br J Dermatol. 1982 Nov;107(5):583-90. doi: 10.1111/j.1365-2133.1982.tb00410.x PMID: 6215056
  21. Leyden JJ, (1982) “Effect of 13-cis-retinoic acid on sebum production and Propionibacterium acnes in severe nodulocystic acne. ” Arch Dermatol Res. 1982;272(3-4):331-7. doi: 10.1007/bf00509064 PMID: 6219631
  22. Rapid response to:Laser refractive eye surgery, “LASIK and isotretinoin: An important contraindication” BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d2345

Appointments and Enquiries

For return visits, please inform us of your 'consultation ticket number' when making an enquiry.
●Hada no clinic Koenji (TEL 03-5913-7435)
4F Anfini Building, 4-6-7 Koenji Minami, Suginami-ku, Tokyo
Mon.~Sta. : 10:30 am - 1:30 pm / 3:30 pm - 6:30 pm
Sun. and Public holiday : closed
●Hada no clinic Kojimachi (TEL 03-6261-7433)
B1F Chichibuya Building, 3-7-4 Kojimachi, Chiyoda-ku, Tokyo
Mon.~Fri. : 11:00 am - 2:00 pm / 4:00 pm - 7:00 pm
Sta. and Sun. : 10:00 am - 1:00 pm / 3:00 pm - 6:00 pm
Public holiday : closed
*Full appointments are required.
*We are very sorry, but sometimes it is difficult to get through on the phone due to the high volume of calls. We ask for your understanding as we have a limited number of staff.
*Please note that a separate 'telephone re-consultation fee' will be charged if a doctor responds to medical questions.