Isotretinoin (Amnesteem, Claravis, and Sotret, and Formerly Accutane)
- Severe recalcitrant nodular acne
- Hidradenitis suppurativa
- Thickened or patchy skin disorders such as keratosis follicularis, palmoplantar keratoderma, lamellar ichthyosis, or pityriasis rubra pilaris
Amnesteem, Claravis, and Sotret, known generically as isotretinoin, belong to the class of medications called retinoids. Approved by the FDA in 1982, isotretinoin comes in 10mg, 20mg, 30mg and 40mg capsules that can be taken orally. In 2009, Roche's brand of isotretinoin, known as Accutane, was removed from the market. Isotretinoin is used for the treatment of severe acne that has not responded to other types of treatment such as antibiotics. One complete course of treatment can take between 15 and 20 weeks. During the first few weeks of treatment you may notice your acne worsening and your skin becoming itchy and sensitive. This usually clears up over the course of treatment, but if it doesn’t get better, see your doctor. If you're taking isotretinoin, follow the prescribing instructions carefully. Although the exact mechanism of action of isotretinoin is not known, it is believed to reduce acne by reducing the secretion of an oily substance caused by inflammation, called sebum. And, sebum also causes inflammation, so if less sebum is secreted then there will be less inflammation and less scarring associated with the acne. Isotretinoin is a naturally occurring derivative of vitamin A - it is formed in the bloodstream from vitamin A – so it can interact with vitamin A. Check with your doctor before starting isotretinoin therapy for any potential drug interactions. Some products that can be affected by isotretinoin include acitretin, corticosteroids (e.g., prednisone), St. John's wort, tetracyclines and tigecycline. The most common reported side effects associated with isotretinoin are: chapped lips; itchy; dry skin nasal dryness and mild nosebleeds; eye and eyelid irritation; joint and muscle pains temporary hair thinning; rash; and some people also experience intestinal symptoms; urinary symptoms; headache; increased sensitivity to sun; depression and thoughts of suicide. People taking isotretinoin are required to have regular blood tests, because it can affect the liver. Isotretinoin carries an FDA pregnancy category of X meaning it is contraindicated in women who are pregnant and not advised for use in women who are trying to get pregnant. Isotretinoin is teratogenic, which means it can adversely affect the growth of the fetus. Additionally, it is not recommended for use by nursing mothers because it's not known whether it is carried in breast milk.