I took it during one month in 2022 (one pill per night) the results was starting good but I stop due to anemia and leucopenia ( I cannot affirm that it was due to the drug ) I was supposed to take it for 6 months but couldn't continue due to fear as leucopenia was also mentioned as one of the side effects of isotretinoin... I recently ( Feb 2024) switch to isotretinoin gel...
Does the doctor recommended iso even if I have only acne marks and oily skin? My breakout already stops and what left is the stubborn marks and large pores
Thank you so much for this information, It’s incredibly encouraging to hear this. I plan on going on Accutane this winter and will definitely work with my dermatologist on a treatment plan that consists of supplementing antihistamines and omega 3.
Thank you for your help. I personally tried Roaccutane 10 mg daily for 2 years and had severe telogen effluvium. Fortunately reversed after discontinuing in 8 months
At first, I was doubting my dermatologist (who am I to doubt a professional who spent years studying right?) as she gave me a lower dose, 10 mg to be exact and I have to take it for almost 2 years and I didn't even get my bloodwork done during my first month which surprised me because a lot of reddit posts and RU-vid videos does that and then I stumbled upon this video. Indeed, great dermatologist who really care for their patient think alike. Thank you so much for this helpful video, it cleared up any uncertainties I was dealing with.
This was so helpful. Your voice is very soothing. Thank you. I have done a lot of research on Accutane as I plan to take it soon and I am in my 30’s. I have some questions maybe you can help answer: 1) Based on my research it looks like about 10% of people experience temporary hair loss while on Accutane. And even smaller percentage seem to experience permanent hair loss. Do you know what causes this? And do you know of any supplements that help decrease this side effect? 2) Based on my research it seems that patients need to have an accumulative dose of 120-150 mg/Kg. Do you believe that Accutane patients need to reach the accumulative dose to have permanent acne remission? 3) Your tip on taking an antihistamine to decrease the purging side effect is helpful. Why does taking an antihistamine decrease purging? Thank you for your help ❤
Glad you found it helpful! 1. Accutane can be associated with a form of hair loss called telogen effluvium. This typically improves with time. There unfortunately is not any clear evidence of effective preventative strategies, though in my experience it is less common than 10%. 2. The best predictor of long-term remission is clear skin x2-3 months before stopping. This is a better predictor than daily dose or cumulative dose (i.e. 120-150mg/kg). pubmed.ncbi.nlm.nih.gov/26471145/ 3. It is not 100% known, but the sebaceous gland cells have histamine receptors and are modulated by antihistamines, which likely explains some of the effect. It also might influence mast-cell mediated inflammation in the skin.
Thank you for this video, ❤ can you please tell us how to avoid hair loss (or at least reduce it) during Accutane. I'm on a low dose (this is my 2nd week of accutane and I see my hair all over the house, this is so sad)
Great question! It seems like some people develop a form of hair loss that is similar to telogen effluvium during Accutane. Unfortunately, I don't think we have very good strategies to prevent it, but it does seem to improve on its own with time for most who experience it.
What a great video! Do you have any tips or advice on how to find a dermatologist that would agree to not test blood once a month? I didn't know that part could be optional and seems like one of the most inconvinient things about trying accutane as an adult. Thanks!
Glad you found it helpful! I don't have any specific advice about finding a dermatologist who would agree to do fewer lab tests, as the need for lab testing will also depend on individual risk factors. However, if they have read the linked articles about lab monitoring, I hope they would be open to a discussion of less monitoring (and many dermatologists now do less monitoring as standard practice).
Hey Doc...glad that I found your channel. My doc has prescribed 20mg Accutane for a month along with omnicortil capsule. Wanted your suggestion on this before starting 🙏
Glad you found the content helpful! Sometimes we will use isotretinoin (accutane) together with oral steroids (omnicortil) to prevent acne flaring. This channel is not to provide medical advice, so I would recommend discussing with your doctors.
They are in the "References" section of the description along with links to the other supporting articles: Antihistamines: pubmed.ncbi.nlm.nih.gov/25081735/
It is a very individualized decision and I would recommend anyone interested in isotretinoin discuss with their dermatologist. You might find the JAMA Dermatology patient page on isotretinoin helpful: jamanetwork.com/journals/jamadermatology/fullarticle/2810450 The recently released AAD guidelines mention (www.jaad.org/article/S0190-9622(23)03389-3/fulltext): For patients with severe acne or for patients who have failed standard treatment with oral or topical therapy, we recommend isotretinoin. Acne patients with psychosocial burden or scarring should be considered as having severe acne and to be candidates for isotretinoin.
We don't have any studies comparing different treatment durations, but usually I recommend taking it until at least the skin is clearing up or until finished with the course of treatment.
Isotretinoin can be helpful in a range of acne scenarios, including acne that is causing significant distress or not responding well to other treatments. Ultimately, it is important to have a discussion with your doctor about whether isotretinoin is right for you.
No, I do not recommend using cod liver oil in this setting. As you point out there is the potential issue of vitamin A. In addition, fish oils tend to be only ~30% Omega-3.
What are the best types of antihistamines? Only ones I could find are cetirizine and loradatine based tablets. Between those two, cetirizine vs loradatine, which is best?
No one has done any head to head studies comparing which are best. In the clinical trials, they used desloratadine and levocetirizine (very similar to loratadine and cetirizine).
The trials were the standard daily dose. For severe flaring (or acne fulminans) we often stop the isotretinoin and use prednisone until calmed down@@captainprice586
The side effects i've been getting is a few breakouts, dry lips and a dry itchy area under my right thigh. I'm really scared of the hair loss side effect that might come, any ways to prevent it?
I can't provide medical advice, so I'd recommend discussing with your doctor. In general, it doesn't seem like there are any treatments that can reliably prevent hair changes from isotretinoin, but fortunately hair changes are relatively infrequent and typically improve once done with the treatment course.
Hi im planning to get my prescription of Accutane? is cetirizine a good drug for the purging? also I'm currently on finasteride 1mg right now does it affect the drug if ever is it safe to take them both at the same time? thank you!
I think any non-sedating antihistamine can be helpful to prevent purging. I typically recommend loratadine for my patients as it might make people less drowsy than cetirizine.
@@DrJohnBarbieri Doc, Im planning to try accutane with my derm doctor. actually he wants to give it to me 2 months ago, instead we just used topicals and benzoyl peroxide but now i want to use accutane, what kind of bloodtest should i get... so in my next visit i'll have my bloodtest along with me.
@@DrJohnBarbieri Really found the video to be helpful. Do you typically prescribe the non-sedating antihistamine before beginning accutane or do patients begin taking it the same day accutane treatment begins? Thanks.
Hi Dr. John, I found your video very helpful. I have just started my isotretinoin as recommended by my dermatologists . My prescription is one tablet isotretinoin 20 gm each alternative day and Azithromycin 500gm thrice a week it have been just 4/5days since I started my medication but am experiencing some rashes on my neck area and mildly on face . Can that be the cause of the isotretinoin? I search about it but did not find rashes on its side effect list, it will be really helpful if your reply about this. I am kind of scare to continue the medication.
I cannot provide medical advice, so I would recommend discussing with your doctor. In general, isotretinoin can cause skin dryness on different parts of the body that often improve with use of moisturizers and/or topical steroids.
Hello doctor I hope u are doing well. I am 17 and I’m using isotretinoin by a doctor perception, I just want to know that does that effect on HGH hormone does it make our HGH hormone weaker??
Are you referring to a specific study? There is not much data on isotretinoin and growth hormone, but there is not a strong signal that it affects growth hormone levels.
There is not any compelling evidence to suggest that this is an issue with either medication class. Mechanistically it also would not be something that I would expect with either medication class.
@@DrJohnBarbieri good to know because I couldn’t find answers to the mechanics of it online. I took accutane as a middle schooler and have superb health now. Was wondering if it would be better if I had never done it but it seems not. Thanks
Hi. My dermatologist prescribed me with isotretinoin 20mg tomorrow. I'hv tried a lot of medicines for more than 1 year but my acne just keeps coming back. Sometimes i get breakouts i dont know what exactly the reason is. I've been sleeping early. Washing and moisturing my face regularly and trying my best to eat right also my face type is oily. Should I take the isotretinoin pills? To be honest im kind of scared
Often patients are scared of isotretinoin and it is a medication that should be prescribed thoughtfully. However, it also can be extremely beneficial for many people with acne. I have several other videos on the channel about acne treatments and what causes acne that you can check out if interested. As I cannot provide medical advice here, ultimately, it is important to work with your doctors to decide what is best for you.
Change to healthy diet. Remove refined sugar, dairy products, drink a lot of water, yeah just remove sugar in your diet. That's what I did and my breakout just stop by itself. Now I'm still hoping a can unddergo iso beacause I have a very oily skin and lots of acne marks
Does isotretinoin 10mg really cause liver damage,i saw it every where on internet.I'm Little hesitant to start this treatment, as prescribed by my dermatologist
It is debatable whether any dose of isotretinoin can cause meaningful, clinical liver damage (rather than just mildly elevated liver function tests): pubmed.ncbi.nlm.nih.gov/35986616/
While diet can play a role in acne, it is not a primary cause of acne (check out our other videos on diet and acne). Isotretinoin can work for nearly any type of acne.
Good morning! Before starting Accutane, I used to be pretty oily, but now I'm enjoying a sebum suppression effect while on it. Will taking omega-3 supplements result in excessive sebum production again? Also, when taking omega-3 supplements while on Accutane, should I take them at the same time or better to space them apart?
Omega-3 doesn't seem to cause excessive sebum production in my experience and I don't think there are any studies to support this being an issue. There isn't much data about when is best to take them and it likely does not particularly matter, so I think one could do whatever is most convenient in terms of timing.
In general, since isotretinoin is so effective on its own, I don't recommend combining it with other treatments. We have other videos on the channel that discuss which acne treatments are able to address acne bacteria (C. acnes).
Many procedures can be done during isotretinoin (jamanetwork.com/journals/jamadermatology/article-abstract/2632046), but it is important to discuss with your doctor the goals of treatment to make sure it is the right approach.
Most side effects from isotretinoin improve after stopping. However, I think rarely some patients may have chronic dry skin/eyes after isotretinoin. Since isotretinoin works by permanently shrinking the oil glands to treat acne, it makes sense that the effects on these oil glands elsewhere could lead to dry skin/eyes.
Isotretinoin does not appear to be associated with diabetes. The best evidence that we have seems to suggest, if anything, that it has a positive effect on glucose metabolism (pubmed.ncbi.nlm.nih.gov/38921259/). There is not much high-quality data with respect to the question of whether there is or is not an association between isotretinoin use and the risk of autoimmune disease such as thyroid disease and vitiligo.
@@DrJohnBarbieri are you sure it doesn’t cause diabetes? I saw few articles on pubmed which clearly states that Isotretinoin causes insulin resistance and can also trigger type 1 diabetes.
Hello Dr. John, Thank you for the video. My son who has UC was cleared to take Isotretinoin by his GI doctor. His dermatologist is starting him on a low dose of 30mg for the first month. After the first month's testing, she has a plan to bump him up to 60mg. I am taking your advise in getting the Omega 3 supplements, Aquaphor, Sustane and Refresh and the Saline solution to minimize side affects. My question is, with him already having gut issues, will he be at a higher risk for inflammation in the gut? I saw where you stated there aren't any thing showing that the drug causes IBD but if you have a gut issue already, would it cause inflammation?
While I cannot speak to your son's situation, in a small study led by Alexandra Charrow, there did not appear to be an association between isotretinoin and flaring of inflammatory bowel disease, particularly for those who were doing well prior to starting isotretinoin (pubmed.ncbi.nlm.nih.gov/35597387/).
For severe acne (or acne fulminans), sometimes we will use prednisone to help when starting isotretinoin. However, oral steroids can come with serious side effects of their own, so we typically do not use them when we can avoid it.
@@DrJohnBarbieri my question came after my dermatologist recommended taking prednisolone between 3-5 days before starting with isotretinoin to help with any purging, but I became very skeptical since I've never take corticosteroid, I don't have severe acne (only resistant type 2) and I couldn't find much scientific material supporting her suggestion. Now with your answear is another thumbs down to her. Unbelievable.
Doc, i have seb derm and i was prescribed primecolimus... After 6 days, my face is better yes, smoother but i'm always feeling hot and warm. I'm gonna use this 10 days max, so i hope this warm sensation fades away.
Acne, rosacea, and seborrheic dermatitis are complex conditions, but the skin barrier plays an important role in each of them and improving skin barrier function can be a helpful part of treatment.
Hi, I have been taking isotretinoin for about 16 days. 40mg daily. I experience dry lips and a very oily face but I'm willing to continue. Been suffering from acne and hyperpigmentation for over four years. Should I stop at 4 or 6 months?
It is up to you and your doctor to decide when is the right time to stop. It seems that clinical response (i.e. clear x2-3 months) is a better predictor of long term clearance than either daily dose or cumulative dose (i.e. months of treatment), so I typically encourage doctors to prescribe isotretinoin based on clinical endpoints rather than fixed durations or cumulative doses (pubmed.ncbi.nlm.nih.gov/26471145/).
Is it safe to use this drug when person suffers from autoimmune disease such as Hashemoto? . I read research says that this drug may triggers autoimmune disease. What do you recommend?
I don't think there is convincing evidence of an association between isotretinoin and autoimmune disease. Is there a particular study that you are referring to?
But the effect of taking the things mentioned by you to mitigate the side effects of Isotretinoin on the efficacy of isotretinoin is not well studied that's why I would avoid these things If getting complete remission of acne is the goal.
Lower daily dose isotretinoin regimens have been examined in RCTs for long-term clearance. Omega-3 and antihistamines do only have shorter term studies, but there is no mechanistic reason to expect they would reduce long term clearance if otherwise treating to clinical endpoints. However, agree there is a need for long-term studies.
I would recommend working with your dermatologist to help with the issue. Little is known about the potential relationship between isotretinoin and insomnia. This article describes a patient who developed insomnia while taking isotretinoin that improved with lowering the dose: pubmed.ncbi.nlm.nih.gov/36788925/
I sort of have it too. What I do is avoid taking it in the evening. I usually take the 1st dose with breakfast (20mg) and 2nd one with lunch. Usually I have insomnia when taking the last dose in the evening.
In uganda..one tablet of accutane is 5000shilllings ..n u r supposed to take one daily for six months thats about 750,000ugshs+ ...on my side its too expensive so i haven't started it yet..but my friends that have started it really have good results they look 😃 great
Could you talk about other less popular side effects like anal fissures and how to minimize the symptoms? I know it’s not a popular subject, but there are side effects no one is talking about that could have serious repercussions even after finishing the treatment.
While the lips are the most common, isotretinoin can cause mucocutaneous dryness anywhere (nose, eyes, anus, genitals, hands/arms). I agree that these other potential areas that can have dryness are important to address (and to counsel that dryness can persist sometimes post treatment). The main strategies to help with mucocutaneous dryness are: 1) Lower the dose; 2) Omega-3 supplementation; 3) Skin barrier repair/support. #3 is going to look different for different sites. For the anal area, using a thick emollient like Vaseline/Aquaphor for mild irritation and then using a low strength topical steroid ointment for more severe irritation can be a good place to start.
Sorry to hear about your experience. Similar to the same mechanism by which isotretinoin can cause lasting remission of acne, it might also predispose to long-term skin or eye dryness. In general, the evidence supports that these improve with time, but some studies show more lasting changes to the Meibomian glands of the eye (which can cause eye dryness). However, it does seem like Omega-3 can be protective for the Meibomian glands. In general, there is very little evidence to support isotretinoin having causal associations with other long-term side effects (GI, neurologic, etc); however, it is possible that there may be some that we have either not yet adequately studied or that are so rare we cannot detect them easily.
Hello Ive been taking accutane for almost 2 weeks but i dont feel side effects and purging, i take 30mg of accutane per day. Is it normal or do I need to go back to my dermatologist so that she will increase my dosage of accutane?
Most patients do not have significant purging with isotretinoin. Often we will increase the dose until there are mild side effects (dryness) or aim for a dose around 0.5-1 mg per kg of body weight per day for most patients. However, best to talk to your doctor about what to expect and what dose is best for you as this channel is not for medical advice.
I cannot provide you with medical advice and would suggest discussing with your dermatologist. In general, I tend to recommend that patients take Omega-3 together with isotretinoin to help reduce side effects like skin, lip, and eye dryness.
My doctor prescribed me 10mg accutane everyother day . But he said bloodwork isn't required for such low dose. Is it true ? I'm skeptical about starting isotretinoin .is it really a low dose ?😞. Please reply
I cannot speak to your specific situation, but typical dosing for isotretinoin is about 0.5-1.0mg/kg/day. Therefore, for most people, 10mg every other day is a relatively low dose. With respect to labs, some have called into question the value of routine bloodwork for those being treated with isotretinoin: pubmed.ncbi.nlm.nih.gov/35986616/
@@DrJohnBarbieri Thank you doctor for this information . I'm starting isotretinoin from today . I spent whole day researching and I think I have to trust my dermatologist. 😄
@@DrJohnBarbieri thank you sir.. My isotretinoin journey now 40th day my skin becoming very worst face full off puss filled pimples how long purging goes?
Hello doc, quick question: i do hypertrophy training 2x per week (most sets to muscular failure, 12-15 reps) and take 3mg creatine daily. Sometimes my joints ache during/after workout but they eventually recover. Should I change anything in the workout because I started taking Isotretinoin? My dose is 10mg and 20mg, i weight 70kg
I cannot speak to your specific situation and I would recommend discussing with your healthcare providers. In general, isotretinoin does not seem to negatively affect muscle function, so I typically tell patients to continue activities as they usually would (which would include being mindful of symptoms that develop with activity).
I can't speak to your situation, but it is uncertain whether isotretinoin for acne can influence growth, but to date there is no convincing evidence that it has a negative effect on final adult height. In addition, most women reach their final height by age 15 and most men by age 18, so this potential issue is even less likely after these ages.
In general it is fine to do physical exercise while on isotretinoin as long as feeling ok. Isotretinoin can cause joint aches and muscle soreness that can be an issue, but it does not appear to influence strength to a significant degree.
I am facing acne problem from age 28. Now I am 34, still facing it. I have tried several medicines by consulting several doctors. After taking medicine of 7/8 months all my acnes go away but come back again within a year. Currently I am taking isotrin(20mg-daily) and Azyth(500mg-3days in a week). As I am taking Isotrin now, can you tell is there any possibility that the acne would not come again after getting clear skin?😢
Sorry to hear about your struggles with acne. While, I cannot speak to your situation, in general about 60-80% of those treated with isotretinoin have long-term clearance of acne.
About 80% who achieve 2-3 months of clear skin prior to stopping isotretinoin will have long term clearance of acne. jamanetwork.com/journals/jamadermatology/fullarticle/2810450
Hi Dr John! My 17 yr old son started accutane 5 days ago. He is to go on 80 mg a day, dermatologist said his is severe cystic acne . I just saw your video and put him on Claritin today. Just stopped the topical as I am expecting dryness but in the interim its hard doing nothing as his face is very cystic and red with new papules daily. Would the Claritin take effect the same day or how exactly would it work for inflammation when you already have bad acne? I assume he is too soon to start purging and this is just his normal acne. Do you also have a comment on mega dosing B5 for acne ?
We have several videos on the role of vitamins/minerals (ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-uBRWQSEouK4.htmlsi=tp6gWVZ99AXkvSdU) and diet more generally (ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-9jYP2BZJZqw.htmlsi=2GYiy6W-ERJxuNb7). Check them out!
@@DrJohnBarbieri thank you watched them. He is already on 100 mg of zinc pic a day and on 2000 iu of D. He was taking vitamin A 2000 a day but I think we will stop that since he on Accutane. He does have a small amount of whey protein in his protein bar, is that enough to cause problems?
I can't comment on individual patient care. Some of the case series have not involved particularly large amounts of whey protein: www.ncbi.nlm.nih.gov/pmc/articles/PMC5350548/
Hi doctor. I have had history of anxiety disorder and panic attacks. I am on Accutane 10 mg dose for 15 days now. I've been feeling a slight issue at breathing, headache, also feeling brain fatigue in a short span of time when engaged in works that require mental strength. Could this be related to my use of this drug, given it's the lowest dose, 10 mg? Highly appreciate a response.
Sorry, this channel is for educational purposes only and I cannot provide you with direct medical advice. I would recommend discussing with your doctor. In general, isotretinoin side effects, while often less common at lower doses, can occur at any dose.
Hello dr my dr proscribed me doxycycline n lymoribe any one table along with isotretinoin 20mg alternative days Is it safe to take doxy along with isolation?
