I took it during one month in 2022 (one pill per night) the results was starting good but I stop due to anemia and leucopenia ( I cannot affirm that it was due to the drug ) I was supposed to take it for 6 months but couldn't continue due to fear as leucopenia was also mentioned as one of the side effects of isotretinoin... I recently ( Feb 2024) switch to isotretinoin gel...
Does the doctor recommended iso even if I have only acne marks and oily skin? My breakout already stops and what left is the stubborn marks and large pores
Thank you so much for this information, It’s incredibly encouraging to hear this. I plan on going on Accutane this winter and will definitely work with my dermatologist on a treatment plan that consists of supplementing antihistamines and omega 3.
Accutane is a miracle :) I‘m in the middle of month 2 and my skin is already completely clear. I‘m still taking an antihistamine as well. The lips are dry but it could be worse!
This was so helpful. Your voice is very soothing. Thank you. I have done a lot of research on Accutane as I plan to take it soon and I am in my 30’s. I have some questions maybe you can help answer: 1) Based on my research it looks like about 10% of people experience temporary hair loss while on Accutane. And even smaller percentage seem to experience permanent hair loss. Do you know what causes this? And do you know of any supplements that help decrease this side effect? 2) Based on my research it seems that patients need to have an accumulative dose of 120-150 mg/Kg. Do you believe that Accutane patients need to reach the accumulative dose to have permanent acne remission? 3) Your tip on taking an antihistamine to decrease the purging side effect is helpful. Why does taking an antihistamine decrease purging? Thank you for your help ❤
Glad you found it helpful! 1. Accutane can be associated with a form of hair loss called telogen effluvium. This typically improves with time. There unfortunately is not any clear evidence of effective preventative strategies, though in my experience it is less common than 10%. 2. The best predictor of long-term remission is clear skin x2-3 months before stopping. This is a better predictor than daily dose or cumulative dose (i.e. 120-150mg/kg). pubmed.ncbi.nlm.nih.gov/26471145/ 3. It is not 100% known, but the sebaceous gland cells have histamine receptors and are modulated by antihistamines, which likely explains some of the effect. It also might influence mast-cell mediated inflammation in the skin.
Hello doctor I hope u are doing well. I am 17 and I’m using isotretinoin by a doctor perception, I just want to know that does that effect on HGH hormone does it make our HGH hormone weaker??
Are you referring to a specific study? There is not much data on isotretinoin and growth hormone, but there is not a strong signal that it affects growth hormone levels.
It is a very individualized decision and I would recommend anyone interested in isotretinoin discuss with their dermatologist. You might find the JAMA Dermatology patient page on isotretinoin helpful: jamanetwork.com/journals/jamadermatology/fullarticle/2810450 The recently released AAD guidelines mention (www.jaad.org/article/S0190-9622(23)03389-3/fulltext): For patients with severe acne or for patients who have failed standard treatment with oral or topical therapy, we recommend isotretinoin. Acne patients with psychosocial burden or scarring should be considered as having severe acne and to be candidates for isotretinoin.
What a great video! Do you have any tips or advice on how to find a dermatologist that would agree to not test blood once a month? I didn't know that part could be optional and seems like one of the most inconvinient things about trying accutane as an adult. Thanks!
Glad you found it helpful! I don't have any specific advice about finding a dermatologist who would agree to do fewer lab tests, as the need for lab testing will also depend on individual risk factors. However, if they have read the linked articles about lab monitoring, I hope they would be open to a discussion of less monitoring (and many dermatologists now do less monitoring as standard practice).
Thank you for your help. I personally tried Roaccutane 10 mg daily for 2 years and had severe telogen effluvium. Fortunately reversed after discontinuing in 8 months
No, I do not recommend using cod liver oil in this setting. As you point out there is the potential issue of vitamin A. In addition, fish oils tend to be only ~30% Omega-3.
They are in the "References" section of the description along with links to the other supporting articles: Antihistamines: pubmed.ncbi.nlm.nih.gov/25081735/
Hi. My dermatologist prescribed me with isotretinoin 20mg tomorrow. I'hv tried a lot of medicines for more than 1 year but my acne just keeps coming back. Sometimes i get breakouts i dont know what exactly the reason is. I've been sleeping early. Washing and moisturing my face regularly and trying my best to eat right also my face type is oily. Should I take the isotretinoin pills? To be honest im kind of scared
Often patients are scared of isotretinoin and it is a medication that should be prescribed thoughtfully. However, it also can be extremely beneficial for many people with acne. I have several other videos on the channel about acne treatments and what causes acne that you can check out if interested. As I cannot provide medical advice here, ultimately, it is important to work with your doctors to decide what is best for you.
Change to healthy diet. Remove refined sugar, dairy products, drink a lot of water, yeah just remove sugar in your diet. That's what I did and my breakout just stop by itself. Now I'm still hoping a can unddergo iso beacause I have a very oily skin and lots of acne marks
What are the best types of antihistamines? Only ones I could find are cetirizine and loradatine based tablets. Between those two, cetirizine vs loradatine, which is best?
No one has done any head to head studies comparing which are best. In the clinical trials, they used desloratadine and levocetirizine (very similar to loratadine and cetirizine).
The trials were the standard daily dose. For severe flaring (or acne fulminans) we often stop the isotretinoin and use prednisone until calmed down@@captainprice586
Hey Doc...glad that I found your channel. My doc has prescribed 20mg Accutane for a month along with omnicortil capsule. Wanted your suggestion on this before starting 🙏
Glad you found the content helpful! Sometimes we will use isotretinoin (accutane) together with oral steroids (omnicortil) to prevent acne flaring. This channel is not to provide medical advice, so I would recommend discussing with your doctors.
For severe acne (or acne fulminans), sometimes we will use prednisone to help when starting isotretinoin. However, oral steroids can come with serious side effects of their own, so we typically do not use them when we can avoid it.
@@DrJohnBarbieri my question came after my dermatologist recommended taking prednisolone between 3-5 days before starting with isotretinoin to help with any purging, but I became very skeptical since I've never take corticosteroid, I don't have severe acne (only resistant type 2) and I couldn't find much scientific material supporting her suggestion. Now with your answear is another thumbs down to her. Unbelievable.
At first, I was doubting my dermatologist (who am I to doubt a professional who spent years studying right?) as she gave me a lower dose, 10 mg to be exact and I have to take it for almost 2 years and I didn't even get my bloodwork done during my first month which surprised me because a lot of reddit posts and RUclips videos does that and then I stumbled upon this video. Indeed, great dermatologist who really care for their patient think alike. Thank you so much for this helpful video, it cleared up any uncertainties I was dealing with.
Isotretinoin can be helpful in a range of acne scenarios, including acne that is causing significant distress or not responding well to other treatments. Ultimately, it is important to have a discussion with your doctor about whether isotretinoin is right for you.
Doc, i have seb derm and i was prescribed primecolimus... After 6 days, my face is better yes, smoother but i'm always feeling hot and warm. I'm gonna use this 10 days max, so i hope this warm sensation fades away.
Acne, rosacea, and seborrheic dermatitis are complex conditions, but the skin barrier plays an important role in each of them and improving skin barrier function can be a helpful part of treatment.
While diet can play a role in acne, it is not a primary cause of acne (check out our other videos on diet and acne). Isotretinoin can work for nearly any type of acne.
Isotretinoin might be associated with sleep disturbances (pubmed.ncbi.nlm.nih.gov/38825758/), though we still have much to learn in this area. I can't speak to your situation, so I would recommend discussing with your doctor. Some strategies that may have helped some people are lowering the dose, trying low dose vitamin A supplementation, and time (e.g. getting better just with continued treatment).
Hello Dr. John, Thank you for the video. My son who has UC was cleared to take Isotretinoin by his GI doctor. His dermatologist is starting him on a low dose of 30mg for the first month. After the first month's testing, she has a plan to bump him up to 60mg. I am taking your advise in getting the Omega 3 supplements, Aquaphor, Sustane and Refresh and the Saline solution to minimize side affects. My question is, with him already having gut issues, will he be at a higher risk for inflammation in the gut? I saw where you stated there aren't any thing showing that the drug causes IBD but if you have a gut issue already, would it cause inflammation?
While I cannot speak to your son's situation, in a small study led by Alexandra Charrow, there did not appear to be an association between isotretinoin and flaring of inflammatory bowel disease, particularly for those who were doing well prior to starting isotretinoin (pubmed.ncbi.nlm.nih.gov/35597387/).
@@willk3915 Yes so far. He has been taking 30mg for 3 months. Since he has been taking it at a low dose, his body is reacting to it really well. We recently went up to 40mg because it seems as his body got use to the 30mg and he was starting to get bumps in his head again (about one to three), so I asked the doctor to go up in dosage. She did. His UC is still under control. Thus far, no issues w/him taking it. I love that his dermatologist worked well w/his GI doctor before giving it to my son. We go for lab work the next visit. So far, no worries or indication that there is an issue.
@@willk3915 I am not sure if my reply was submitted. If it was...here is my short answer. As of today, he has been taking the medicine for about 6 months at a low dosage of 30mg now 40mg. He is doing well. He go do lab work next month. Thus far, he has not had any issues. Good Luck!
Many procedures can be done during isotretinoin (jamanetwork.com/journals/jamadermatology/article-abstract/2632046), but it is important to discuss with your doctor the goals of treatment to make sure it is the right approach.
I would not anticipate this to be a major problem since they are metabolized by different liver enzymes and in general there is a lack of evidence that isotretinoin causes meaningful liver issues (pubmed.ncbi.nlm.nih.gov/35986616/). Anecdotally, the combination of the two also has not appeared to be an issue.
There is not any compelling evidence to suggest that this is an issue with either medication class. Mechanistically it also would not be something that I would expect with either medication class.
@@DrJohnBarbieri good to know because I couldn’t find answers to the mechanics of it online. I took accutane as a middle schooler and have superb health now. Was wondering if it would be better if I had never done it but it seems not. Thanks
Hi, I have been taking isotretinoin for about 16 days. 40mg daily. I experience dry lips and a very oily face but I'm willing to continue. Been suffering from acne and hyperpigmentation for over four years. Should I stop at 4 or 6 months?
It is up to you and your doctor to decide when is the right time to stop. It seems that clinical response (i.e. clear x2-3 months) is a better predictor of long term clearance than either daily dose or cumulative dose (i.e. months of treatment), so I typically encourage doctors to prescribe isotretinoin based on clinical endpoints rather than fixed durations or cumulative doses (pubmed.ncbi.nlm.nih.gov/26471145/).
Hello doctor, regarding the omega-3 does it have to be a supplement or can i just have it from foods like flaxseed for example, might that much still help?
Hello Ive been taking accutane for almost 2 weeks but i dont feel side effects and purging, i take 30mg of accutane per day. Is it normal or do I need to go back to my dermatologist so that she will increase my dosage of accutane?
Most patients do not have significant purging with isotretinoin. Often we will increase the dose until there are mild side effects (dryness) or aim for a dose around 0.5-1 mg per kg of body weight per day for most patients. However, best to talk to your doctor about what to expect and what dose is best for you as this channel is not for medical advice.
We don't have any studies comparing different treatment durations, but usually I recommend taking it until at least the skin is clearing up or until finished with the course of treatment.
@DrJohnBarbieri Thankyou Doc for considering my comment and yes I consulted my dermatologist before taking isotretinoin. However, I forgot to mention to her that I have hypothyroidism.
Doctor gave to me isotretinion and azythromycin for my acne. i used azythromycin for two weeks. But i am afraid to use accutane because of its sideeffects. Is this medicine cause hairfall?
Isotretinoin appears to occasionally be associated with hair changes that are typically temporary and may be more common with higher doses. pubmed.ncbi.nlm.nih.gov/35199047/
I'm prescribed to take 8mg for one month. I don't have sever acne, I have Slightly moderate, and I'm not concerned about my acne, However I already have anxity issue I'm concenred should I take it or fix my workout and diet
Thank you for sharing your experience. This channel is not for medical advice. There are many over-the-counter, prescription, procedures, and diet/lifestyle approaches to managing acne. I would recommend discussing with your doctors.
Is it safe to use this drug when person suffers from autoimmune disease such as Hashemoto? . I read research says that this drug may triggers autoimmune disease. What do you recommend?
I don't think there is convincing evidence of an association between isotretinoin and autoimmune disease. Is there a particular study that you are referring to?
In general it is fine to do physical exercise while on isotretinoin as long as feeling ok. Isotretinoin can cause joint aches and muscle soreness that can be an issue, but it does not appear to influence strength to a significant degree.
I typically encourage my patients to use for at the least the first few months. I would recommend discussing any personal medication questions with your doctor.
Does isotretinoin 10mg really cause liver damage,i saw it every where on internet.I'm Little hesitant to start this treatment, as prescribed by my dermatologist
It is debatable whether any dose of isotretinoin can cause meaningful, clinical liver damage (rather than just mildly elevated liver function tests): pubmed.ncbi.nlm.nih.gov/35986616/
This channel is not for personal medical advice, so I would recommend discussing with your doctor. However, many agree that microneedling could be considered during treatment with isotretinoin: pubmed.ncbi.nlm.nih.gov/28658462/
In uganda..one tablet of accutane is 5000shilllings ..n u r supposed to take one daily for six months thats about 750,000ugshs+ ...on my side its too expensive so i haven't started it yet..but my friends that have started it really have good results they look 😃 great
There are no quality epidemiologic studies suggesting a link between isotretinoin and chronic thyroid disease, so it is very unlikely, but it cannot be completely excluded as a possibility.
Isotretinoin is not right for everyone, but there is no age cutoff for its use. For instance, sometimes we use it for more severe cases of rosacea (e.g. phymatous rosacea) in older individuals.
I can't speak to your situation, but it is uncertain whether isotretinoin for acne can influence growth, but to date there is no convincing evidence that it has a negative effect on final adult height. In addition, most women reach their final height by age 15 and most men by age 18, so this potential issue is even less likely after these ages.
Hello. I took isotretinoin for around 20 days but I stopped cause my stomach kept hurting on the 3rd week of using it.. it did have a good effect after on my face but not completely since I stopped... would it be good to take it again and is it still safe given that I had stomach pain after taking it the last time?
Most of the data we have suggests that joint pains associated with isotretinoin resolve once the medication is stopped: pubmed.ncbi.nlm.nih.gov/32034553/
Isotretinoin can rarely cause telogen effluvium (a form of temporary hair loss that usually improves after treatment). It seems like this might be less common at lower doses.
@ I started isotretinoin 3 month ago . Since then , my hair volume has decreased so much, if it is happening should i stop isotretinoin or should I continue
Most side effects from isotretinoin improve after stopping. However, I think rarely some patients may have chronic dry skin/eyes after isotretinoin. Since isotretinoin works by permanently shrinking the oil glands to treat acne, it makes sense that the effects on these oil glands elsewhere could lead to dry skin/eyes.
My doctor prescribed me 10mg accutane everyother day . But he said bloodwork isn't required for such low dose. Is it true ? I'm skeptical about starting isotretinoin .is it really a low dose ?😞. Please reply
I cannot speak to your specific situation, but typical dosing for isotretinoin is about 0.5-1.0mg/kg/day. Therefore, for most people, 10mg every other day is a relatively low dose. With respect to labs, some have called into question the value of routine bloodwork for those being treated with isotretinoin: pubmed.ncbi.nlm.nih.gov/35986616/
@@DrJohnBarbieri Thank you doctor for this information . I'm starting isotretinoin from today . I spent whole day researching and I think I have to trust my dermatologist. 😄
Hey my dermatologist has had me on 20mg for about a year and now I’ve dropped to 10mg for about 4 months. So I’ve been on low dose for about a year and 4 months. Is this normal ? She keeps telling me it’s safe to be on low dose and won’t take me off it till bumps stop completely. But it has helped my skin 90 percent. Also what do you think about Ibd and accutane connection ?
This channel is not for medical advice, so I cannot speak to your specific situation. With respect to isotretinoin and inflammatory bowel disease, in general the evidence is reassuring that there is not a signal for a meaningful increase in risk. In addition, acne itself is associated with inflammatory bowel disease and oral antibiotics (common alternative to isotretinoin) are associated with inflammatory bowel disease, so we have to consider these factors as well.
@@DrJohnBarbieri thank you for your response doctor . I’m more so just curious if it’s safe to be on a dose like this for the period of time I’ve been on it
I am facing acne problem from age 28. Now I am 34, still facing it. I have tried several medicines by consulting several doctors. After taking medicine of 7/8 months all my acnes go away but come back again within a year. Currently I am taking isotrin(20mg-daily) and Azyth(500mg-3days in a week). As I am taking Isotrin now, can you tell is there any possibility that the acne would not come again after getting clear skin?😢
Sorry to hear about your struggles with acne. While, I cannot speak to your situation, in general about 60-80% of those treated with isotretinoin have long-term clearance of acne.
But the effect of taking the things mentioned by you to mitigate the side effects of Isotretinoin on the efficacy of isotretinoin is not well studied that's why I would avoid these things If getting complete remission of acne is the goal.
Lower daily dose isotretinoin regimens have been examined in RCTs for long-term clearance. Omega-3 and antihistamines do only have shorter term studies, but there is no mechanistic reason to expect they would reduce long term clearance if otherwise treating to clinical endpoints. However, agree there is a need for long-term studies.
Could you talk about other less popular side effects like anal fissures and how to minimize the symptoms? I know it’s not a popular subject, but there are side effects no one is talking about that could have serious repercussions even after finishing the treatment.
While the lips are the most common, isotretinoin can cause mucocutaneous dryness anywhere (nose, eyes, anus, genitals, hands/arms). I agree that these other potential areas that can have dryness are important to address (and to counsel that dryness can persist sometimes post treatment). The main strategies to help with mucocutaneous dryness are: 1) Lower the dose; 2) Omega-3 supplementation; 3) Skin barrier repair/support. #3 is going to look different for different sites. For the anal area, using a thick emollient like Vaseline/Aquaphor for mild irritation and then using a low strength topical steroid ointment for more severe irritation can be a good place to start.
About 80% who achieve 2-3 months of clear skin prior to stopping isotretinoin will have long term clearance of acne. jamanetwork.com/journals/jamadermatology/fullarticle/2810450
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What has been your experience with isotretinoin? What have you found helpful to reduce or prevent side effects?
I took it during one month in 2022 (one pill per night) the results was starting good but I stop due to anemia and leucopenia ( I cannot affirm that it was due to the drug )
I was supposed to take it for 6 months but couldn't continue due to fear as leucopenia was also mentioned as one of the side effects of isotretinoin... I recently ( Feb 2024) switch to isotretinoin gel...
@@eliztshiamamukendi6082did you figure out the cause for leucopenia?
Isotretinoin was the best thing to ever happen to my skin and confidence 😊
Thank you for sharing your experience!
What was the dose and duration? Did your acne return after isotretinoin?
Does the doctor recommended iso even if I have only acne marks and oily skin? My breakout already stops and what left is the stubborn marks and large pores
how long did it take
@@RickSanchezc-xh3kyno ot does nt bcoz this shit detroys the glands that causes acne and oil unluckily
Thank You so much Dr. Barbieri this is very helpful💫🌿🌷very well explained.
Thank you for watching, glad that you found it clearly explained!
I’m about to start accutane and was worried about what was going to happen to my skin and this helped a lot
Glad that you found it helpful! Make sure to check out the other content on the channel!
Ur voice is so relaxing
Thank you for watching.
Thank you so much for this information, It’s incredibly encouraging to hear this.
I plan on going on Accutane this winter and will definitely work with my dermatologist on a treatment plan that consists of supplementing antihistamines and omega 3.
Glad that you found it helpful!
Accutane is a miracle :) I‘m in the middle of month 2 and my skin is already completely clear. I‘m still taking an antihistamine as well. The lips are dry but it could be worse!
Glad to hear you are doing well!
This was so helpful. Your voice is very soothing. Thank you. I have done a lot of research on Accutane as I plan to take it soon and I am in my 30’s. I have some questions maybe you can help answer:
1) Based on my research it looks like about 10% of people experience temporary hair loss while on Accutane. And even smaller percentage seem to experience permanent hair loss. Do you know what causes this? And do you know of any supplements that help decrease this side effect?
2) Based on my research it seems that patients need to have an accumulative dose of 120-150 mg/Kg. Do you believe that Accutane patients need to reach the accumulative dose to have permanent acne remission?
3) Your tip on taking an antihistamine to decrease the purging side effect is helpful. Why does taking an antihistamine decrease purging?
Thank you for your help ❤
Glad you found it helpful!
1. Accutane can be associated with a form of hair loss called telogen effluvium. This typically improves with time. There unfortunately is not any clear evidence of effective preventative strategies, though in my experience it is less common than 10%.
2. The best predictor of long-term remission is clear skin x2-3 months before stopping. This is a better predictor than daily dose or cumulative dose (i.e. 120-150mg/kg). pubmed.ncbi.nlm.nih.gov/26471145/
3. It is not 100% known, but the sebaceous gland cells have histamine receptors and are modulated by antihistamines, which likely explains some of the effect. It also might influence mast-cell mediated inflammation in the skin.
@@DrJohnBarbieri Such helpful information. Thank you again!
thank you so much for such an informative video! I very much enjoyed listening to you like a teacher on skincare. ı hope you have a wonderful life.
Thank you!
Thank you so much for this video. I will hopefully be starting a low dose next week. ☺️
Glad that you found it helpful!
Been on isotretinoin 40mg/day for 2 months without prescription of a doctor in India. Just chapped lips and dry forehead. 🙃
Glad that it sounds like it is going well. Thanks for watching!
Is this cure your acne bro ?
@@piratescaptainmr4844 Yes 100%
Pls share experience
Hello, have your chapped lips become fine? Because mine haven't become so yet.
hi! do you think that people with less severe acne are more likely to have a permanent removal of acne in the long term? thank you for this video !
This is probably true as those whose acne begins at an earlier age (and typically have more severe acne) have higher rates of acne recurrence.
@ i’ve had acne thats nor severe but just stubborn since i was about 11 do you think it’s likely to
come back after accutane?
Hello doctor
I hope u are doing well.
I am 17 and I’m using isotretinoin by a doctor perception,
I just want to know that does that effect on HGH hormone does it make our HGH hormone weaker??
Are you referring to a specific study? There is not much data on isotretinoin and growth hormone, but there is not a strong signal that it affects growth hormone levels.
Hi Dr. Barbiei,
I am considering isotretinoin. Can you please elaborate more on who is a good candidate for treatment please?
It is a very individualized decision and I would recommend anyone interested in isotretinoin discuss with their dermatologist.
You might find the JAMA Dermatology patient page on isotretinoin helpful: jamanetwork.com/journals/jamadermatology/fullarticle/2810450
The recently released AAD guidelines mention (www.jaad.org/article/S0190-9622(23)03389-3/fulltext):
For patients with severe acne or for patients who have failed standard treatment with oral or topical therapy, we recommend isotretinoin. Acne patients with psychosocial burden or scarring should be considered as having severe acne and to be candidates for isotretinoin.
What a great video! Do you have any tips or advice on how to find a dermatologist that would agree to not test blood once a month? I didn't know that part could be optional and seems like one of the most inconvinient things about trying accutane as an adult. Thanks!
Glad you found it helpful! I don't have any specific advice about finding a dermatologist who would agree to do fewer lab tests, as the need for lab testing will also depend on individual risk factors. However, if they have read the linked articles about lab monitoring, I hope they would be open to a discussion of less monitoring (and many dermatologists now do less monitoring as standard practice).
@@DrJohnBarbieri Thank you so much for all the thoughtful advice!
Thank you for your help. I personally tried Roaccutane 10 mg daily for 2 years and had severe telogen effluvium. Fortunately reversed after discontinuing in 8 months
Glad you found the video helpful! Fortunately hair changes from isotretinoin do tend to get better after stopping.
how it's reversed please help me
Do you recommend cod liver oil as a omega 3 supplement? I was wondering if the excess vitamin A from it would cause more harm than good.
No, I do not recommend using cod liver oil in this setting. As you point out there is the potential issue of vitamin A. In addition, fish oils tend to be only ~30% Omega-3.
You mentioned antihistamines and purging...could you please link the studies you referenced in the video?
They are in the "References" section of the description along with links to the other supporting articles:
Antihistamines: pubmed.ncbi.nlm.nih.gov/25081735/
Hi. My dermatologist prescribed me with isotretinoin 20mg tomorrow. I'hv tried a lot of medicines for more than 1 year but my acne just keeps coming back. Sometimes i get breakouts i dont know what exactly the reason is. I've been sleeping early. Washing and moisturing my face regularly and trying my best to eat right also my face type is oily. Should I take the isotretinoin pills? To be honest im kind of scared
Often patients are scared of isotretinoin and it is a medication that should be prescribed thoughtfully. However, it also can be extremely beneficial for many people with acne. I have several other videos on the channel about acne treatments and what causes acne that you can check out if interested. As I cannot provide medical advice here, ultimately, it is important to work with your doctors to decide what is best for you.
Change to healthy diet. Remove refined sugar, dairy products, drink a lot of water, yeah just remove sugar in your diet. That's what I did and my breakout just stop by itself. Now I'm still hoping a can unddergo iso beacause I have a very oily skin and lots of acne marks
Are the antihistamines taken with isotretinoin or separately at different times a day? Thank you for the informative video.
I don't think it matters when they are taken.
@drjohn is antihistamine taken once a day only?
@@sooandy7177 The trials were taking it once daily.
What are the best types of antihistamines? Only ones I could find are cetirizine and loradatine based tablets. Between those two, cetirizine vs loradatine, which is best?
No one has done any head to head studies comparing which are best. In the clinical trials, they used desloratadine and levocetirizine (very similar to loratadine and cetirizine).
What is the recommended dose with antihistamines and accutane? if the purge is too strong should prednisone be a replacement?
The trials were the standard daily dose. For severe flaring (or acne fulminans) we often stop the isotretinoin and use prednisone until calmed down@@captainprice586
I personally had good luck with benadryl and pepcid. Alternating them each night for first month when starting accutane + topical tretinoin
When would you take the antihistamine and Omega 3, before or after the daily Isotret?
I don't think it is likely that it matters whether these are taken before or after taking the isotretinoin.
Hey Doc...glad that I found your channel. My doc has prescribed 20mg Accutane for a month along with omnicortil capsule. Wanted your suggestion on this before starting 🙏
Glad you found the content helpful! Sometimes we will use isotretinoin (accutane) together with oral steroids (omnicortil) to prevent acne flaring. This channel is not to provide medical advice, so I would recommend discussing with your doctors.
What about corticosteroid some days before starting the isotretinoin treatment to relief the worsening?
For severe acne (or acne fulminans), sometimes we will use prednisone to help when starting isotretinoin. However, oral steroids can come with serious side effects of their own, so we typically do not use them when we can avoid it.
@@DrJohnBarbieri my question came after my dermatologist recommended taking prednisolone between 3-5 days before starting with isotretinoin to help with any purging, but I became very skeptical since I've never take corticosteroid, I don't have severe acne (only resistant type 2) and I couldn't find much scientific material supporting her suggestion. Now with your answear is another thumbs down to her. Unbelievable.
At first, I was doubting my dermatologist (who am I to doubt a professional who spent years studying right?) as she gave me a lower dose, 10 mg to be exact and I have to take it for almost 2 years and I didn't even get my bloodwork done during my first month which surprised me because a lot of reddit posts and RUclips videos does that and then I stumbled upon this video. Indeed, great dermatologist who really care for their patient think alike. Thank you so much for this helpful video, it cleared up any uncertainties I was dealing with.
Glad that you found it helpful! Make sure to check out the other videos on isotretinoin that we have on the channel.
I am considering taking accutane soon
I hope you found the video educational.
Thanks for the helpful video. I want to know if it’s okay to take accurate in case of moderate acne. Thanks in advance🙏🏼
Isotretinoin can be helpful in a range of acne scenarios, including acne that is causing significant distress or not responding well to other treatments. Ultimately, it is important to have a discussion with your doctor about whether isotretinoin is right for you.
Great video!
Thanks! Glad you found it helpful!
Doc, i have seb derm and i was prescribed primecolimus... After 6 days, my face is better yes, smoother but i'm always feeling hot and warm. I'm gonna use this 10 days max, so i hope this warm sensation fades away.
Also: I got seb derm and rosacea from topical acne treatments that destroyed my skin. I think this is a skin barrier issue, only.
Acne, rosacea, and seborrheic dermatitis are complex conditions, but the skin barrier plays an important role in each of them and improving skin barrier function can be a helpful part of treatment.
I have a question regarding type of acne that causes by food (dairy) or skincare ingredient, does Isotretinoin also combat this issue
While diet can play a role in acne, it is not a primary cause of acne (check out our other videos on diet and acne). Isotretinoin can work for nearly any type of acne.
Do you recommend loratadine for all patient who are on isotretinoin?
I generally do suggest it for any patient starting isotretinoin, particularly if they are concerned about having a flare when starting it.
Does it cause insomnia? If so what dose can I take to avoid that side effect. My weight is 54 kg, female, 171 cm
Isotretinoin might be associated with sleep disturbances (pubmed.ncbi.nlm.nih.gov/38825758/), though we still have much to learn in this area. I can't speak to your situation, so I would recommend discussing with your doctor. Some strategies that may have helped some people are lowering the dose, trying low dose vitamin A supplementation, and time (e.g. getting better just with continued treatment).
Hello Dr. John, Thank you for the video. My son who has UC was cleared to take Isotretinoin by his GI doctor. His dermatologist is starting him on a low dose of 30mg for the first month. After the first month's testing, she has a plan to bump him up to 60mg. I am taking your advise in getting the Omega 3 supplements, Aquaphor, Sustane and Refresh and the Saline solution to minimize side affects. My question is, with him already having gut issues, will he be at a higher risk for inflammation in the gut? I saw where you stated there aren't any thing showing that the drug causes IBD but if you have a gut issue already, would it cause inflammation?
While I cannot speak to your son's situation, in a small study led by Alexandra Charrow, there did not appear to be an association between isotretinoin and flaring of inflammatory bowel disease, particularly for those who were doing well prior to starting isotretinoin (pubmed.ncbi.nlm.nih.gov/35597387/).
@@DrJohnBarbieri Thank you for your immediate response.
Was your son okay with his UC taking accutane ?
@@willk3915 Yes so far. He has been taking 30mg for 3 months. Since he has been taking it at a low dose, his body is reacting to it really well. We recently went up to 40mg because it seems as his body got use to the 30mg and he was starting to get bumps in his head again (about one to three), so I asked the doctor to go up in dosage. She did. His UC is still under control. Thus far, no issues w/him taking it. I love that his dermatologist worked well w/his GI doctor before giving it to my son. We go for lab work the next visit. So far, no worries or indication that there is an issue.
@@willk3915 I am not sure if my reply was submitted. If it was...here is my short answer. As of today, he has been taking the medicine for about 6 months at a low dosage of 30mg now 40mg. He is doing well. He go do lab work next month. Thus far, he has not had any issues. Good Luck!
Do you recommend lasers (BBL or Co2) during low dose accutane?
Many procedures can be done during isotretinoin (jamanetwork.com/journals/jamadermatology/article-abstract/2632046), but it is important to discuss with your doctor the goals of treatment to make sure it is the right approach.
can taking an antihistamine with isotretinoin lead to higher levels in the liver given both are processed through the liver?
I would not anticipate this to be a major problem since they are metabolized by different liver enzymes and in general there is a lack of evidence that isotretinoin causes meaningful liver issues (pubmed.ncbi.nlm.nih.gov/35986616/). Anecdotally, the combination of the two also has not appeared to be an issue.
Can accutane or anti hormonal medicine hurt hormone levels permanently
There is not any compelling evidence to suggest that this is an issue with either medication class. Mechanistically it also would not be something that I would expect with either medication class.
@@DrJohnBarbieri good to know because I couldn’t find answers to the mechanics of it online. I took accutane as a middle schooler and have superb health now. Was wondering if it would be better if I had never done it but it seems not. Thanks
Hi, I have been taking isotretinoin for about 16 days. 40mg daily. I experience dry lips and a very oily face but I'm willing to continue. Been suffering from acne and hyperpigmentation for over four years. Should I stop at 4 or 6 months?
It is up to you and your doctor to decide when is the right time to stop. It seems that clinical response (i.e. clear x2-3 months) is a better predictor of long term clearance than either daily dose or cumulative dose (i.e. months of treatment), so I typically encourage doctors to prescribe isotretinoin based on clinical endpoints rather than fixed durations or cumulative doses (pubmed.ncbi.nlm.nih.gov/26471145/).
Please how long did you eventually use it to?
hello dr.John its a great video.
i was wondering if i could help you edit your videos and make it more enagaging.
Glad you liked it. Unfortunately, I lack funds to support an editor.
Hello doctor, regarding the omega-3 does it have to be a supplement or can i just have it from foods like flaxseed for example, might that much still help?
The trials were with supplements, but I would think dietary Omega-3 can also help. Of note, Omega-3 from whole flaxseeds is not well absorbed.
Hello Ive been taking accutane for almost 2 weeks but i dont feel side effects and purging, i take 30mg of accutane per day. Is it normal or do I need to go back to my dermatologist so that she will increase my dosage of accutane?
Most patients do not have significant purging with isotretinoin. Often we will increase the dose until there are mild side effects (dryness) or aim for a dose around 0.5-1 mg per kg of body weight per day for most patients. However, best to talk to your doctor about what to expect and what dose is best for you as this channel is not for medical advice.
How long would you take the antihistamine for ?
We don't have any studies comparing different treatment durations, but usually I recommend taking it until at least the skin is clearing up or until finished with the course of treatment.
Hi Doc, can a person with hypothyroidism also take isotretinoin?
Typically yes. Though one should always discuss with your doctor whether isotretinoin is right for you.
@DrJohnBarbieri Thankyou Doc for considering my comment and yes I consulted my dermatologist before taking isotretinoin. However, I forgot to mention to her that I have hypothyroidism.
Im on topical tretinoin would this help someone like me too?
You might find my videos on topical retinoids informative: ruclips.net/video/EyWbNoRZY_I/видео.html
Doctor gave to me isotretinion and azythromycin for my acne. i used azythromycin for two weeks. But i am afraid to use accutane because of its sideeffects. Is this medicine cause hairfall?
Isotretinoin appears to occasionally be associated with hair changes that are typically temporary and may be more common with higher doses.
pubmed.ncbi.nlm.nih.gov/35199047/
I'm prescribed to take 8mg for one month. I don't have sever acne, I have Slightly moderate, and I'm not concerned about my acne,
However I already have anxity issue I'm concenred should I take it or fix my workout and diet
Thank you for sharing your experience. This channel is not for medical advice. There are many over-the-counter, prescription, procedures, and diet/lifestyle approaches to managing acne. I would recommend discussing with your doctors.
Is it safe to use this drug when person suffers from autoimmune disease such as Hashemoto? . I read research says that this drug may triggers autoimmune disease.
What do you recommend?
I don't think there is convincing evidence of an association between isotretinoin and autoimmune disease. Is there a particular study that you are referring to?
Does the type of omega 3 supplement matter? Should we take DHA, EPA, or both? Thanks.
DHA+EPA are likely better than other Omega-3, but beyond that, it likely does not matter so long as good quality.
@@DrJohnBarbierithanks!
Is it okay to do intense weightlifting/bodybuilding while taking accutane? I’m currently on 20mg
In general it is fine to do physical exercise while on isotretinoin as long as feeling ok. Isotretinoin can cause joint aches and muscle soreness that can be an issue, but it does not appear to influence strength to a significant degree.
@@DrJohnBarbieri thank you! 🙏
How long do u take antihistamines for I just started accutane a day ago
I typically encourage my patients to use for at the least the first few months. I would recommend discussing any personal medication questions with your doctor.
@oh thank you
Does isotretinoin 10mg really cause liver damage,i saw it every where on internet.I'm Little hesitant to start this treatment, as prescribed by my dermatologist
It is debatable whether any dose of isotretinoin can cause meaningful, clinical liver damage (rather than just mildly elevated liver function tests): pubmed.ncbi.nlm.nih.gov/35986616/
@@DrJohnBarbieri My triglycerides level is very high. Should I take this medicine
Can i do micro needling while on isotretinoin treatment
This channel is not for personal medical advice, so I would recommend discussing with your doctor. However, many agree that microneedling could be considered during treatment with isotretinoin: pubmed.ncbi.nlm.nih.gov/28658462/
In uganda..one tablet of accutane is 5000shilllings ..n u r supposed to take one daily for six months thats about 750,000ugshs+ ...on my side its too expensive so i haven't started it yet..but my friends that have started it really have good results they look 😃 great
Thanks for watching. Sorry to hear about the challenges with cost.
What about thyroid disease - can Accutane cause Graves?
There are no quality epidemiologic studies suggesting a link between isotretinoin and chronic thyroid disease, so it is very unlikely, but it cannot be completely excluded as a possibility.
@ THANK YOU Dr.
Do recommend this treatment for adults in their 50’s??
Isotretinoin is not right for everyone, but there is no age cutoff for its use. For instance, sometimes we use it for more severe cases of rosacea (e.g. phymatous rosacea) in older individuals.
Will it stun growth my doctor say no am 18 she told me to yake it but i don't buy and take it yet
I can't speak to your situation, but it is uncertain whether isotretinoin for acne can influence growth, but to date there is no convincing evidence that it has a negative effect on final adult height. In addition, most women reach their final height by age 15 and most men by age 18, so this potential issue is even less likely after these ages.
Hello. I took isotretinoin for around 20 days but I stopped cause my stomach kept hurting on the 3rd week of using it.. it did have a good effect after on my face but not completely since I stopped... would it be good to take it again and is it still safe given that I had stomach pain after taking it the last time?
This channel is not for medical advice. I would recommend discussing with your doctors.
Hi Doc, isotretenoin works on PCOS acne? Please reply
Yes, isotretinoin can work for acne in those with PCOS, though I think rates of recurrence might be slightly higher.
Could joint pain be a long term side effect?
Most of the data we have suggests that joint pains associated with isotretinoin resolve once the medication is stopped: pubmed.ncbi.nlm.nih.gov/32034553/
I still get joint pain, exercise and diet seems to help. I took Accutane 5 years ago
what about hairfall and hair thinning .
Isotretinoin can rarely cause telogen effluvium (a form of temporary hair loss that usually improves after treatment). It seems like this might be less common at lower doses.
@ I started isotretinoin 3 month ago . Since then , my hair volume has decreased so much, if it is happening should i stop isotretinoin or should I continue
I used roaccutane 20mg for 6 days. I hope my acne will be fade away
I hope your acne gets better soon!
Do you think 1 month is enough to cure the acne ?
Can these side-effects be permament?
Most side effects from isotretinoin improve after stopping. However, I think rarely some patients may have chronic dry skin/eyes after isotretinoin. Since isotretinoin works by permanently shrinking the oil glands to treat acne, it makes sense that the effects on these oil glands elsewhere could lead to dry skin/eyes.
My doctor prescribed me 10mg accutane everyother day . But he said bloodwork isn't required for such low dose. Is it true ? I'm skeptical about starting isotretinoin .is it really a low dose ?😞. Please reply
I cannot speak to your specific situation, but typical dosing for isotretinoin is about 0.5-1.0mg/kg/day. Therefore, for most people, 10mg every other day is a relatively low dose. With respect to labs, some have called into question the value of routine bloodwork for those being treated with isotretinoin: pubmed.ncbi.nlm.nih.gov/35986616/
@@DrJohnBarbieri Thank you doctor for this information . I'm starting isotretinoin from today . I spent whole day researching and I think I have to trust my dermatologist. 😄
@@sristic8372how’s it going?
Hey my dermatologist has had me on 20mg for about a year and now I’ve dropped to 10mg for about 4 months. So I’ve been on low dose for about a year and 4 months. Is this normal ? She keeps telling me it’s safe to be on low dose and won’t take me off it till bumps stop completely. But it has helped my skin 90 percent. Also what do you think about Ibd and accutane connection ?
This channel is not for medical advice, so I cannot speak to your specific situation. With respect to isotretinoin and inflammatory bowel disease, in general the evidence is reassuring that there is not a signal for a meaningful increase in risk. In addition, acne itself is associated with inflammatory bowel disease and oral antibiotics (common alternative to isotretinoin) are associated with inflammatory bowel disease, so we have to consider these factors as well.
@@DrJohnBarbieri thank you for your response doctor . I’m more so just curious if it’s safe to be on a dose like this for the period of time I’ve been on it
I am facing acne problem from age 28. Now I am 34, still facing it. I have tried several medicines by consulting several doctors. After taking medicine of 7/8 months all my acnes go away but come back again within a year. Currently I am taking isotrin(20mg-daily) and Azyth(500mg-3days in a week). As I am taking Isotrin now, can you tell is there any possibility that the acne would not come again after getting clear skin?😢
Sorry to hear about your struggles with acne. While, I cannot speak to your situation, in general about 60-80% of those treated with isotretinoin have long-term clearance of acne.
@@DrJohnBarbieri Hoping to be in the 60-80% cases. Thanks for you response.
But the effect of taking the things mentioned by you to mitigate the side effects of Isotretinoin on the efficacy of isotretinoin is not well studied that's why I would avoid these things If getting complete remission of acne is the goal.
Lower daily dose isotretinoin regimens have been examined in RCTs for long-term clearance. Omega-3 and antihistamines do only have shorter term studies, but there is no mechanistic reason to expect they would reduce long term clearance if otherwise treating to clinical endpoints. However, agree there is a need for long-term studies.
Could you talk about other less popular side effects like anal fissures and how to minimize the symptoms? I know it’s not a popular subject, but there are side effects no one is talking about that could have serious repercussions even after finishing the treatment.
While the lips are the most common, isotretinoin can cause mucocutaneous dryness anywhere (nose, eyes, anus, genitals, hands/arms). I agree that these other potential areas that can have dryness are important to address (and to counsel that dryness can persist sometimes post treatment). The main strategies to help with mucocutaneous dryness are: 1) Lower the dose; 2) Omega-3 supplementation; 3) Skin barrier repair/support. #3 is going to look different for different sites. For the anal area, using a thick emollient like Vaseline/Aquaphor for mild irritation and then using a low strength topical steroid ointment for more severe irritation can be a good place to start.
Can acne be permanently fixed after taking isotretion treatment? Will it never come back in life?
About 80% who achieve 2-3 months of clear skin prior to stopping isotretinoin will have long term clearance of acne.
jamanetwork.com/journals/jamadermatology/fullarticle/2810450
Does it cause weight gain?
No, there is not evidence to suggest isotretinoin causes weight gain.