This month, husband-wife dermatologists Bill Danby and Lynne Margesson share their patient handout on isotretinoin, which Dr. Danby calls “the closest thing to a sure cure for acne.” Isotretinoin is the closest thing to a sure cure for acne that has ever been invented,” says Dr. Danby of the drug long known to the public mainly by the original brand name Accutane, which is no longer available. Yet his handout, which is featured this month, makes it abundantly clear to his patients that there is a price to pay for the freedom it offers from nodular acne and the scarring it causes. Side Effects Related to the Skin According to the handout, most users of this “wonder drug” experience side effects related to the drying mechanism that shuts down the functioning oil gland. Nearly all (96%) complain of chapped lips, and a majority experience facial drying (67%) or nose dryness (55%); some get nosebleeds (25%). There may also be body skin dryness (22%) or itching (30%), or sun sensitivity (20%). Less commonly the dryness extends to eyes and eyelids, leading to blepharoconjunctivitis or problems with vision. For all, Drs. Danby and Margesson offer tips including various emollients, sunscreens, eyedrops and vitamins. Other less common side effects, they warn, require other types of treatments. A return to the office for prescribed treatments is in order for the 10% who experience acne flares. The rarest side effects include pyogenic granuloma, dissemination of existing herpes lesions, skin fragility or skin infections such as impetigo. Hair thinning, which occurs in about 5% of users, they note, is temporary and reversible. And in the rare instance of blood in urine, it is usually due to dry split skin in the area. General Side Effects The handout also covers a long laundry list of other side effects that have been reported, including headaches, depression, arthralgia, myalgia, blood sugar abnormalities, tinnitus, and gastrointestinal problems. Patients are made aware that various blood tests will be altered by isotretinoin and that half experience an elevation in blood fats. The Side Effect That Must Be Prevented… But, as all dermatologists know, for women there is a far more worrisome side effect — birth defects — the prevention of which requires vigilant ascertainment that patients are using at least two forms of effective birth control. Their negative pregnancy status must be verified not only before a first prescription, but every month before they can receive a new one. There is no misunderstanding the anti-pregnancy message in their handout: Any pregnancy occurring on this medication must be terminated. Your acceptance of a prescription for isotretinoin means you accept these facts, you will report any pregnancy to your dermatologist, and you will comply with termination (an abortion) in the event of any pregnancy. You must follow the iPLEDGE rules to the letter or you may be discharged from our care. Males taking isotretinoin are reminded to “NEVER loan pills to your girlfriend!” What Patients Can Expect Drs. Danby and Margesson include instructions for use, noting that tetracycline, minocycline or doxycycline must be discontinued, the pill should be taken with food, “preferably fatty food,” and what to do if their acne flares during the third to fifth week of treatment. They advise avoidance of all dairy products both during and after their treatment with isotretinoin. The handout also outlines their office procedures for isotretinoin patients, including regular blood testing, and, of course, monthly pregnancy testing for women of childbearing potential.
ISOTRETINOIN
This month, husband-wife dermatologists Bill Danby and Lynne Margesson share their patient handout on isotretinoin, which Dr. Danby calls “the closest thing to a sure cure for acne.” Isotretinoin is the closest thing to a sure cure for acne that has ever been invented,” says Dr. Danby of the drug long known to the public mainly by the original brand name Accutane, which is no longer available. Yet his handout, which is featured this month, makes it abundantly clear to his patients that there is a price to pay for the freedom it offers from nodular acne and the scarring it causes. Side Effects Related to the Skin According to the handout, most users of this “wonder drug” experience side effects related to the drying mechanism that shuts down the functioning oil gland. Nearly all (96%) complain of chapped lips, and a majority experience facial drying (67%) or nose dryness (55%); some get nosebleeds (25%). There may also be body skin dryness (22%) or itching (30%), or sun sensitivity (20%). Less commonly the dryness extends to eyes and eyelids, leading to blepharoconjunctivitis or problems with vision. For all, Drs. Danby and Margesson offer tips including various emollients, sunscreens, eyedrops and vitamins. Other less common side effects, they warn, require other types of treatments. A return to the office for prescribed treatments is in order for the 10% who experience acne flares. The rarest side effects include pyogenic granuloma, dissemination of existing herpes lesions, skin fragility or skin infections such as impetigo. Hair thinning, which occurs in about 5% of users, they note, is temporary and reversible. And in the rare instance of blood in urine, it is usually due to dry split skin in the area. General Side Effects The handout also covers a long laundry list of other side effects that have been reported, including headaches, depression, arthralgia, myalgia, blood sugar abnormalities, tinnitus, and gastrointestinal problems. Patients are made aware that various blood tests will be altered by isotretinoin and that half experience an elevation in blood fats. The Side Effect That Must Be Prevented… But, as all dermatologists know, for women there is a far more worrisome side effect — birth defects — the prevention of which requires vigilant ascertainment that patients are using at least two forms of effective birth control. Their negative pregnancy status must be verified not only before a first prescription, but every month before they can receive a new one. There is no misunderstanding the anti-pregnancy message in their handout: Any pregnancy occurring on this medication must be terminated. Your acceptance of a prescription for isotretinoin means you accept these facts, you will report any pregnancy to your dermatologist, and you will comply with termination (an abortion) in the event of any pregnancy. You must follow the iPLEDGE rules to the letter or you may be discharged from our care. Males taking isotretinoin are reminded to “NEVER loan pills to your girlfriend!” What Patients Can Expect Drs. Danby and Margesson include instructions for use, noting that tetracycline, minocycline or doxycycline must be discontinued, the pill should be taken with food, “preferably fatty food,” and what to do if their acne flares during the third to fifth week of treatment. They advise avoidance of all dairy products both during and after their treatment with isotretinoin. The handout also outlines their office procedures for isotretinoin patients, including regular blood testing, and, of course, monthly pregnancy testing for women of childbearing potential.
You can download the handout (PDF) here and photocopy for your patients.
This month, husband-wife dermatologists Bill Danby and Lynne Margesson share their patient handout on isotretinoin, which Dr. Danby calls “the closest thing to a sure cure for acne.” Isotretinoin is the closest thing to a sure cure for acne that has ever been invented,” says Dr. Danby of the drug long known to the public mainly by the original brand name Accutane, which is no longer available. Yet his handout, which is featured this month, makes it abundantly clear to his patients that there is a price to pay for the freedom it offers from nodular acne and the scarring it causes. Side Effects Related to the Skin According to the handout, most users of this “wonder drug” experience side effects related to the drying mechanism that shuts down the functioning oil gland. Nearly all (96%) complain of chapped lips, and a majority experience facial drying (67%) or nose dryness (55%); some get nosebleeds (25%). There may also be body skin dryness (22%) or itching (30%), or sun sensitivity (20%). Less commonly the dryness extends to eyes and eyelids, leading to blepharoconjunctivitis or problems with vision. For all, Drs. Danby and Margesson offer tips including various emollients, sunscreens, eyedrops and vitamins. Other less common side effects, they warn, require other types of treatments. A return to the office for prescribed treatments is in order for the 10% who experience acne flares. The rarest side effects include pyogenic granuloma, dissemination of existing herpes lesions, skin fragility or skin infections such as impetigo. Hair thinning, which occurs in about 5% of users, they note, is temporary and reversible. And in the rare instance of blood in urine, it is usually due to dry split skin in the area. General Side Effects The handout also covers a long laundry list of other side effects that have been reported, including headaches, depression, arthralgia, myalgia, blood sugar abnormalities, tinnitus, and gastrointestinal problems. Patients are made aware that various blood tests will be altered by isotretinoin and that half experience an elevation in blood fats. The Side Effect That Must Be Prevented… But, as all dermatologists know, for women there is a far more worrisome side effect — birth defects — the prevention of which requires vigilant ascertainment that patients are using at least two forms of effective birth control. Their negative pregnancy status must be verified not only before a first prescription, but every month before they can receive a new one. There is no misunderstanding the anti-pregnancy message in their handout: Any pregnancy occurring on this medication must be terminated. Your acceptance of a prescription for isotretinoin means you accept these facts, you will report any pregnancy to your dermatologist, and you will comply with termination (an abortion) in the event of any pregnancy. You must follow the iPLEDGE rules to the letter or you may be discharged from our care. Males taking isotretinoin are reminded to “NEVER loan pills to your girlfriend!” What Patients Can Expect Drs. Danby and Margesson include instructions for use, noting that tetracycline, minocycline or doxycycline must be discontinued, the pill should be taken with food, “preferably fatty food,” and what to do if their acne flares during the third to fifth week of treatment. They advise avoidance of all dairy products both during and after their treatment with isotretinoin. The handout also outlines their office procedures for isotretinoin patients, including regular blood testing, and, of course, monthly pregnancy testing for women of childbearing potential.
