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Isotretinoin (a derivative of vitamin A) is available on hospital-only prescription
because of its potential toxicity and teratogenicity. It is used in the treatment
of acne, reducing sebum production and surface propionibacterium acnes.
Since it may be obvious
early on which patients are going to be referred, it may be worth starting the
patient on antibiotics at the time of referral.
Isotretinoin is contraindicated in:
- hypervitaminosis A
- uncontrolled hyperlipidaemia
- during pregnancy or lactation (1)
Before commencement on isotretoin therapy:
- baseline investigations are required (FBC, fasting lipid profile, liver
function tests)
- if the patient is female then it is important that a negative pregnancy
test is confirmed before therapy is commenced. Also female patients must use
effective contraception for at least four weeks before treatment, during the
treatment period and for at least four weeks following its cessation (1)
- history of previous and current psychiatric health should be obtained (1).
A
single course of oral isotretinoin can induce remission of acne patients and is
most effective acne treatment available (2)In general patients require isootretinoin
treatment for four to eight months Oral isotretinoin indications include
- nodulocystic acne
- scarring
- frequent relapsing acne (4)
- patients with mild-to-moderate acne that has failed to respond to at least
two courses of antibiotics
Reference:
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