Prescription Medication for Severe Acne Treatment

People with nodules or cysts should be treated by a dermatologist. For patients with severe inflammatory acne that does not improve with medicines such as antibiotics and topical retinoids, a doctor may prescribe an oral retinoid.

Oral Retinoids are reserved for the most severe cases of acne and should only be used as a last resort if all else fails. Oral retinoids work by normalizing the epidermal lifecycle, reducing the amount of P. acnes, reducing the amount of sebum production and excretion, and acts as an anti-inflammatory agent.

Isotretinoin (Accutane). The most effective oral retinoid on the market is called Isotretinoin. Isotretinoin is an oral drug that is usually taken once or twice a day with food for 15 to 20 weeks. It markedly reduces the size of the oil glands so that much less oil is produced. As a result, the growth of bacteria is decreased.

Oral retinoids such as Isotretinoin (Accutane) are very effective and can help prevent acne scarring. After 15 to 20 weeks of treatment with isotretinoin, acne completely or almost completely goes away in up to 90 percent of patients. In those patients where acne recurs after a course of isotretinoin, the doctor may institute another course of the same treatment or prescribe other medicines.

Side effects. The side effects of oral retinoids can be plentiful and severe, thus they are recommended for only the most severe cases of acne when other treatments have not worked. Side effects usually go away after the medicine is stopped.

  • Birth Defects. Oral retinoids are teratogens and can cause severe birth defects. It is important that women of childbearing age are not pregnant and do not get pregnant while taking this medicine. Some States require mandatory pregnancy counseling, multiple negative pregnancy tests, multiple and separate evidence of the use of birth control and/or a vow of abstinence. Expect even stricter legislation in the future.
  • Blood Testing. More serious side effects include changes in the blood, such as an increase in triglycerides and cholesterol, or a change in liver function. To make sure Accutane is stopped if side effects occur, the doctor monitors blood studies that are done before treatment is started and periodically during treatment. Your physician should order appropriate blood tests to monitor your liver enzymes.
  • Depression. Though the exact cause is yet unclear, oral retinoids are thought to be associated with mood changes resulting in depression and suicidal ideation. This risk factor should be made clear before treatment. A doctor should be consulted if a person feels unusually sad or has other symptoms of depression, such as loss of appetite or trouble concentrating.
  • Other side effects. Dysphagia (difficulty swallowing), chest pain, headaches, vision impairment, nausea, vomiting, rectal bleeding, skin dryness and thinning hair.
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