Meds and you

27 September 2013

Isotretinoin (topical)

Isotretinoin is a retinoid. Retinoids are drugs that are derived from vitamin A. On the skin it acts to cause a reduction of natural skin oil.


Isotretinoin is the active ingredient of Isotrex gel (Nappi code: 821853-007).

General information
Isotretinoin is a retinoid. Retinoids are drugs that are derived from vitamin A. On the skin it acts to cause a reduction of natural skin oil, thereby assisting in the treatment of acne.

In South Africa isotretinoin is registered for the treatment of mild to moderate inflammatory and non-inflammatory acne.

In some patients acne may worsen during the first few weeks of treatment with this medication. This, together with symptoms such as very dry, flaky and itchy skin, usually improves as treatment continues.

Isotretinoin may also leave your skin more susceptible to sunlight and sunburn. It is advised to keep sun exposure to the minimum and wear sunscreen and protective clothing whenever exposed to the sun while using this medication. If sunburn occurs, discontinue use until the skin is fully recovered.

Avoid contact with the mucous membranes, eyes, mouth, angles of the nose and areas with eczema, as isotretinoin’s excessive drying effects may cause irritation.

Severe caution is advised to prevent falling pregnant while taking this medication as this group of drugs can cause abnormalities in the foetus. Isotretinoin should not be used in women of childbearing age, unless they are using effective contraception as precaution.

For this medication to be effective, it has to be applied regularly, even if you do not notice an immediate effect. Excessive application will not produce better or more rapid results. Optimal results may only be acquired after 6 or more weeks of use.

Tell your doctor about all other medicines you are taking, including prescription and non-prescription medicines, vitamins and herbal supplements.

How does isotretinoin work?
Isotretinoin reduces the production of sebum, the oily substance produced by sebaceous glands in the skin. This causes drying and peeling of the skin, making it useful in treating acne. It is also believed to have a mild anti-inflammatory and antibacterial activity. It may furthermore unblock and reduce the formation of blackheads.

Fast facts

Drug schedule: schedule 5
Available as: isotretinoin is available as a gel.
What does it do? Isotretinoin is used to treat acne.
Overdose risk: low
Dependence risk: low
Is isotretinoin available as a generic? no
Is isotretinoin available on prescription only? yes

User information

Onset of effect: the full effect of this drug may only be seen after 4 - 6 weeks.
Duration of action: after the drug is stopped, effects on the skin may still be visible for a couple of weeks after stopping treatment.
Stopping this medicine: this drug can be safely stopped when it is no longer needed. Premature stoppage may cause a return of initial symptoms. The best results are obtained when the full course is completed.

Special precautions
Consult your doctor before using this drug if:

  • you have eczema
  • you have been diagnosed with a condition called cutaneous epithelioma
  • you are pregnant or intend to fall pregnant
  • you, or someone in your family, has skin cancer
  • you are taking other medication


  • do not use isotretinoin concurrent with other topical agents for the treatment of acne without consulting your doctor or pharmacist
  • caution is advised when using medicated or abrasive cleaners, soaps, degreasing agents, cosmetics that have a strong drying effect and products that contain high concentrations of alcohol
  • do not apply to sunburnt skin, and minimise unprotected sun exposure
  • do not apply to cuts, burns, abrasions and eczema

Pregnancy: avoid. Potential risk to the foetus has been reported. Consult your doctor before use, or if you are planning to fall pregnant.
Breastfeeding: avoid. This medication is passed through breast milk and may affect your baby adversely. Consult your doctor before use.
Porphyria: avoid. This medication may cause serious adverse effects. Consult your doctor before use.
Infants and children: this medication is not intended for use in children.
The elderly: no special precautions need to be taken.
Driving and hazardous work: no special precautions need to be taken.
Alcohol: no special precautions need to be taken.

Possible side effects

Side Effect
Consult your doctor

Only if severe
In all cases








sun sensitivity


peeling of skin



Drug interactions

irritating cosmetics – toners, peeling agents, perm solutions increased potential of skin irritation
medicated cosmetics increased potential of skin irritation
soaps, abrasives and cleansers increased potential of skin irritation. Use mild soaps only
topical preparations with a high content of alcohol, menthol, spices, lime etc. (perfumes, shaving lotions) increased potential of skin irritation
topical keratolytics – sulphur, resorcinol, benzoyl peroxide, salicylic acid increased potential of skin irritation

Disease interactions
Consult your doctor before using this drug if you have eczema or a family history of skin cancer.

Overdose action
A small overdose is no cause for concern. In case of intentional large overdose, seek emergency medical attention.

Recommended dosage
Adults, topical: apply sparingly to the affected area 2 - 3 times daily.

This material is not intended to substitute medical advice, but is for informational purposes only. Please consult a physician for specific treatment and recommendations.


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