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Is Isotretinoin safe?

Is there cure for acne? I would say, yes. After years of treating acne with various treatment regimes, I still find systemic Isotretinoin offers the best outcome (> 90% efficacy from clinical studies) and potential cure, albeit significant side effects.

Try google the word "Roacutane", you will see more negative than positive comments. Some are absurd and some are hate pages. Whatever it is, no one will understand the feeling of those patients with severe acne and especially those nodulo-cystic type, where patients end up with permanent facial scarring, if they never experienced themselves.

No one can denied the significant side effects caused by Isotretinoin, but the key words here are, "severe", "nodulo-cystic", "unresponsive" and "scarring". Therefore, Isotretinoin should be considered as first line treatment for people with severe, nodulo-cystic acne that cause severe scarring or those who fails treatments with conventional or various other regimes.

Most people are really concern with the potential side effects. The list goes on. Most of the data are obtained from the western countries but what about Asians? There are not many good studies with big number of subjects published.

In a recent article published in the Journal of Dermatological Treatment, entitled "Isotretinoin is safe and efficacious in Asians with acne vulgaris", the authors concluded that Isotretinoin was generally well tolerated, efficacious and safe.

Of the total 2, 255 patients studied, majority (93.9%, n=2109) of patients achieved complete remission or substantial improvement.

Side effects documented are:

Side effects
Cases (%)
Chelitis
1461 (64.8)
Muscle/joint pain
52 (2.3)
Headache
41 (1.8)
Mood change
37 (1.6)
Temporary hair loss
33 (1.5)
Photosensitivity
33 (1.5)
Nausea
8 (0.4)
Blurred vision
8 (0.4)
Dizziness
5 (0.2)
Raised ALT
38 (2.2)
Raised AST
24 (2.7)
Raised TG > 2.3 mmol/l
80 (4.8)
Raised LDL > 4.0 mmol/l
194 (12.1)

The weakness of this publication is that, it was a retrospective study. Limitations such as incomplete documentation and missing data need to be taken into account.

Source: 

J  Dermatolog Treat. 2013 Oct;24(5):387-91. doi: 10.3109/09546634.2012.672708.
Epub 2012 Apr 12
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