isotretinoin

**1. Talg production:* *

• Reduces the size and activity of sebaceous glands
• Talg production decreases by up to 90%
• This effect often lasts

**2. Mapping disorder:* *

• Normalizes keratinization in the folliculars
• Prevents clogging of pores
• Comedons (center) are reduced

3. Bacteria:

• Indirectly antibacterial by less sebum
• P. acnes finds less breeding ground
• Reduced settlement of the follicles

**4. inflammation:* *

• Anti-inflammatory action
• Reduces redness and swelling
• Prevents scar formation

• Severe nodulary/cystic acne
• Therapy-resistant medium-heavy acne
• Acne with high scar risk
• Acne with severe mental stress
• Acne that does not appeal to antibiotics

Strenge conditions:

• Women: Safe prevention (two methods), monthly pregnancy tests
• All: Regular blood and liver value controls
• Informed consent after clarification

Not suitable for:

• Pregnancy (absolute contraindicated)
• Still time
• Heavy liver disease
• Very high blood fats

Standard dosing:

• Start: 0.5 mg/kg/day
• Increase to 0.5-1 mg/kg/day
• Typical: 40-80 mg/day in adults

Cumulative total dose:

• Objective: 120-150 mg/kg over the entire treatment
• At 70 kg: about 8,400-10500 mg total
• 4-6 months treatment

Long-term therapy:

• Alternatively: 10-20 mg/day over longer time
• In patients with severe side effects
• Similar effectiveness, better compatibility

Available starches:

• capsules: 10 mg, 20 mg, 40 mg

Intake:

• Take with a meal (fat for better absorption)
• swallow whole capsules, not chew
• Always at the same time
• At doses >40 mg: split into two revenues

During treatment:

• No blood donation (until 1 month after the end)
• No waxes
• Consistent sun protection (LSF 30+)
• No vitamin A preparations
• Drink plenty of water
• Lip care and moisturizer

Control checks:

• Before treatment: liver values, blood fats, pregnancy test
• Monthly: Pregnancy Test (Women)
• Regular: liver values, blood fats (all 1-2 months)

• Pregnancy (absolutely contraindicated – severe malformations!)
• Still time
• Women without safe contraception
• Heavy liver failure
• Very high blood fats (hypertriglyzeridemia)
• Hypervitaminose A
• Simultaneous tetracycline therapy

Prevention programme:

• 2 effective prevention methods (e.g. pill + condom)
• Start 1 month before therapy
• Up to 1 month after therapy
• Monthly pregnancy tests
• No pregnancy during + 1 month after

Preview at:

• Depression or mental illnesses
• Diabetes mellitus
• Contact lenses (dryness)

Very common (>10%):

• Dry skin and lips (virtually all patients)
• Nose bleeding, dry nose
• Dry eyes, contact lenses incompatibility
• joint pain, muscle pain
• Increased liver levels
• Increased blood fats

Acid (1-10%):

• Skin sensitivity
• Sunburn tendency
• Hair loss (reversible)
• Headaches
• fatigue

Psychical side effects:

• mood changes, depression (same, but note)
• In case of signs inform doctor immediately!

Selten, but seriously:

• Pseudotumor cerebri (strong headaches, visual disorders)
• Inflammable detection
• Heavy skin reactions

Contracted:

• Tetracycline (doxycycline, minocycline) – increased risk for Pseudotumor cerebri
• Vitamin A – Hypervitaminosis
• Other retinoides

Preview at:

• Methotrexate – increased liver toxicity
• Johanniskraut – can make contraceptives ineffective
• Alcohol - increased liver value increase