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Final part of our series reviewing Acne and successful treatment

Posted by Eamonn Brady on

Acne Treatment Part 4


Severe Acne

Characterised by the condition being widespread on the face and upper body, especially if nodules and cysts occur and scarring occurs. Can be considered if acne is causing severe psychological stress too. Referral to a dermatologist is advised for severe acne.


Treatment options

Oral isotretinoin (Roaccutane®) should be trialed on its own, especially if other treatment options such as systemic antibiotics have failed and especially if scarring is occurring and it is having a major psychological on the patient. Oral isotretinoin works like topical retinoids but has a more potent effect.


Isotretinoin works in four ways:

  • Reduce bacteria especially C acnes
  • Decreases size and secretions of sebaceous glands
  • Stops comedones forming
  • Reduces inflammation


Due to safety concerns and precautions, a dermatologist should initiate isotretinoin. Isotretinoin is used with caution with a history of depression as it can exacerbate the condition. Despite initial concerns, there is no medical evidence isotretinoin increases suicide risk.


Rarely isotretinoin causes hepatic (liver) impairment, elevated serum lipid levels and pancreatitis so it is necessary to do lipid and hepatic blood tests before starting isotretinoin. These blood tests should be repeated after another one and two months, and then every two months after that.


A four to six-month course is a usual treatment range. Acne may get worse during the first seven to days of treatment. This is normal and caused by the medication pushing out bacteria present in deeper layers of the skin. Isotretinoin carries elevated risk of causing serious birth defects. Women of childbearing age can only be prescribed isotretinoin following a negative pregnancy test. It is recommended this is repeated monthly throughout isotretinoin treatment. Two forms of contraception are recommended while women use isotretinoin (oral contraceptive and carrier contraceptive). The progesterone only contraceptive may be less effective while taking isotretinoin so is not recommended and as mentioned earlier, progesterone only contraceptives can worsen acne.


If a further course of isotretinoin is required after the initial course (e.g., after using for 6 months) then a minimum period of 8 weeks is recommended before re-starting isotretinoin. Combining isotretinoin with tetracyclines should be avoided due to the risk of intracranial pressure. Isotretinoin is recommended as monotherapy for acne. Common side effects of isotretinoin include dryness and cracking of the skin and lips, headaches, skin rash and peeling.


For comprehensive and free health advice and information call in to Whelehans Pharmacies, log on to or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore).



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