Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
BRAND NAME: Sotret, Claravis, Amnesteem (Note: Accutane is no longer
available)
DRUG CLASS AND MECHANISM: Isotretinoin is an oral drug used for the
treatment and prevention of severe acne. Acne is caused by inflammation of the
skin. It primarily affects teenagers, but it also affects adults. Severe acne
causes permanent scarring of the skin. The inflammation is caused in part by an
increased secretion of sebum (oily substance) from glands in the skin (sebaceous
glands). The sebum provokes inflammation, and the inflammation resolves (heals)
with the formation of a scar (keratinization). The exact mechanism of action of
isotretinoin is not known; however, it may reduce acne by reducing the secretion
of sebum. If less sebum is secreted it is likely that there will be less
inflammation and keratinization. The Food and Drug Administration approved
isotretinoin in May 1982.
PRESCRIPTION: yes
GENERIC AVAILABLE: yes
PREPARATIONS: capsules: 10, 20, 30 & 40 mg
STORAGE: Store at room temperature 15-30 C (59-86 F) and protect from
light
PRESCRIBED FOR: Isotretinoin is used to treat severe acne that is resistant
to more conservative treatments such as creams, drying agents, and topical or
oral antibiotics. Complete remission or prolonged improvement is seen in many
patients after one course of 15 to 20 weeks of isotretinoin. Because of its
serious side effects, isotretinoin should be used only for severe resistant
acne.
Because isotretinoin causes birth defects, isotretinoin is sold only under a
special program approved by the Food and Drug Administration called
iPLEDGE.
Isotretinoin can only be prescribed by healthcare providers and dispensed by
pharmacies registered in iPLEDGE.
DOSING: The recommended dose of isotretinoin is 0.5 to 2 mg per kg of body
weight daily. The daily dose usually is administered in two divided doses for
15-20 weeks. Isotretinoin should be taken with food in order to improve its
absorption.
DRUG INTERACTIONS: Isotretinoin is closely related to
vitamin A. Therefore,
the use of both vitamin A and isotretinoin at the same time may lead to vitamin
A side effects.
Treatment with tetracycline
(Achromycin) and isotretinoin should not be given at the same
time since the combination has been associated with brain swelling. (See side
effects below.)
PREGNANCY: Isotretinoin is harmful to the fetus and therefore should not be
used during pregnancy. Women of childbearing age must have two negative
pregnancy test results before therapy is started, and a pregnancy test must be
conducted during each month of therapy. Two effective forms of birth control
must be used during therapy, and pregnancy should be avoided one month before,
during, and at least one month after stopping isotretinoin.
NURSING MOTHERS: It is not known whether isotretinoin is secreted in
breast
milk, but because of its potentially serious side effects, it should not be used
by nursing mothers.
SIDE EFFECTS: The most common side effects of isotretinoin are dry skin,
itching, dry nose,
nosebleeds (epistaxis), cracks in the corners of the mouth
(chilitis), dry mouth, and inflammation of the whites of the eyes. Joint aches
also are common. Patients may develop an increase in blood cholesterol and
triglycerides. Psychiatric problems such as depression, hallucinations and
suicidal behavior have been reported. Rare side effects include skin infections,
peeling, sun sensitivity, hearing impairment and hepatitis. Rarely, isotretinoin
can cause brain swelling (pseudotumor cerebri or intracranial hypertension),
which produces nausea,
vomiting, headache, and changes in vision.
Erythema multiforme and severe skin reactions (for example, Stevens-Johnson syndrome, toxic epidermal necrolysis) have been associated with isotretinoin use. These events may be serious and result in life-threatening events or death, hospitalization, or disability. Patients should be monitored closely for severe skin reactions, and
isotretinoin discontinued if necessary.
A boil is a skin abscess, a collection of
pus localized deep in the skin. There are several different types of boils. Among them are the following: furuncle or
carbuncle, Cystic acne, Hidradenitis suppurativa, and Pilonidal cyst.
Acne is a localized skin inflammation as a result of overactivity of oil glands at the
base of hair follicles. This inflammation, depending on its location, can take the form
of a superficial pustule (contains pus), a pimple, a deeper cyst, congested pores, whiteheads, or blackheads. Treatments vary depending on the severity of the acne.
Rosacea is a skin disease that causes redness of the forehead, chin, and lower half of the nose. In addition to inflammation of the facial skin, symptoms include dilation of the blood vessels and pimples (acne rosacea) in the middle third of the face. Oral and topical antibiotics are treatments for rosacea. If left untreated, rhinophyma (a disfiguring nose condition) may result.
Folliculitis is a skin condition that causes small red bumps to form around the hair follicles. Skin bacteria such as Staphylococcus and Pseudomonas my infect the follicles. Treatment involves over-the-counter bacterial washes, topical antibiotics, and/or topical steroids.
Keratosis pilaris (KP) is a common skin disorder in which small white or red bumps appear around hair follicles on the upper arms, thighs, buttocks, and cheeks. The cause of KP is unknown. There is no cure for keratosis pilaris, and the condition may resolve on its own. Gentle exfoliation, professional manual extraction, chemical peels, and microdermabrasion, along with topical products, are the best treatments for this condition.
Head and neck cancer is cancer of the oral cavity, salivary glands, paranasal sinuses and nasal cavity, pharynx, larynx, or lymph nodes in the upper part of the neck. These cancers account for 3% to 5% of cancers in the U.S. Tobacco and alcohol use are important risk factors. Treatment may involve surgery, radiation therapy, and/or chemotherapy.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Cleft palate and cleft lip are facial and oral defects that occur early in pregnancy. A cleft lip is a split of the two sides of the upper lip, and a cleft palate is a split in the roof of the mouth. Cleft lip the fourth most common birth defect in the U.S. Repair of a cleft palate or cleft lip may require multiple surgeries.
Sun sensitivity (photosensitivity) is an inflammation of the skin induced by the combination of medications or substances and sunlight. The affect on the skin is redness, which looks similar to a sunburn. Generally, these reactions are either phototoxic or photoallergic. Phototoxic drugs are more common than photoallergic drugs. Symptoms of phototoxic reactions are a burning and stinging sensation and then redness. Symptoms of photoallergic reactions are itching, redness, swelling, blisters of the affected area. Treatment generally is discontinuation of the medication and topical application of creams.
Taking prescription medications or over-the-counter drugs or supplements should be discussed with your doctor. There are some medications that have been found to cause no problems in pregnancy, however, medications such as Accutane for acne, should never be taken during pregnancy.
Teenagers recognize that they are developmentally between child and adult. Teen health prevention includes maintaining a healthy diet, exercising regularly, preventing injuries and screening annually for potential health conditions that could adversely affect teenage health.
What is folliculitis? What are folliculitis symptoms? What does folliculitis look like?
Folliculitis is a common skin condition that appears as numerous small red or
pink little bumps at hair follicles. It can cause a "chicken
skin" appearance on the skin. Folliculitis can affect any part of the skin,
including the chest, back, arms, legs, buttocks, and cheeks. Often, 10-100 very small, slightly smooth
bumps are scattered in a body area like the back. Some of the bumps may be
slightly red or have an accompanying light-red halo indicating inflammation. Sometimes, scratching off the top reveals a small trapped or coiled hair within. Acne whiteheads, called milia, may also be in the same areas as
folliculitis. Although folliculitis is
primarily a skin condition of teenagers and younger adults, it is also
seen in all ages.
In general, folliculitis is often cosmetically displeasing and otherwise
medically harmless. Many cases of folliculitis may resolv...
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