Most people have minor Isotretinoin (Accutane®) side effects that disappear within 2 weeks after stopping the medication. Almost everybody gets dry lips, and blood work to monitor the liver and blood fats (lipids) must be done periodically. Possible side effects are numerous and well documented, most side effects are dose related which means they get worse as the dose gets higher.
Your patient may experience some side effects from Isotretinoin that will require some medical attention while on this acne treatment. The side effects that typically require treatment are aggravated skin, dry eyes, dry nose and sun damage on their lips.
Side Effects That May Be Noticed By The Patient:
Aggravated skin:
Overcleansing their skin can cause irritation that may aggravate their acne as well as encourage them to use other products that will grease up their skin. This may then complicate their skin care in that they will need to use a toner to remove the oil, which in turn may irritate their skin further.
Skin Cleansers Can Be Grouped As:
- Wipe-off cleansers (cold creams and makeup removers)
- Soaps (for example, Dove® unscented soap)
- Cosmetics
- Water-soluble cleansers (soap substitutes), these are most gentle (these should be non-irritating, non greasy, unscented, and able to remove some excess)
Examples:
- Cetaphil® gentle skin cleanser
- Spectrojel®
- Dormer® cleanser
- Aquanil®
- Dove®, by Unilever
Dry Lips And Skin:
Dry lips are the most common side effect of Isotretinoin (Accutane®). If your patient is on a course of Accutane® and their lips are not dry, then they are either not using the drug, or they are not taking the medication with fatty food. Sticky ointments are best for relieving this dryness and may prevent cracking, these products must be used multiple times a day. Occasionally, patients may get a secondary bacterial infection on their lips, this will usually respond to topical antibiotics. Some physicians will advise a few days of mild cortisone ointment for their patients if they have significant inflammation on and around their lips.
With dry skin, you may see this most often on the back of your patient’s hands and forearms. Dryness may cause a secondary bacterial infection in their skin, their skin may become fragile and the healing of their skin may slow down.
We often forget about protecting our lips from chronic sun damage, long term exposure will often produce “actinic cheilitis”, which describes changes such a loss of a distinct lip line, and white patches on the lower lip called leucoplakia. These changes are precancerous and we should take care to protect our lips to reduce this occurrence. Those who are prone to cold sores may get them more frequently after sunexposure. Those taking Accutane® will have dry lips that are more sensitive to sunburn.
Regular sunscreens are not entirely satisfactory for lip protection, and a number of lip sunscreens have been developed.
Examples:
- Antherpos-Ceralip Solaire® (Cosmair)
- Artistry Lip Colors® (Amway)
- Banana Boat Aloe Vera Lip Balm Sunblock® (Banana Boat)
- Blistex Ultra Lip Balm® (Blistex)
- Chapstick Lip Balm® (Blistex)
- Ombrelle Stick® (Cosmair)
- Shiseido Sun Block Stick® (Shisedo)
- Sun Buffer Lipstick® (Clinique)
- Sunseekers Protective Lip Balm® (Avon)
- Vaseline Lip Therapy® (Lever Ponds)
Dry Eyes And Vision:
Rarely, night vision problems have been reported, they are mostly transient, but could be permanent. Loss of visual acuity is uncommon but if your patient does experience this, an ophthalmologist should assess them. Dry gritty eyes, contact lenses may have to be discontinued, use of artificial tears is encouraged and in most cases can be very helpful.
Dry eyes are a common problem. There are multiple contributing factors and a spectrum of severity. The film of tears over your eyes is composed of oil, water and mucin. These are produced in the meibomian glands, lacrimal glands and goblet cells. Your tears are then spread by your eyelids to coat your eyeballs which helps to moisten them. The tears drain away through a tear duct that is found in the inner part of your lower eyelid. If this is blocked it will produce excess tears and lead to watery eyes.
Many disease conditions, trauma and/or environmental conditions may play a part in causing symptoms of dry eyes such as burning, grittiness and blurry vision. It is also known that a low level of inflammation that is often not seen (subclinical) can produce dry eyes. Accutane® (Isotretinoin) will cause dry eyes in some individuals. Your patient may find this to be a problem, particularly if they wear contact lenses. They may need to stop wearing them temporarily, but frequent use of artificial tears may allow the patient to continue using their lenses.
Artificial tears have active ingredients that may contain various methylcellulose compounds, polyvinyl alcohol and polyethylene glycol.
Examples:
- Refresh tears® (Allergan)
- Artificial tears
- Bion tears® (Alcon)
- Cellufresh® (Allergan)
- Celluvisc® (Allergan)
- Isopto tears® (Alcon)
- Liquidfilm tears® (Allergan)
- Tears naturale® (Alcon)
- Visine true tears® (Pfizer Consumer)
Nasal Dryness:
Patients may have a dry nose or nose bleeds due to dryness and subsequent cracking of the inner lining of their nose, frequent use of lubricants is recommended.
Dryness of the inner linings of the nose can be caused by a variety of factors. Allergic conditions, viral infections, chronic irritation, sinus inflammation, dry climates and postnasal discharge as well as oxygen therapy, can change the moisture content of the nasal lining. Accutane® (Isotretinoin) will often cause dry nose, which may in turn produce cracking and consequent nosebleeds. Lubricating their nose can minimize or prevent this side effect.
Nose lubricants that are most often used are in the form of a gel. These will often contain polyethylene glycol and propylene glycol.
Examples:
- Rhinaris Lubricating Nasal Gel® (Pharmascience)
- Secaris® (Pharmascience)
Hair:
Thirteen percent of people taking Accutane® experience thinning hair, though this is usually temporary.
Photosensitivity:
Patients may sunburn more easily, this can be a problem particularly during vacations and recreational activities. While taking Accutane® alcohol based sunscreens may be too drying.
Fatigue: (15-20%)
This may be confused with depressive symptoms.
Headaches: (5-16%)
A rare side effect of this drug is benign intracranial hypertension, which is an increase in pressure of the fluid surrounding your brain. If patients have persistant headaches that are present in the morning on waking and ware off through the day, the patient should be evaluated by a doctor.
