Roaccutane and Acnecutane: reviews of dermatologists on Isotretinoin, instructions

From this article you will learn:

what is isotretinoin,
Acnecutane and Roaccutane - instructions, reviews,
differences between these drugs.

The article was written by a specialist with higher medical education.

Isotretinoin is a retinoid that is also known as 13-cis-retinoic acid (Figure 1). This chemical compound is an isomer of tretinoin (trans-retinoic acid), which, like isotretinoin, is a structural analogue of vitamin A. Isotretinoin is best known as an oral systemic retinoid that is used to treat severe forms of acne. The latter include, for example, nodular and conglobate forms of acne, as well as forms of acne that are resistant even to oral antibiotics.

Systemic retinoids containing isotretinoin include drugs such as Acnecutane and Roaccutane. As we said above, they are intended for oral administration (available in capsule form). However, there are preparations with isotretinoin for external use that can be used to treat photoaging of facial skin. These drugs include those available on the Russian market - Retasol drugs, as well as retinoic ointment.

Isotretinoin (13-cis-retinoic acid) –

Reviews from dermatologists about Acnecutane and Roaccutane are the most positive, because in fact, these drugs with isotretinoin have made a real revolution in the treatment of severe forms of acne. They have improved the quality of life for many patients, including preventing the formation of scars. Isotretinoin therapy provides complete remission of the disease in almost all patients with acne, and after completion of the course of therapy, remission can last up to several months or even years.

However, therapy with systemic retinoids is associated with the risk of quite severe side effects, which we will discuss in detail below (they occur especially often if the dosage is incorrectly selected). Girls and women should take into account that these drugs have a pronounced teratogenic effect, and therefore they are prohibited both during pregnancy and breastfeeding. In addition, the entire period of use of the drug will require a two-level contraceptive system (both oral contraceptives and condoms).

How much do Roaccutane and Acnecutane cost in pharmacies -

For 2022, the price for Roaccutane will be from 1900 rubles - for a package of 30 capsules of 10 mg. It should be noted that this drug can now not be purchased in every pharmacy, which is apparently due to the current re-registration of the drug on the Russian market. For Acnekutan, the price for a package of 30 capsules of 8 mg will be from 1650 rubles, and for a package of 30 capsules of 16 mg - from 2600 rubles.

Analogs of Roaccutane include such drugs as Sotret (India) and Verocutan (Russia). The first one costs from 1350 rubles per pack of 30 capsules of 10 mg. As for the Russian drug Verokutan, it has currently disappeared from sale.

Roaccutane and Acnecutane (mechanism of action) –

The drug Roaccutane is produced by a pharmaceutical company (Switzerland), and the drug Acnecutane is produced by a pharmaceutical company (Croatia). The drugs contain isotretinoin and are practically equivalent to each other, however, in the production of the drug Acnekutan, the “Lidose” technology is used, which makes it possible to reduce the daily and course doses of isotretinoin, and therefore the risk of side effects during treatment. Lidose technology is a Belgian development.

Indications for use –

severe forms of acne (nodular, conglobate, fulminant),
forms of acne with a risk of scarring,
acne that cannot be treated with topical medications or oral antibiotics.

These are the indications you can find in the official instructions for the drugs Roaccutane and Acnecutane.
However, according to numerous clinical studies and the most authoritative textbook on dermatology in the world, Fitzpatrick's Dermatology (we use the 8th edition), isotretinoin preparations are also very effective for the treatment of gram-negative folliculitis and facial pyoderma. Gram-negative folliculitis is exactly the complication that very often develops in patients with acne after using local and systemic antibacterial drugs. The mechanism of action of isotretinoin for acne -

The mechanism of action of isotretinoin has not been fully studied, but it is known that it quite strongly suppresses the activity of the sebaceous glands. It suppresses both the activity of sebocytes (these are cells in the sebaceous glands that secrete fatty secretions) and their proliferation, i.e. reproduction. Accordingly, as a result of a course of isotretinoin, both the secretion of sebum (secretion of the sebaceous glands) decreases and the sebaceous glands decrease in size.

Studies have shown that after completing the course of treatment with isotretinoin, in most patients the usual activity of the sebaceous glands returns only after 2-4 months, however, in some patients this effect can be expressed even up to 1 year. In addition, isotretinoin helps indirectly reduce the number of P. acnes bacteria, normalizes the processes of follicular keratinization, and also has anti-inflammatory activity.

The latter, however, requires clarification, because at the first stage of drug therapy with Acnecutane or Roaccutane - on the contrary, acne may worsen. This effect usually lasts up to 2 weeks and its appearance does not require discontinuation of the drug, and to reduce the symptoms of acne exacerbation, reduced dosages of isotretinoin are usually used at the first stage of treatment.

Isotretinoin: before and after photos

Important: Keep in mind that it usually takes at least 4 weeks to notice the first positive changes. In addition, during the first 1-2 weeks, your acne may worsen (this is normal with systemic use of isotretinoin). The full course of treatment will last from 16 to 24 weeks.

Retinoids (in-depth review)

Acnecutane, Roaccutane, Erase

Systemic retinoids contain the active ingredient isotretinoin. This substance has been used in world medicine for almost 40 years and is the gold standard for the treatment of acne and acne.

What kind of substance is this? This is trans-retinoic acid and it very powerfully suppresses the activity of the sebaceous glands.

When does acne occur?

Acne occurs when, under the influence of excessive effects of the hormone testosterone on the sebaceous gland, powerful production of sebum in large quantities is stimulated.

How do systemic retinoids work?

Systemic retinoids act on the sebaceous gland receptors, joining the sebaceous gland receptors, they inhibit the activity of sebum secretion from the gland and acne goes away.

The most frequently prescribed drugs from systemic retinoids (approved in the Russian Federation):

Roaccutane
Aknekutan
Will erase

Comment from cosmetologist, dermatologist Yuliana Shiyan:
When I prescribe one of these drugs, I am asked why this particular drug and what is the difference between retinoids? All these drugs have one substance in common: Isotretinoin. Roaccutane was the very first to appear. This is the original drug, and all other drugs are its *generics. All generics of isotretinoin have their own registration certificates and are approved in Russia.

*GENERIC - approved copy of the original drug

Roaccutane and Sotret practically do not differ from each other either in formula or dose. When assigning them, there is no difference and the choice in favor of one or the other is immaterial. Acnecutane contains the same substance, but its formula is slightly different from Roaccutane and Sotret.

Why is Acnecutane more interesting for a cosmetologist and the patient himself, as a choice for treatment and how to understand which retinoid drug is better?

Isotretinoin is a fat-soluble substance. It is absorbed by the body only in combination with absorbed fats. If you take Roaccutane and wash it down with plain water, you will absorb less than 40% of it. If you take Acnecutan and drink it with plain water, it will be absorbed by the body by about 70%.

When prescribing Acnecutane, the doctor insures patients against their own mistakes. Patients may neglect fatty foods while taking Roaccutane and Sotret, forget to eat anything fatty or fatty foods are forbidden to them (on a diet), and the required dose of the drug must enter the body! Necessary, not a small part of it! Therefore, the drug Acnekutan is more preferable for the patient; a lack of fat when taking it is less likely to affect the outcome of treatment.

Its daily dose is regulated by the doctor, but there is also a cumulative dosage of the drug that the patient’s body must accumulate. It is when it is achieved that we can talk about a high chance of stable remission in the patient.

Due to the fact that Acnecutane is better absorbed, the manufacturer made slightly less active ingredient in one dose, which means: The working dose is 20 mg. Roaccutane corresponds to the working dose of Acnecutane with 16 milligrams of Isotretinoin.

The conclusion is simple: if less isotretinoin accumulates in the body, then the risks of side effects are also reduced. This is very good for the patient!

For ardent supporters of all original and original drugs, Roaccutane is recommended. But all other retinoids will be useful for you, provided that they are prescribed by a dermatologist, and you, in turn, comply with all the conditions for taking retinoids.

Acnecutane and Roaccutane: instructions for use

The drug Acnekutan is available in capsules (there are 2 forms of release - capsules of 8 and 16 mg). The drug Roaccutane also has 2 release forms - capsules 10 or 20 mg. A very important issue is determining the optimal daily dose in each specific clinical case. Never take these medications without the advice of a dermatologist and laboratory tests. According to the dermatology textbook Fitzpatrick's Dermatology, the recommended daily dose of isotretinoin is in the range of 0.5-1.0 mg/kg/day.

For Acnecutane, the average daily dosage will be slightly lower (than for Roaccutane), which is explained by the use of Lidose technology in its production. By the way, reviews of dermatologists on Acnecutan note that, apparently due to this circumstance, side effects are less likely to occur. At the 1st stage of therapy, it is customary to use slightly lower doses of isotretinoin than during the main period of treatment. For example, for Acnecutane the daily dose will usually be only 0.4 mg/kg/day at the 1st stage of therapy, and in the future we can increase it to 0.8 mg/kg/day. And for Roaccutane at stage 1, the daily dose will already be 0.5 mg/kg/day, and then it will need to be increased to approximately 1.0 mg/kg/day.

In addition to the standard daily dose recommended above in the range of 0.5-1.0 mg/kg/day, studies have described treatment regimens that use even lower daily doses (in the range of 0.1 to 0.4 mg/kg/day). day). It should be noted that such daily doses also show their effectiveness, but you must understand that in these cases the duration of remission after discontinuation of the drug will be shorter.

1) Recommended cumulative doses –

There is also the concept of a cumulative dose, which during the entire course of therapy can be: 1) for Acnecutane - 100-120 mg/per 1 kg of weight, 2) for Roaccutane - 120-150 mg/per 1 kg. Calculation of the cumulative dose per 1 kg of weight is very important for patients whose daily dosages change or there are breaks in treatment. In these cases, achieving the recommended cumulative dose per 1 kg of weight allows for the longest remission of the disease. In patients with severe lesions of the back and chest, the recommended daily dose can reach up to 2 mg/kg/day, because these areas are less sensitive to isotretinoin therapy.

2) Duration of treatment –

Complete remission of acne symptoms can be achieved after 16 to 24 weeks of taking isotretinoin. In each specific case, the duration of the course is individual and can only be determined by a dermatologist. Please note that an improvement in the condition of your acne may be observed, including within 1-2 months after stopping the drug. Therefore, the drug can be discontinued in some cases even before the inflammatory elements of acne completely disappear.

Approximately 10% of patients treated with isotretinoin require a second course of the drug, with the likelihood of repeat therapy increasing in patients younger than 16–17 years. A second course of therapy can be prescribed no earlier than 8 weeks (after the end of the first).

Important: in patients with severe forms of acne (especially granulomatous lesions), isotretinoin therapy often leads to a sharp exacerbation of acne. And in such patients, it is important not only to use lower dosages at the 1st stage of treatment, but also to conduct a short course of treatment with prednisolone (for 1-2 weeks, 40-60 mg/day). But if necessary, the course of prednisolone can be extended, and can cover the first 2 weeks of isotretinoin therapy (24stoma.ru).

→ Roaccutane instructions for use official. (PDF) → Acnecutane official instructions (PDF)

Roaccutane capsules 10 mg No. 30

Compound

Active substance: isotretinoin 10 mg.
Excipients: soybean oil - 107.92 mg, yellow beeswax - 7.68 mg, hydrogenated soybean oil - 7.68 mg, partially hydrogenated soybean oil - 30.72 mg.

Composition of the capsule shell: glycerol 85% - 31.275 mg, gelatin - 75.64 mg, Karion 83 (hydrolyzed potato starch, mannitol, sorbitol) - 8.065 mg, red iron oxide dye (E172) - 0.185 mg, titanium dioxide (E171) - 1.185 mg .

Ink composition: shellac, black iron oxide dye (E172); Ready-made ink Opacode Black S-1-27794 can be used.

Pharmacokinetics

Since the kinetics of isotretinoin and its metabolites is linear, its plasma concentrations during therapy can be predicted based on data obtained after a single dose. This property of the drug also suggests that it does not affect the activity of liver enzymes involved in the metabolism of drugs.

Suction

Absorption of isotretinoin from the gastrointestinal tract varies. The absolute bioavailability of isotretinoin was not determined, since there is no release form of the drug for intravenous use in humans. However, extrapolation of data obtained in an experiment in dogs suggests a rather low and variable systemic bioavailability. In patients with acne, maximum plasma concentrations (Cmax) at steady state after administration of 80 mg isotretinoin on an empty stomach were 310 ng/ml (range 188-473 ng/ml) and were achieved after 2-4 hours. Plasma concentrations of isotretinoin are approximately 1.7 times higher than blood concentrations due to poor penetration of isotretinoin into red blood cells.

Taking isotretinoin with food increases bioavailability by 2 times compared to taking it on an empty stomach.

Distribution

Isotretinoin binds to a high degree (99.9%) with plasma proteins, mainly with albumin, therefore, over a wide range of therapeutic concentrations, the content of the free (pharmacologically active) fraction of the drug is less than 0.1% of its total amount.

The volume of distribution of isotretinoin in humans has not been determined because there is no dosage form available for intravenous administration.

Equilibrium concentrations of isotretinoin in the blood (C ss min) in patients with severe acne who took 40 mg of the drug 2 times a day ranged from 120 to 200 ng/ml.

The concentrations of 4-oxo-isotretinoin in these patients were 2.5 times higher than those of isotretinoin. There is insufficient data on the penetration of isotretinoin into tissues in humans. Concentrations of isotretinoin in the epidermis are two times lower than in serum.

Metabolism

Following oral administration, three major metabolites are found in plasma: 4-oxo-isotretinoin, tretinoin (all-trans retinoic acid) and 4-oxo-retinoin. The main metabolite is 4-oxo-isotretinoin, whose plasma concentrations at steady state are 2.5 times higher than the concentrations of the parent drug. Less significant metabolites have also been discovered, including glucuronides, but the structure of not all metabolites has been established.

Isotretinoin metabolites have biological activity confirmed in several laboratory tests. Thus, the clinical effects of the drug in patients may be the result of the pharmacological activity of isotretinoin and its metabolites.

Indications for use

Severe forms of acne (nodulocystic, conglobate acne or acne with risk of scarring);
acne that does not respond to other types of therapy.

Contraindications

Liver failure;
hypervitaminosis A;
severe hyperlipidemia;
concomitant therapy with tetracyclines;
pregnancy;
breastfeeding period;
children under 12 years of age;
hypersensitivity to the drug or its components.

With caution: history of depression, diabetes mellitus, obesity, lipid metabolism disorders, alcoholism.

Directions for use and doses

Orally, during meals, once or twice a day.

The therapeutic effectiveness of Roaccutane and its side effects depend on the dose and vary among different patients. This dictates the need for individual dose selection during treatment.

Treatment with Roaccutane should begin with a dose of 0.5 mg/kg body weight/day. In most patients, the dose ranges from 0.5 to 1.0 mg/kg body weight per day. Patients with very severe forms of the disease or with acne of the trunk may require higher daily doses - up to 2.0 mg/kg/day. It has been proven that the frequency of remission and prevention of relapses are optimal when using a course dose of 120-150 mg/kg (per course of treatment), therefore the duration of therapy in specific patients varies depending on the daily dose. Complete remission of acne can often be achieved within 16-24 weeks of treatment. In patients who tolerate the recommended dose very poorly, treatment can be continued at a lower dose, but last longer.

In most patients, acne completely disappears after a single course of treatment. In case of obvious relapse, a second course of treatment with Roaccutane is indicated in the same daily and course dose as the first. Since improvement can continue up to 8 weeks after discontinuation of the drug, a second course should be prescribed no earlier than the end of this period.

Dosing in special cases

In patients with severe renal impairment, treatment should be initiated at a lower dose (eg, 10 mg/day) and further increased to 1 mg/kg/day or the maximum tolerated.

Storage conditions

Store at a temperature not exceeding 25°C, protected from light and moisture. Keep out of the reach of children.

Best before date

3 years. The drug should not be used after the expiration date indicated on the package.

special instructions

Roaccutane should only be prescribed by physicians, preferably dermatologists, who are experienced in the use of systemic retinoids and are aware of the drug's teratogenicity risk. Both female and male patients should be given a copy of the Patient Information Leaflet.

To avoid accidental exposure of the drug to the body of other people, donated blood should not be taken from patients who are receiving or have recently (1 month) received Roaccutane.

It is recommended to monitor liver function and liver enzymes before treatment, 1 month after treatment, and then every 3 months or as indicated. A transient and reversible increase in liver transaminases was noted, in most cases within normal values. If the level of liver transaminases exceeds the norm, it is necessary to reduce the dose of the drug or discontinue it.

Fasting serum lipid levels should also be determined before treatment, 1 month after initiation, and then every 3 months or as indicated. Typically, lipid concentrations normalize after dose reduction or discontinuation of the drug, as well as with diet. It is necessary to monitor a clinically significant increase in triglyceride levels, since their rise above 800 mg/dL or 9 mmol/L can be accompanied by the development of acute pancreatitis, possibly fatal. In case of persistent hypertriglyceridemia or symptoms of pancreatitis, Roaccutane should be discontinued.

In rare cases, depression, psychotic symptoms, and very rarely, suicide attempts have been described in patients treated with Roaccutane. Although their causal relationship with the use of the drug has not been established, special caution should be exercised in patients with a history of depression and all patients should be monitored for the occurrence of depression during treatment with the drug, if necessary, referring them to an appropriate specialist. However, discontinuation of Roaccutane may not lead to the disappearance of symptoms and further observation and treatment by a specialist may be required.

In rare cases, at the beginning of therapy, an exacerbation of acne is observed, which resolves within 7-10 days without adjusting the dose of the drug.

Several years after the use of Roaccutane for the treatment of dyskeratosis, at a total course dose and duration of therapy higher than those recommended for the treatment of acne, bone changes developed, including premature closure of the epiphyseal growth plates, hyperostosis, calcification of ligaments and tendons. Therefore, when prescribing the drug to any patient, the ratio of possible benefits and risks should first be carefully assessed.

Patients receiving Roaccutane are recommended to use moisturizing ointment or body cream, lip balm to reduce dry skin and mucous membranes at the beginning of therapy.

During post-marketing surveillance with the use of the drug Roaccutane, cases of severe skin reactions, such as erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis, have been described. These events can be serious and can lead to disability, life-threatening conditions, hospitalization or death. Patients receiving Roaccutane require careful monitoring to identify severe skin reactions and, if necessary, consider discontinuing the drug.

While taking Roaccutane, pain in muscles and joints and an increase in serum creatinine phosphokinase are possible, which may be accompanied by a decrease in tolerance to intense physical activity.

Deep chemical dermoabrasion and laser treatment should be avoided in patients receiving Roaccutane, as well as for 5-6 months after the end of treatment due to the possibility of increased scarring in atypical places and the occurrence of hyper- and hypopigmentation. During treatment with Roaccutane and for 6 months after it, hair removal using wax applications cannot be performed due to the risk of epidermal detachment, scar development and dermatitis.

Since some patients may experience a decrease in night vision acuity, which sometimes persists even after the end of therapy, patients should be informed about the possibility of this condition, advising them to exercise caution when driving at night. Visual acuity must be carefully monitored.

Dryness of the conjunctiva of the eyes, corneal opacities, deterioration of night vision and keratitis usually disappear after discontinuation of the drug. If the mucous membrane of the eyes is dry, you can use applications of a moisturizing eye ointment or an artificial tear preparation. Patients with dry conjunctiva should be monitored for possible development of keratitis. Patients with vision complaints should be referred to an ophthalmologist and consider the advisability of discontinuing Roaccutane. If you are intolerant to contact lenses, you should use glasses during therapy.

Exposure to sunlight and UV rays should be limited. If necessary, use sunscreen with a high protection factor of at least 15 SPF.

Rare cases of the development of benign intracranial hypertension (“pseudotumor cerebri”) have been described, incl. when used in combination with tetracyclines. In such patients, Roaccutane should be discontinued immediately.

During therapy with Roaccutane, inflammatory bowel disease may occur. In patients with severe hemorrhagic diarrhea, Roaccutane should be immediately discontinued.

Rare cases of anaphylactic reactions that occurred only after previous external use of retinoids have been described. Severe allergic reactions dictate the need to discontinue the drug and carefully monitor the patient.

Patients at high risk (with diabetes, obesity, chronic alcoholism or lipid metabolism disorders) may require more frequent laboratory monitoring of glucose and lipid levels when treated with Roaccutane.

If diabetes is present or suspected, more frequent monitoring of glycemia is recommended.

Description

A drug for the treatment of acne. Retinoid.

Use in children

Contraindication: children under 12 years of age.

Pharmacodynamics

Retinoid for systemic treatment of acne.

Isotretinoin is a stereoisomer of all-trans retinoic acid (tretinoin).

The exact mechanism of action of Roaccutane has not yet been clarified, but it has been established that the improvement in the clinical picture of severe forms of acne is associated with suppression of the activity of the sebaceous glands and a histologically confirmed reduction in their size. In addition, isotretinoin has been shown to have anti-inflammatory effects on the skin.

Hyperkeratosis of epithelial cells of the hair follicle and sebaceous gland leads to desquamation of corneocytes into the gland duct and to blockage of the latter with keratin and excess sebaceous secretion. This is followed by the formation of a comedone and, in some cases, the addition of an inflammatory process. Roaccutane inhibits the proliferation of sebocytes and acts on acne, restoring the normal process of cell differentiation. Sebum is the main substrate for the growth of Propionibacterium acnes, so reducing sebum production inhibits bacterial colonization of the duct.

Side effects

Most of the side effects of Roaccutane depend on the dose. As a rule, when prescribing the recommended doses, the benefit-risk ratio, taking into account the severity of the disease, is acceptable for the patient. Side effects are usually reversible after dose adjustment or drug discontinuation, but some may persist after treatment is stopped.

From the central nervous system and the mental sphere: behavioral disturbances, depression, headache, increased intracranial pressure (“pseudotumor cerebri”: headache, nausea, vomiting, blurred vision, papilledema), seizures.

From the senses: isolated cases of impaired visual acuity, photophobia, impaired dark adaptation (decreased acuity of twilight vision), rarely - impaired color vision (passing after discontinuation of the drug), lenticular cataract, keratitis, blepharitis, conjunctivitis, eye irritation, papilledema ( as a manifestation of intracranial hypertension); hearing loss at certain sound frequencies.

From the digestive system: nausea, diarrhea, inflammatory bowel diseases (colitis, ileitis), bleeding; pancreatitis (especially with concomitant hypertriglyceridemia above 800 mg/dl). Rare cases of pancreatitis with a fatal outcome have been described. Transient and reversible increase in the activity of liver transaminases, isolated cases of hepatitis. In many of these cases, the changes did not go beyond the normal range and returned to the initial values during treatment, but in some situations there was a need to reduce the dose or discontinue Roaccutane.

From the hematopoietic system: anemia, decreased hematocrit, leukopenia, neutropenia, increase or decrease in the number of platelets, acceleration of ESR.

From the respiratory system: rarely - bronchospasm (more often in patients with a history of bronchial asthma).

From the musculoskeletal system: muscle pain with or without increased serum CPK levels, joint pain, hyperostosis, arthritis, calcification of ligaments and tendons, other bone changes, tendinitis.

Dermatological reactions: rash, itching, facial erythema/dermatitis, sweating, pyogenic granuloma, paronychia, onychodystrophy, increased proliferation of granulation tissue, persistent hair thinning, reversible hair loss, fulminant forms of acne, hirsutism, hyperpigmentation, photosensitivity, photoallergy, easy skin trauma. At the beginning of treatment, acne may worsen and persist for several weeks.

Effects caused by hypervitaminosis A: dry skin, mucous membranes, incl. lips (cheilitis), nasal cavity (bleeding), hypopharynx (hoarseness), eyes (conjunctivitis, reversible corneal opacity and contact lens intolerance).

Laboratory indicators: hypertriglyceridemia, hypercholesterolemia, hyperuricemia, decreased levels of high-density lipoproteins, rarely - hyperglycemia. Cases of newly diagnosed diabetes mellitus have been reported while taking Roaccutane. In some patients, especially those involved in intense physical activity, isolated cases of increased CK activity in the serum have been described.

From the immune system: local or systemic infections caused by gram-positive pathogens (Staphylococcus aureus).

Other: lymphadenopathy, hematuria, proteinuria, vasculitis (Wegener's granulomatosis, allergic vasculitis), systemic hypersensitivity reactions, glomerulonephritis.

Post-marketing surveillance

During post-marketing surveillance with the use of Roaccutane, cases of the development of severe skin reactions, such as erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, have been described (see also section “Special instructions”).

Use during pregnancy and breastfeeding

Pregnancy is an absolute contraindication for Roaccutane therapy. If pregnancy occurs, despite warnings, during treatment or within a month after the end of therapy, there is a very high risk of giving birth to a child with severe malformations.

Isotretinoin is a drug with a strong teratogenic effect. If pregnancy occurs during a period when a woman takes isotretinoin orally (at any dose and even for a short time), there is a very high risk of giving birth to a child with developmental defects.

Roaccutane is contraindicated in women of childbearing potential unless the woman's condition meets all of the following criteria:

she must suffer from severe acne that is resistant to conventional treatments;
she must certainly understand and follow the doctor’s instructions;
she must be informed by the doctor about the danger of pregnancy during treatment with Roaccutane, within one month after it, and urgent consultation if pregnancy is suspected;
she should be warned about the possible ineffectiveness of contraceptives;
she must confirm that she understands the precautions;
she must understand the need and continuously use effective methods of contraception for one month before treatment with Roaccutane, during treatment and for a month after its completion (see section “Interaction with other drugs”); it is advisable to use 2 different methods of contraception at the same time, including barrier;
she must have received a negative result from a reliable pregnancy test within 11 days before starting the drug; A pregnancy test is strongly recommended monthly during treatment and 5 weeks after the end of therapy;
she should start treatment with Roaccutane only on the 2-3 day of the next normal menstrual cycle;
she must understand the need for mandatory visits to the doctor every month;
when treated for relapse of the disease, she must constantly use the same effective methods of contraception for one month before starting treatment with Roaccutane, during treatment and for a month after its completion, and also undergo the same reliable pregnancy test;
she must fully understand the need for precautions and confirm her understanding and desire to use reliable methods of contraception as explained to her by the doctor.

Use of contraception as directed above during treatment with isotretinoin should be recommended even in women who do not routinely use contraception due to infertility (except in patients who have had a hysterectomy), amenorrhea, or who report not being sexually active.

The doctor must be sure that:

the patient suffers from a severe form of acne (nodulocystic, conglobate acne or acne with a risk of scarring); acne that does not respond to other types of therapy;
a negative result from a reliable pregnancy test was obtained before starting the drug, during therapy and 5 weeks after the end of therapy; the dates and results of the pregnancy test must be documented;
the patient uses at least 1, preferably 2 effective methods of contraception, including a barrier method, for one month before starting treatment with Roaccutane, during treatment and for a month after its completion;
the patient is able to understand and fulfill all of the above requirements for pregnancy protection;
the patient meets all of the above conditions.

Pregnancy test

According to current practice, a pregnancy test with a minimum sensitivity of 25 mIU/ml should be performed in the first 3 days of the menstrual cycle:

Before starting therapy

To rule out possible pregnancy, the result and date of the initial pregnancy test must be recorded by a doctor before starting contraception. In patients with irregular menstruation, the timing of a pregnancy test depends on sexual activity and should be performed 3 weeks after unprotected intercourse. The doctor should inform the patient about contraceptive methods.

A pregnancy test is carried out on the day of Roaccutane's prescription or 3 days before the patient's visit to the doctor. The specialist should record the test results. The drug can only be prescribed to patients receiving effective contraception for at least 1 month before starting Roaccutane therapy.

During therapy

The patient must visit the doctor every 28 days. The need for monthly pregnancy testing is determined in accordance with local practice and taking into account sexual activity and previous menstrual irregularities. If indicated, a pregnancy test is performed on the day of the visit or three days before the visit to the doctor, the test results must be recorded.

End of therapy

5 weeks after the end of therapy, a test is performed to exclude pregnancy.

A prescription for Roaccutane for a woman capable of childbearing can be issued only for 30 days of treatment; continuation of therapy requires a new prescription of the drug by a doctor. It is recommended that a pregnancy test, writing a prescription and receiving the drug be carried out on the same day.

Roaccutane should be dispensed at a pharmacy only within 7 days from the date of issuing the prescription.

To help doctors, pharmacists and patients avoid the risk of fetal exposure to Roaccutane, the company aims to warn about the drug's teratogenicity and emphasize the absolute mandatory use of reliable contraceptive measures for women of childbearing age. The program contains the following materials:

for doctors:

a doctor's guide to prescribing Roaccutane to women;
informed consent form for the patient;
form for recording drug prescriptions for women.

for the patient:

patient information leaflet;
what you need to know about contraception.

for the pharmacist:

A pharmacist's guide to dispensing Roaccutane.

Full information about teratogenic risk and strict adherence to measures to prevent pregnancy should be provided to both men and women.

For male patients

Existing data suggest that in women, exposure to the drug from the semen and seminal fluid of men taking Roaccutane is not sufficient to cause the teratogenic effects of Roaccutane.

Men should exclude the possibility of taking the drug by other persons, especially women.

If, despite the precautions taken, pregnancy does occur during treatment with Roaccutane or within a month after its end, there is a high risk of very severe fetal malformations (in particular, from the central nervous system, heart and large blood vessels). In addition, the risk of spontaneous miscarriage increases.

If pregnancy occurs, Roaccutane therapy is discontinued. The advisability of maintaining it should be discussed with a doctor specializing in teratology.

Severe congenital malformations of the fetus in humans associated with the use of Roaccutane have been documented, including hydrocephalus, microcephaly, cerebellar malformations, anomalies of the external ear (microtia, narrowing or absence of the external auditory canal), microphthalmia, cardiovascular anomalies (tetralogy of Fallot, transposition of the great vessels, septal defects), malformations of the face (cleft palate), thymus gland, pathology of the parathyroid glands.

Because isotretinoin is highly lipophilic, it is very likely that it passes into breast milk. Due to possible side effects, Roaccutane should not be prescribed to nursing mothers.

Interaction

Due to a possible increase in the symptoms of hypervitaminosis A, the simultaneous administration of Roaccutane and vitamin A should be avoided.

Since tetracyclines can also cause increased intracranial pressure, their use in combination with Roaccutane is contraindicated.

Isotretinoin may reduce the effectiveness of progesterone preparations, so contraceptives containing low doses of progesterone should not be used.

Combined use with topical keratolytic or exfoliative drugs for the treatment of acne is contraindicated due to the possible increase in local irritation.

Overdose

In case of overdose, signs of hypervitaminosis A may appear. In the first few hours after an overdose, gastric lavage may be necessary.

Side effects of isotretinoin -

The severity of side effects always depends on the daily dose of isotretinoin. Most of the side effects will be similar to chronic hypervitaminosis syndrome “A” and, accordingly, they will be associated with the skin and mucous membranes. Below you can see statistics on the most common side effects associated with the skin and mucous membranes.

Frequency of side effects (per number of patients) –

cheilitis (inflammation of the lips) – in 100% of patients,
facial dermatitis – 46.1%,
dry nasal mucosa – 24.8%,
dry skin – 21.4%,
skin itching – 14.5%,
increased cholesterol levels – 9.3%,
dermatitis of the hands – 6.0%,
dry conjunctiva of the eye – 3.4%,
bleeding of the nasal mucosa – 2.6%.

This study of side effects was published in the scientific journal “Bulletin of Dermatology and Venereology 2017”. The study was conducted at the Federal State Budgetary Educational Institution of Higher Education "KSMU" of the Ministry of Health of Russia. Considering that Acnecutane was used as a drug with isotretinoin, which is taken in slightly lower doses (compared to Roaccutane), then the statistics of side effects for Roaccutane should therefore be somewhat worse.

Less common side effects –

hair thinning,
myalgia (muscle pain),
from the eyes - xerophthalmia, night blindness, conjunctivitis, keratitis (corneal clouding) and optic neuritis,
hearing loss (both transient and permanent),
severe headaches, lethargy, fatigue,
risk of depression, suicide, psychosis and aggressive behavior,
from the gastrointestinal tract - nausea, esophagitis, gastritis, colitis, acute pancreatitis, acute hepatitis,
an increase in cholesterol levels with a decrease in high-density lipoprotein levels - in the first 4 weeks from the start of therapy,
impaired bone mineralization (with a repeated course of therapy, osteoporosis may be diagnosed and the risk of fractures increases).

Isotretinoin and pregnancy -

All drugs containing isotretinoin have a strong teratogenic effect. Patients should use 2 reliable methods of contraception at once (both oral contraceptives and condoms). Contraception should be started at least 1 month in advance and continued for at least 1 month after completion of isotretinoin therapy. The patient must have a negative pregnancy test result within 11 days before starting the drug, plus regular monthly testing throughout the course. If the drug is taken by a man, then there is no risk to the fetus.

The use of isotretinoin for the correction of wrinkles –

But the retinoid isotretinoin can be used not only systemically (orally).
There are a small number of drugs with isotretinoin for external use, which were initially used exclusively for the treatment of acne and pimples, but later these drugs began to be used to correct the symptoms of photoaging. As in the case of the retinoid tretinoin, preparations with isotretinoin also help to increase skin elasticity and reduce the depth of wrinkles. What effects do external forms of isotretinoin cause in the skin:

Peeling effect - the thickness of the superficial stratum corneum of the epidermis decreases (due to exfoliation of dead skin cells). This evens out skin tone and texture, leaving skin looking more youthful and radiant—like you've had a few superficial chemical peels.
Increasing the thickness of the deep layers of the epidermis - isotretinoin affects stem keratinocytes located at the basement membrane, increasing the rate of their division and differentiation. This leads to an increase in the thickness of the deep layers of the epidermis, consisting of living keratinocytes. As a result, the hydrophobicity of the epidermis increases, which contributes to less evaporation of moisture from the surface of the skin. In addition, it prevents skin photoaging.
Stimulation of the production of collagen and hyaluronic acid - isotretinoin affects not only the epidermis, but also the dermis. It promotes the proliferation (reproduction) of fibroblasts, and also significantly stimulates their activity, which leads to an increase in their production of collagen, elastin and endogenous hyaluronic acid. This leads to an increase in the thickness of the dermis, a decrease in the depth of wrinkles, and an increase in skin elasticity. It is known that thicker skin is less susceptible to the aging process.

Optimal concentrations of external forms of Isotretinoin –

There are a number of clinical studies where scientists have determined the optimal concentration of isotretinoin for the treatment of photoaging.

1) “Armstrong RB, Lesiewicz J, Harvey G et al. Clinical panel assessment of photodamaged skin treated with isotretinoin using photographs. Arch Dermatol 1992; 128:352–6.” 2) “Sendagorta E, Lesiewicz J, Armstrong RB. Topical isotretinoin for photodamaged skin. J Am Acad Dermatol 1992; 27:S15–18.”

In these studies, the concentration of Isotretinoin was increased from 0.05% at the beginning of the study to 0.1% at the end of the study. Despite the increase in concentration, the drug was well tolerated by patients without causing significant skin irritation. As a result of the treatment of photoaging skin with 0.1% Isotretinoin, the skin condition gradually improved throughout the 36-week treatment, and a decrease in the depth of wrinkles and fine lines was achieved.

3) The study “Maddin S, Lauharanta J, Agache P et al. Isotretinoin improves the appearance of photodamaged skin: results of a 36-week, multicenter, double-blind, placebo-controlled trial. J Am Acad Dermatol 2000; 42:56–63.” In this study, a combination of 0.05% Isotretinoin plus SPF sunscreen was used to treat photoaging. The result was that the condition of skin with visible photodamage was significantly improved, which was recorded using profilometry.

Conclusions: if you are interested in preventing skin photoaging, it is best to use a 0.05% concentration in combination with sunscreen. If you want to achieve an increase in skin elasticity and a decrease in the depth of wrinkles, then the main treatment should be carried out using a 0.1% concentration (it is better to use a 0.05% concentration for the first month so that the skin gets used to retinoids).

Isotretinoin has a delayed effect - it will take at least 8-12 weeks before you notice any positive changes, although the first positive effect associated with improved skin tone and texture will be noticeable after 4-6 weeks. It must be admitted that abroad isotretinoin is used for the correction of photoaging much less frequently than other types of retinoids - tretinoin or pure retinol.

Preparations with isotretinoin for external use –

“Retinoic ointment” (Fig. 8) – is available with an isotretinoin concentration of 0.05% or 0.1%. The cost will be from 300 rubles for a 15 g tube. About a tenth of the volume is ethyl alcohol, so you should not use this drug if you have dry and/or sensitive skin. In principle, the manufacturer writes in this regard that this drug is intended for the treatment of acne in patients with oily skin.

"Retasol" (Fig. 9) - is a solution for external use, with an isotretinoin concentration of 0.025%. But keep in mind that this drug also contains alcohol, but in less quantity than retinoic ointment. In addition, the drug contains propylene glycol, which may cause irritation in patients with sensitive skin. Cost from 400 rubles per 50 ml bottle.

EXPERIENCE OF USING ROACCUTENE IN MODERATE FORMS OF ACNE

Eremenko A.A.

KB No. 1 FGU YuOMTS FMBA of Russia

INTRODUCTION. Acne vulgaris is one of the most common skin diseases encountered at an outpatient appointment with a dermatologist. To define the most severe, common, chronic, difficult-to-treat forms of acne, the term “acne disease” is used. As is known, acne has a complex pathogenesis, the leading links of which are genetically determined hyperandrogenemia, or increased sensitivity of the receptors of the hair follicles and sebaceous glands to a normal or reduced amount of androgens in the body.

Follicular hyperkeratosis - hypertrophy of the sebaceous glands, their increased functioning - is one of the important investigative causes of the effects of sex hormones. As a result of increased keratinization inside the follicle, impaired desquamation, against the background of increased secretion of the sebaceous glands, anaerobic conditions are created that are optimal for reproduction, activation of microflora, with subsequent inflammation of the sebaceous gland. Thus, the normal microflora present in comedones (Propionbacterium acnes, Staphylococus epidermidis, etc.) becomes pathogenic. Inflammatory acne forms. Currently, the most effective in the treatment of moderate and severe forms of acne is Roaccutane, a synthetic retinoid of systemic action that has a complex mechanism that can cause a specific response as a result of binding and activation of retinoic acid receptors in cell nuclei. The general biological properties of retinoids are diverse and include the ability to suppress the proliferation of epidermal cells and sebaceous glands, promote normal cell differentiation, have an immunomodulatory effect, and restore photodamage to the skin.

The mechanism of action of retinoids in acne is to inhibit the processes of keratinization, reduce sebum secretion, as well as reduce the activity of P. acnes and the local inflammatory response, thus affecting all parts of the pathogenesis of the disease. In recent years, the indications for its use have expanded. There is information available for prescribing isotretinoin for less severe forms of acne.

Indications for its systemic (oral) administration for moderate severity of acne are: lack of effect or dissatisfaction with the use of traditional systemic antibiotic therapy;
relapse of the disease;
scar formation, seborrhea;
psychological problems;

appointment at the insistence of the patient, having received consent to the intervention. PURPOSE OF THE STUDY. To study the effectiveness of using a systemic retinoid (Roaccutane) in patients with moderate forms of acne, side effects.

METHODS. Over the past 3 years, 18 patients with moderate severity of acne aged from 18 to 34 years have been under my supervision. Traditional treatment methods, including systemic antibiotic therapy, have not been successful.

The treatment regimen for patients included isotretinoin at an initial dose of 0.5 mg/kg per day, increased to 1.0 mg/kg over two weeks to achieve a cumulative dose of 120–130 mg/kg. On average, the course of treatment lasted 4 months. Taking into account the complications that arise when using Roaccutane, 60% of patients were prescribed a dose of 0.5 mg/kg per day until a cumulative dose of at least 120 mg/kg was achieved. At the same time, the duration of treatment increased, but the effectiveness did not deteriorate.

In parallel, local treatment was carried out with cleansing lotions (Clearasil, Exfoliak), creams, ointments (Skinoren, Zinerit Klenzit, etc.)

On the eve of and during treatment, liver function was monitored monthly (liver tests, AST, ALT, bilirubin, cholesterol, lipid metabolism indicators).

RESULTS. After a month of treatment, all patients showed significant improvement. The secretion of sebum decreased, the formation of new comedones and inflammatory elements stopped. By the end of treatment, the skin pathological process was almost completely resolved in 85% of patients. Normal was the exfoliation of skin flakes. Only secondary pigmentation remains. In 15% of patients, taking into account the severity and extent, isolated infiltrates and single conglobate elements remained.

When using isotretinoin, complications from the skin and mucous membranes were observed in the form of dryness, peeling, and cheilitis in 70% of patients, which were easily corrected by reducing the dose of Roaccutane and using emollients and moisturizers. Some patients experienced mild redness of the facial skin in the form of dermatitis. Due to the thinning of the facial skin when using Roaccutane, increased sensitivity to sunlight is possible. As for adverse metabolic events, repeated studies of liver function tests and indicators of lipid metabolism, hyperlipidemia and hypercholesterolemia showed that they were not observed during therapy with Roac cutan.

CONCLUSION. Isotretinoin, prescribed orally for moderate acne, gives amazing results in the case of unsuccessful traditional, systemic antibiotic treatment. Side effects that occur on the skin and mucous membranes are easily eliminated by adjusting the dose of the drug, provided that the patient receives a cumulative dose of at least 120–130 mg/kg over the treatment period.

‹ External therapy for trophic skin lesionsUp Experience of using systemic terbinafine in the treatment of onychomycosis in workers of a mining and chemical plant ›

Isotretinoin: instructions for use

These instructions for using the drug are equally suitable for the treatment of acne and for facial skin rejuvenation techniques, for which information will be given below.

1) Wash your face thoroughly with a mild cleanser. 2) It is advisable to wait 20-30 minutes for the skin to dry thoroughly. 3) Squeeze out a pea-sized amount of the preparation and rub evenly. 4) Avoid contact of the drug with the mucous membranes of the eyes, lips, and nose. 5) After applying the drug, wash your hands thoroughly. 6) Use Isotretinoin 1 time per day (before bed). 7) Be patient - you will see the first results after 4 weeks when treating acne, and after 8-12 weeks for skin rejuvenation. The average treatment duration is 16-24 weeks for acne, and up to 36 weeks for improving the appearance and firmness of the skin.

Features of application –

Do not use more of the drug than recommended or more often than prescribed, because This will not speed up the effect, but will cause more redness, peeling and itching. In addition, isotretinoin should not be used if the skin in the area of application is damaged. During the treatment period, it is necessary to avoid exposure to sunlight, especially during periods of high solar activity (otherwise you may get hyperpigmentation of the treated skin areas).

Always apply sunscreen with SPF 50 before going outside. In summer, wear wide-brimmed hats to shield your face from the sun.

Side effects of topical forms of isotretinoin -

It should be noted that isotretinoin may affect different people differently. In most patients they are completely absent or mild. The most common side effects are redness, dryness, flaking, itching and burning of the skin, and increased sensitivity to sunlight. You can see the side effects from the use of retinoids in Fig. 10-11.

We hope that our article: Acnecutane and Roaccutane reviews was useful to you!

Sources:

1. Higher medical education of the author of the article, 2. Textbook on dermatology “Fitzpatrick's Dermatology” (8th edition), 3. American Academy of Dermatology (USA), 4. “Isotretinoin in the treatment of acne” (Tlish M., Shavilova M.), 5. “Cosmetic dermatology” (Bauman L.).

The use of roaccutane for the treatment of acne in cosmetology

Korchevaya T.A.

Acne is a disease of the hair follicles and sebaceous glands. In the pathogenesis of acne, four interrelated factors are important: pathological follicular hyperkeratosis, excessive secretion of the sebaceous glands, proliferation of Propionibactertum acnes (P. acnes) and inflammation. In addition, the nature and volume of secretion of the sebaceous glands is influenced by androgens, which can also play an important role in the pathogenesis of acne.

Excess sebum production plays an additional role in the pathogenesis of acne. In patients suffering from acne, sebum production increases significantly, which usually correlates with the severity of the disease. The secretion of the sebaceous glands is a substrate for the proliferation of P. acnes. In this case, lipolysis of sebum occurs by bacterial lipases to free fatty acids, which in turn contribute to inflammation and the formation of comedones.

In patients with acne, P. acnes multiplies and plays a key role in the inflammatory phase of the disease. When the contents of the follicle enter the skin itself, aseptic inflammation occurs. Depending on the location and extent of inflammation, papules, pustules and cysts are formed.

In connection with the above, for rational treatment of acne, it is important for us to solve the following main tasks:

reduce the effect of androgens on the sebaceous glands,
reduce sebum formation,
reduce inflammation,
reduce the number of P. acnes,
normalize the mitotic activity of the skin.

Rational treatment is based on correct clinical assessment. The duration of acne, the maximum severity and location of the lesion should be determined.

Topical treatment alone may be indicated for mild to moderate noninflammatory acne, mild superficial inflammatory acne without scarring, and as an adjunct to oral therapy for moderate to severe acne.

Systemic therapy is necessarily combined with local therapy and is indicated for the treatment of patients with moderate to severe acne, especially in cases of scarring or a tendency to psychosocial disorders.

Currently, Roaccutane is the most effective drug for the treatment of severe forms of acne. Clinical experience shows that it can cause long-term remissions or cures in most patients. Roaccutane reduces sebum production by 80%. There is a significant reduction in comedogenesis and P. acnes counts within 4 to 8 weeks after initiation of treatment.

Roaccutane is teratogenic. When prescribing it to women of childbearing age, it is necessary to exclude pregnancy two weeks before treatment. But the drug does not stay in the tissues for a long time and therefore, 1-2 months after treatment with Roaccutane, pregnancy is not prohibited. The opinion of some gynecologists and a number of other specialists who do not recommend getting pregnant for the entire first year after treatment with Roaccutane is erroneous: the level of the drug in the blood returns to the physiological norm within two weeks after discontinuation of the drug. And for men, in terms of childbearing, it has no contraindications, since it has no effect on sperm.

Economic efficiency. The cost of a course of treatment with Roaccutane is not always clearly perceived not only by the patient, but even by the doctor. But we must remember the high effectiveness of the drug, its surprisingly lasting effect on severe cystic, atheromatous acne, which, unfortunately, has always been considered a chronic recurrent skin disease. And here the doctor is faced with a choice: either he offers the patient treatment for a long time followed by numerous cosmetic procedures to prevent relapse; carry out repeated courses of treatment in case of relapse of inflammation, which, especially in cystic forms, is almost inevitable. With this tactic for treating acne, the total costs of treatment extended over time without the use of Roaccutane will undoubtedly be higher. Doctors are attracted to treatment with Roaccutane, of course, by the result itself: “I receive deep satisfaction from the results of treatment with this drug, as the patient’s skin improves and evens out almost without much effort on the part of the doctor.” Indeed, often even with the most complex cosmetic procedures we cannot achieve the same cosmetic effect on the skin that Roaccutane treatment provides. And most importantly, clinical cure is observed in the vast majority of patients. We understand that investing money in a temporary effect such as we often see from antibiotics for acne would, of course, be inappropriate. Therefore, the patient asks about guarantees. According to various authors, the percentage of effectiveness is very high: from 80% to 95%.

We have noticed that treating foci of chronic infection increases the effectiveness of treatment and reduces the percentage of relapses.

We begin to prepare the patient for taking Roaccutane already at the stage of a standard examination for the drug:

1. Sanitation of foci of chronic infection (gastrointestinal tract, ENT organs, etc.), 2. Sanitation of the skin with concomitant demodicosis: - Delex-acne gel (contains sulfur), - Metrogyl jelly (contains metronidazole).

We believe that it is not always advisable to carry out monotherapy with Roaccutane. To improve skin smoothing, enhance the anti-inflammatory effect, accelerate healing, eliminate post-acne defects in the early stages, when they are more susceptible to influence, we recommend combining Roaccutane at different stages of treatment with a number of medications and cosmetic procedures:

vitamin E (taken orally in a prophylactic dosage),
homeopathy and antihomotoxicology,
Skinoren,
oxygen ozone therapy,
mesotherapy,
myostimulation,
enzymatic peeling (to remove possible peeling of facial skin),
diathermocoagulation of abscesses,
massotherapy.

Among antihomotoxic drugs, I would like to especially highlight the use of Traumeel in complex therapy with Roaccutane.

The use of Traumeel S and Roaccutane in the treatment of severe forms of acne (240 patients)

Roaccutane	Roaccutane and Traumeel S
Stopping new items from appearing	5-8 weeks	After 2-4 weeks
Duration of treatment	12-16 weeks	After 10-12 weeks
Anti-scarring effect	Moderate	Expressed

The table shows that when Roaccutane is combined with the antihomotoxic drug Traumeel, the effect of treatment occurs much earlier and the smoothing of scars is more pronounced.

Unfortunately, Roaccutane does not combine well with liquid nitrogen, cosmetic cleansing, dermabrasion, chemical and acid peels. After completion of treatment with this drug for different periods of 3 months. up to 6 months if necessary, chemical and acid peeling and dermabrasion can be performed. Cosmetic cleansing - earlier: after 1-2 weeks, and with small dosages - at the end of the Roaccutane course.

Conclusion.

Roaccutane acts on the most important mechanism of acne - increased sebum secretion. Gradually, the sebaceous glands decrease in size, sebaceous cysts disappear, and therefore, inflammation in the area of these glands decreases. It is with the restructuring of the sebaceous glands that a lasting effect or clinical recovery is associated with treatment with Roaccutane.

It is possible to combine Roaccutane at different stages of treatment with anti-scarring and anti-inflammatory homeopathy, as well as with a number of cosmetic procedures.