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When Can I Treat My Acne Scars After Accutane?.What acne scar treatment is suitable for me if I am on Isotretinoin? - human
Check out the areas below: Louisiana. Baton Rouge. San Antonio Medical Center. SBA Dermatology. Schedule Online. View Details. Old Metairie. Steiner Ranch. Dripping Springs. Central Austin. North Austin. Book Online. Book appointment by First Available Location Provider. When the oil glands get clogged, inflammation occurs in the skin which appears as a red pimple that hurts when it is touched. Basically, Accutane has an immense effect on the oil glands by reducing the size of the oil glands, cell shedding and the stickiness of cells in the glands.
And the result…? That is a reduction in acne activity with fewer whiteheads, blackheads, and pimples. YES, the best thing about Accutane is that it prevents acne scarring because it is highly effective in clearing up acne.
For me, as a laser and acne scar specialist, there is no doubt that isotretinoin e. Acne can cause a lot of mental stress and last for years. In my opinion, as a specialist, prescribing Accutane for my patients is not only a question about the severity of the skin disease but also a question about the mental stress which acne causes to the patient.
In most patients, the side effects are so mild e. If otherwise, the side effects are intolerable, then simply discontinue the medication. No harm done! Well, that would be an exaggeration in my eyes so say that Accutane is dangerous! Just think of it this way: Why would doctors all over the world prescribe isotretinoin Accutane for millions of acne patients each year if it was so dangerous [ ref ]?
Personally, I have prescribed Accutane for several hundreds of my patients during my career as an acne scar specialist. And of course, side effects do occur once in a while. Although not all of these side effects may occur, if they do occur and if they are not to endure during the entire course of therapy, then simply stop taking the medicine!
The most frequently occurring adverse events are listed below:. Frequent side effects:. However, Accutane is not compatible with pregnancy, because Accutane can lead to birth defects, just as alcohol and other forms of medication can. Hence, a woman in the childbearing years should be aware to use an appropriate birth control method for 1 month before therapy begins, during the entire course of therapy, and for 2 full months after therapy stops.
Pregnancy tests should be taken every month during the entire course of treatment. Usually, oral isotretinoin should be taken until it clears acne. This corresponds to a daily dosage of mg during the course of some months. Part 2: Isotretinoin and Timing of Procedural Interventions. You might ask yourself why early procedural intervention, e. The well-known result of moderately to severely inflammatory acne is disfiguring, life-altering scarring, which should be treated as soon as possible.
Hence, patients with acne scarring experience both physical and mental sequelae of acne scarring [ ref ]. There is even evidence that supports a better cosmetic outcome when treating acne scars early on. The fact is that laser intervention at an early state simply provides more controlled scarring as evidenced in a randomized split-wound trial where one-half of surgical scars were treated with a fraction laser and significantly improved both wound healing and cosmetic outcome as shown in the photo below [ ref ].
For years it has inappropriately been taught and practiced that acne scar revision has to be delayed at least months after finishing a course of isotretinoin e. This practice was based on 3 very small case series including only some few patients from the mids in other words, the evidence was very weak.
Therefore, a panel of independent dermatologists and plastic surgeons set up to investigate the evidence gathered since the s. In this way, Accutane can be a very effective treatment to gain control over the troubling appearance of redness or discoloration that so often occurs within acne scars.
Another important consideration is that Accutane is the most effective way to prevent further acne scarring. That is, by preventing more breakouts, Accutane is a very effective treatment which can limit the risk of additional scars forming. This is a vital part of any treatment or discussion regarding acne scar treatment.
Once this is explained and once an acne sufferer understands that the persistent discoloration will disappear completely over time as long as we can prevent new breakouts from forming, expectations are better managed and hopefulness can be achieved once again.
So in this scenario, a patient who is seeking treatment for acne scars may be best helped by explaining the difference between scars and discoloration and by further targeting what is actually the source of their frustration. The Advanced Acne Institute is a unique dermatology practice located in Miami, Florida specializing only in the treatment of acne. We focus solely on providing the most effective treatments to help our patients achieve clear skin.
We are pleased to share our insights and perspectives in acne treatment as an educational service, however this information is provided strictly for educational purposes only and should not be considered medical advice and is not a substitute for seeking the advice and treatment by an appropriate medical professional.
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❾-50%}- Will Accutane Remove Acne Scars? - Advanced Acne Institute
While it does have a marginal edge in the fed state vs generic isotretinoin keep in mind this was tested with the 1, calorie high fat meal, which very few people eat its real advantage is in the fasting state.
Its fasting absorption is 68 percent versus the fed state. This was much better than standard isotretinoin, which only reached Over the course of treatment, poor absorption could lead to lower actual cumulative doses and higher relapse rates. Patients with low fat diets or those who have irregular meal schedules benefit most from isotretinoin-Lidose. Birth defects: This medication can cause birth defects only while you are taking it and a month after, which is explained at the last visit but does not affect long-term fertility.
What this means is that if you become pregnant while taking it there are very strong odds of losing the baby or of serious birth defects. For this reason every female who is biologically capable of becoming pregnant must take monthly pregnancy tests and have a pregnancy prevention plan.
Your colleagues will almost certainly offer positive feedback and praise for this drug. Many have even prescribed it to their own children.
However, when you discuss it with patients, a significant number have a negative opinion. How did this huge disconnect happen? It would take an entire article to detail the history of the bad press isotretinoin has received. This creates significant challenges reconciling our views with what the patient has heard from non-expert sources.
Great care must be taken when discussing isotretinoin as a treatment option, as it has a potential to alienate patients if not done properly. They report feeling overwhelmed and like they had little input and were not given all the treatment options.
Even if the patient is open to taking isotretinoin, it is easy to understand their concern taking a medication that requires monitoring and is teratogenic. The right approach is crucial. If our opinion is that isotretinoin is the only viable option, the conversation is straightforward. A new acne patient questionnaire is a great starting point. Isotretinoin is on that list listed as Accutane so patients recognize it.
Some people circle it and some cross it out this does not necessarily mean they will never consider it, but expect resistance. This level is very difficult to achieve for severe acne patients without isotretinoin and patients need to be educated to that reality.
Many believe that there has to be something else that will get them these results, therefore, a breakdown of available treatments and expected results is often needed.
If not, the patient may believe that you are just pushing one treatment option on them. Accutane is also a good option. The patient may then offer up what they have heard about Accutane, negative or positive. Many will not say anything, which usually indicates they have not heard of it at all and need to know the basics. Even if we convince them that this is the best treatment choice, and they agree, many will not return or will return wanting to try something else.
We cannot and should not hold it against patients or look down on them that they have been exposed to misinformation that they accept it as fact. There are not experts. It is considered safe, very effective, and has never been withdrawn from the market in any country for safety concerns.
Within the dermatology community, it is not considered a controversial medication. Dermatologists are very comfortable with its use, so much so that many prescribe it to their own children or relatives I usually add here that my brother took it on my recommendation. But the most important thing is that you have to be comfortable with it.
If the patient wants to consider it as an option right then and there they will pursue that conversation, if not I pivot to other treatments.
If the patient chooses other treatments, at least you have set the stage for more informative discussion down the road if they are not getting the results they want. We have become very comfortable with using isotretinoin but must remember that for a patient, parent or teen, to consider taking a medication that is teratogenic and needs monitoring may just be too scary to consider, even if it is the only thing that will help.
Often times our failure to navigate it and guide patients through it prevents patients from getting their medication. Prescribers should not delegate iPLEDGE responsibilities to medical assistants without first mastering the system ourselves. For me this required several months of clearing people and making multiple calls to iPLEDGE, but it was a worthwhile investment.
Going through this process, I concluded that it is unrealistic to expect a person with a medical assistant level education to master iPLEDGE on their own. We have to register them and clear them every month but they do absolutely nothing. Whether these patients had blood tests is not a criteria for clearing them. They have a day window to pick up their medication. Registration cannot take place without a pregnancy test and even if the pregnancy test date precedes the registration date, the day window starts on the registration date.
This is why it is important to register patients the day the pregnancy test results come in to avoid delays. Schedule a four and a half to five week follow-up rather than four weeks follow-up for the second visit. Two pregnancy tests must be taken more than 30 days apart.
This means that if you schedule your female patient back for a one month follow up, they return 28 days later 4 weeks with their labs in hand that they took a few days beforehand,this is too early, and they have to re-take the pregnancy test after the 30 days window. A four and a half to five week follow-up is ideal as it gives the patient enough time to get their next pregnancy test and labs. If female patients miss the seven day window to pick up their medication when they are getting their first prescription they have to wait at least 19 days to get another pregnancy test and pick up their prescription look at the patients calendar on iPLEDGE for the first date they can get another pregnancy test again.
For any prescription other than the first, if the seven day window is missed, all the patient has to do is take another pregnancy test, which immediately opens up another seven day window to get their medication. For example, is it the skin imperfection that is bothering them or is it the discoloration?
Furthermore, red or dark discoloration often accompanies the actual physical scars. Therefore it is often necessary to tease apart the feature that is most unsettling for each patient. Is it the scar itself or is it the discoloration within the scar?
So the first objective is to develop a mutual understanding of what is meant by a scar. And then it is vital to understand whether the patient is bothered by the redness or discoloration within the scar or if it is only the skin depression or the hole within the surface of the skin or the unevenness of the skin surface. Only after achieving common ground as to what the real concern is can a treatment plan be effectively formulated and the role of Accutane considered.
To be more clear, if an acne sufferer is concerned mostly about how visible the scar is, this can often be addressed by targeting the discoloration without having to actually treat the actual scar itself. In other words, if we use Accutane treatment to prevent new breakouts from erupting, this will prevent new spots of discoloration and allow the old marks to simply fade away with time.
The effectiveness of waiting for discoloration to fade should not be under-appreciated. In reality, the fading can occur relatively quickly and the patient can be very happy with the results. What is Accutane? How does Accutane work? Are there any side effects? Isotretinoin is sold under the brand name Accutane and Roaccutane among others and is a form of vitamin A. As you might already know, acne is a skin condition that occurs when your oil glands sebaceous glands and hair follicles of the skin become clogged with oil sebum and dead skin cells keratin.
It often causes whiteheads, blackheads, and pimples, and usually appears on the face, forehead, chest, upper back and shoulders. When the oil glands get clogged, inflammation occurs in the skin which appears as a red pimple that hurts when it is touched. Basically, Accutane has an immense effect on the oil glands by reducing the size of the oil glands, cell shedding and the stickiness of cells in the glands.
And the result…? That is a reduction in acne activity with fewer whiteheads, blackheads, and pimples. YES, the best thing about Accutane is that it prevents acne scarring because it is highly effective in clearing up acne. For me, as a laser and acne scar specialist, there is no doubt that isotretinoin e. Acne can cause a lot of mental stress and last for years. In my opinion, as a specialist, prescribing Accutane for my patients is not only a question about the severity of the skin disease but also a question about the mental stress which acne causes to the patient.
In most patients, the side effects are so mild e. If otherwise, the side effects are intolerable, then simply discontinue the medication. No harm done! Well, that would be an exaggeration in my eyes so say that Accutane is dangerous! Just think of it this way: Why would doctors all over the world prescribe isotretinoin Accutane for millions of acne patients each year if it was so dangerous [ ref ]?
Personally, I have prescribed Accutane for several hundreds of my patients during my career as an acne scar specialist. And of course, side effects do occur once in a while. Although not all of these side effects may occur, if they do occur and if they are not to endure during the entire course of therapy, then simply stop taking the medicine! The most frequently occurring adverse events are listed below:. Frequent side effects:.
However, Accutane is not compatible with pregnancy, because Accutane can lead to birth defects, just as alcohol and other forms of medication can. Hence, a woman in the childbearing years should be aware to use an appropriate birth control method for 1 month before therapy begins, during the entire course of therapy, and for 2 full months after therapy stops.
Pregnancy tests should be taken every month during the entire course of treatment. Usually, oral isotretinoin should be taken until it clears acne. This corresponds to a daily dosage of mg during the course of some months.
Part 2: Isotretinoin and Timing of Procedural Interventions. You might ask yourself why early procedural intervention, e. The well-known result of moderately to severely inflammatory acne is disfiguring, life-altering scarring, which should be treated as soon as possible.
As Dr Wu has pointed out, it is generally safe to commence acne scar treatments whilst on Isotretinoin. If your skin is irritated, flaky and sensitive from the Isotretinoin, then it might be best to delay intense ablative treatments till later so as to minimise the side effects associated with such treatments.
Treatment of acne and scars do take time so be patient and discuss your options with your doctor. Thank you for your question. You can actually start acne scar treatment while you are on isotretinoin. There are studies done in recent years that show insufficient evidence to support delaying treatments such as chemical peels, non-ablative lasers or fractional ablative lasers on patients receiving accutane treatment. Microneedling RF and fractional erbium laser will usually have a shorter downtime 3 to 4 days compared to fractional CO2 laser 5 to 7 days.
Bruising from subcision may take a few days to subside. You can conceal the bruises with makeup in the mean time. Speak to a doctor to get a proper assessment first before deciding on your treatment. Hope this helps!
The question on if you are suitable to start on any treatment for your acne scar would depend on several factors. First of all, is your skin getting more sensitive? If you find that your skin get red easily and is more fragile to scratch, it will be important to be more careful as the healing of your skin might be affected.
Second, how is the condition of your acne now? Is it well controlled or are you still getting new acne? Some treatment for acne scar might aggravate the condition of your acne, while others might actually benefit you. Third, how severe is your acne scar? Different acne scar would require different strategy.
While you might been able to tolerate certain treatment while on isotretinoin, it might or might not be the correct treatment. It is therefore more important to have an open discussion with your doctor to understand your condition and concern. Discuss on the risks and benefits of the proposed treatment before embarking on the therapy for a safer journey.
It might even be a combination therapy. Remember to be patient. Treatment for acne and acne scar takes time and multiple sessions. Be moderated on your expectation as well. More and more treatments are available. Take your time to understand them. Sorry to see that you are still suffering from acne and acne scarring. I believe you need to restart the isotretinoin and we need to review the dosage and duration.
From your photos, you continue to have a lot of underlying comedones blackheads and these need to be addressed. With the right combination of treatment, I believe you can control your acne successfully. Once the active acne is controlled, you can then focus on the acne scarring which can be improved with a combination of subcision, punch excision and fractional CO2 laser to treat the different types of scars. Doctor's Answers 3. Dr Rui Ming Ho Aesthetic. Get Quote.
Personally, 2 main factors will determine the treatment plan: 1 Condition of your skin If your skin is irritated, flaky and sensitive from the Isotretinoin, then it might be best to delay intense ablative treatments till later so as to minimise the side effects associated with such treatments.
Hope this helps. All the best! Dr Jiwei Wu Aesthetic. Hello Dabbie Thank you for your question. Regards Dr Jiwei Wu. Dr Elias Tam Aesthetic. Understand that you have already been on isotretinoin for 2 months for your acne problem. Regards, Dr Elias Tam. Similar Questions. View More. How should I prevent Post-Accutane relapse, and advise on long term maintenance isotretinoin dose?
Read full answer. Answered By Human. What is the best treatment for acne scars if I still have acne outbreaks? Ask a Question. Get The Pill.
Accutane has not been reported to cause scarring, but you may just be noticing your acne scars more now that there are no inflammatory or cystic lesions to mask. localhost › pages › acne-scarring-post-. Many people who have taken the drug Accutane (aka Roaccutane) as an acne treatment are left with this pink, red and purple scarring. We strongly suggest. As Dr Wu has pointed out, it is generally safe to commence acne scar treatments whilst on Isotretinoin. Personally, 2 main factors will determine the. Accutane is an important medication in dermatology and an essential medication in acne treatment and acne scar prevention. Accutane® has been considered the. Therefore it is often necessary to tease apart the feature that is most unsettling for each patient.Isotretinoin, the drug that revolutionized acne treatment, is the only medication that can clear acne and produce long-term remissions. Since its introduction in , it continues to be a vital and widely used acne medication worldwide. It is used mainly for severe, recalcitrant nodulocystic acne as well as recalcitrant moderate acne. Abroad, isotretinoin tends to be dispensed more liberally than in the US and with a trend toward lower doses. This article will not cover the well known pharmacology, dosing, and side effects of this medication.
The goal is to have the patient very well educated and for the provider to have all the tools and knowledge to guide the patient through a successful treatment. Educating patients about isotretinoin and how it differs from other treatments is no easy task. Isotretinoin is a unique drug and is completely different than any other acne medication.
Below are the topics that are essential to cover during the patient visit and information on how I explain them to patients. Much of this information is included in the Isotretinoin Fact Sheet to be discussed later that I routinely hand out. Q: What is isotretinoin? Isotretinoin is a pill you take for four to five months. Your acne will start to improve in one to two months, and the vast majority of people are clear at the end of treatment. It is the only acne medication that permanently reduces acne an average of 80 percent—some people a little more and some a little less.
It also makes our skin less oily long-term. Twenty percent of patients take the medication a second time if they still have significant acne. Some blood tests are required. After hearing so much about how effective isotretinoin is, patients expect dramatic results the first month and need to have their expectations managed. Temporary improvement vs. Isotretinoin is the only medication to produce a substantial permanent reduction in acne after you stop taking it. Isotretinoin is the only medication where these expectations can largely be met.
For some people, it is quite a shock that at age 14 for example, without isotretinoin and sometimes with it if they do not get full clearance they will be treating their acne at least another five years.
This stark contrast between isotretinoin and non-isotretinoin treatment should be made crystal clear. How does it work? Isotretinoin works by shrinking your oil glands and normalizing the way your skin grows, which prevents pimples and clogged pores. Because your lips have a lot of oil glands they will become dry first, followed by your face and possibly other areas. Using lip balm frequently and moisturizing creams can manage these symptoms quite well. You will also sunburn faster.
We expect the medication to do this—this is how it works. Isotretinoin does not make scars or PIH post inflammatory hyperpigmentation , or post inflammatory erythema disappear. Some of the red marks and brown spots will clear up as your acne clears. The scars will not be affected by isotretinoin.
A few months after you finish treatment, we can see what red marks and brown marks remain, assess your scarring, and review your treatment options for clearing those up. Some treatments, like hydroquinone blend bleaching creams, can be initiated immediately after isotretinoin is finished or even during treatment if the skin can tolerate it. For some treatments lasers, chemical peels, etc.
Initial flare is not therapeutic! I f your acne gets worse in the first month or two, let us know so we can treat it! Initial flare is a common but preventable side effect. The more severe, inflammatory, widespread and cystic the acne is, the more common initial flare is.
Strategies to prevent initial flare include lower initial dose and concurrent use of prednisone the first month. Acne can also get worse the first month simply because all other acne medications have been discontinued and isotretinoin may take a month or two to begin working, causing a treatment gap.
Keep in mind that non-drying topical medications can be continued as can spironolactone for female patients and any antibiotic except tetracyclines due to the increased risk of Pseudotumor Cerebri. Take with food: Isotretinoin absorbs twice as well if you take it with meals. Isotretinoin is a lipophilic medication. One study showed 1. For the first few monthly follow-ups, I reinforce this important message of taking the medication with food.
The easiest way to asses if the patient is a candidate for bid dosing is to ask if they have breakfast most days. If they do, ask what they eat. If it is a light meal or they do not regularly eat breakfast, stick with QD dosing. Although the pharmacokinetics do favor twice daily dosing, if that causes more medication to be taken in the fasting state with poor absorption, it is counterproductive.
In isotretinoin-Lidose Absorica came on the market promising higher absorption both in the fed and fasting states. While it does have a marginal edge in the fed state vs generic isotretinoin keep in mind this was tested with the 1, calorie high fat meal, which very few people eat its real advantage is in the fasting state.
Its fasting absorption is 68 percent versus the fed state. This was much better than standard isotretinoin, which only reached Over the course of treatment, poor absorption could lead to lower actual cumulative doses and higher relapse rates.
Patients with low fat diets or those who have irregular meal schedules benefit most from isotretinoin-Lidose. Birth defects: This medication can cause birth defects only while you are taking it and a month after, which is explained at the last visit but does not affect long-term fertility. What this means is that if you become pregnant while taking it there are very strong odds of losing the baby or of serious birth defects.
For this reason every female who is biologically capable of becoming pregnant must take monthly pregnancy tests and have a pregnancy prevention plan. Your colleagues will almost certainly offer positive feedback and praise for this drug. Many have even prescribed it to their own children. However, when you discuss it with patients, a significant number have a negative opinion. How did this huge disconnect happen? It would take an entire article to detail the history of the bad press isotretinoin has received.
This creates significant challenges reconciling our views with what the patient has heard from non-expert sources. Great care must be taken when discussing isotretinoin as a treatment option, as it has a potential to alienate patients if not done properly. They report feeling overwhelmed and like they had little input and were not given all the treatment options. Even if the patient is open to taking isotretinoin, it is easy to understand their concern taking a medication that requires monitoring and is teratogenic.
The right approach is crucial. If our opinion is that isotretinoin is the only viable option, the conversation is straightforward. A new acne patient questionnaire is a great starting point.
Isotretinoin is on that list listed as Accutane so patients recognize it. Some people circle it and some cross it out this does not necessarily mean they will never consider it, but expect resistance.
This level is very difficult to achieve for severe acne patients without isotretinoin and patients need to be educated to that reality. Many believe that there has to be something else that will get them these results, therefore, a breakdown of available treatments and expected results is often needed.
If not, the patient may believe that you are just pushing one treatment option on them. Accutane is also a good option. The patient may then offer up what they have heard about Accutane, negative or positive.
Many will not say anything, which usually indicates they have not heard of it at all and need to know the basics. Even if we convince them that this is the best treatment choice, and they agree, many will not return or will return wanting to try something else.
We cannot and should not hold it against patients or look down on them that they have been exposed to misinformation that they accept it as fact. There are not experts. It is considered safe, very effective, and has never been withdrawn from the market in any country for safety concerns. Within the dermatology community, it is not considered a controversial medication.
Dermatologists are very comfortable with its use, so much so that many prescribe it to their own children or relatives I usually add here that my brother took it on my recommendation. But the most important thing is that you have to be comfortable with it. If the patient wants to consider it as an option right then and there they will pursue that conversation, if not I pivot to other treatments.
If the patient chooses other treatments, at least you have set the stage for more informative discussion down the road if they are not getting the results they want. We have become very comfortable with using isotretinoin but must remember that for a patient, parent or teen, to consider taking a medication that is teratogenic and needs monitoring may just be too scary to consider, even if it is the only thing that will help.
Often times our failure to navigate it and guide patients through it prevents patients from getting their medication. Prescribers should not delegate iPLEDGE responsibilities to medical assistants without first mastering the system ourselves.
For me this required several months of clearing people and making multiple calls to iPLEDGE, but it was a worthwhile investment. Going through this process, I concluded that it is unrealistic to expect a person with a medical assistant level education to master iPLEDGE on their own. We have to register them and clear them every month but they do absolutely nothing. Whether these patients had blood tests is not a criteria for clearing them.
They have a day window to pick up their medication. Registration cannot take place without a pregnancy test and even if the pregnancy test date precedes the registration date, the day window starts on the registration date. This is why it is important to register patients the day the pregnancy test results come in to avoid delays. Schedule a four and a half to five week follow-up rather than four weeks follow-up for the second visit.
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