Medications

Isotretinoin | Preparatory Steps for Using Acrylif

Isotretinoin is an oral retinoid used for acne treatment.

It is prescribed for patients with dermatitis accompanied by acne, not only for acne treatment but also to enable the use of rich moisturizers.

Table of Contents

1. What is Isotretinoin?

The active ingredient in Isotretinoin is Isotretinoin, a retinoid which is a derivative of vitamin A.

Retinoids are medications that inhibit excessive keratin and sebum from blocking pores.

A real product photo showing the front and back of a 10mg Isotretinoin soft capsule (engraved IS10), a professional medical product in the form of an apricot-colored oval gel cap.

2. Why Isotretinoin is Used for Dermatitis Patients

The core issue in atopic dermatitis, rosacea, and seborrheic dermatitis is skin barrier damage. As a weakened barrier makes the skin vulnerable to external stimuli, protecting the skin with rich moisturizers is fundamental to treatment.

However, rich moisturizers can clog pores and worsen acne, which this medication can help resolve.

3. How acne develops

Acne occurs when keratin and sebum block pores, and Isotretinoin inhibits the excessive production of keratin and sebum (for more details, refer to the Acne page).

Therefore, even while using rich moisturizers, it can help reduce acne worsening due to clogged pores. Whether it is needed is determined by assessing the degree of pore blockage with a Wood’s lamp exam.

Clinical photo showing pink punctate sebum fluorescence reactions on the cheeks and around the nose during a Wood's lamp examination — used to determine whether to use Isotretinoin.

4. Initial Discomfort

Retinoids extend the lifespan of keratinocytes. As cells live longer, the number of dead cells forming the stratum corneum decreases, and the adhesion between dead cells also weakens.1 As a result, the skin barrier may weaken in the initial stages of use.

Illustration comparing normal skin and the epidermis after retinoid application — showing the process where the stratum corneum thins and the skin barrier temporarily weakens in the initial stages due to accelerated keratinocyte turnover.

Additionally, it suppresses sebum secretion. Since it is an oral medication, this effect can appear not only on the skin but also throughout the body, including the lips and eyes. Therefore, it should be used for as short a period as possible, and transitioning to topical retinoids can minimize discomfort. Topical retinoids, especially fourth-generation retinoids, have almost no systemic side effects.

5. Reasons for Using Before Topical Retinoids

If pores are blocked, topical retinoids cannot effectively reach the target area (inside the pores), whereas oral retinoids can reach inside the pores via the bloodstream.

Therefore, in many cases, it is more effective to open the pores with an oral retinoid like Isotretinoin before starting topical retinoids.

However, since it can weaken the skin barrier in the initial stages of use, sufficient barrier recovery must precede its initiation. The state of the barrier is evaluated by a TEWL test.

Information on topical retinoids can be found on the Acrylif page.

6. Dosage and Duration of Use

Previously, a high-dose approach was common, where a total cumulative dose proportional to body weight was required to reduce recurrence.2 However, since Isotretinoin also weakens the barrier, excessive doses in patients with a history of dermatitis can exacerbate barrier damage.

Therefore, for dermatitis patients, we improve pore occlusion with 1-2 pills per day before transitioning to topical retinoids.3,4

7. Side Effects and Pre-prescription Tests

The most common discomforts experienced during Isotretinoin use are dry lips, dry skin, and dry eyes. Nosebleeds, muscle pain, and joint pain can also occur. Most can be managed with moisturizing and dose adjustment, but if symptoms are too severe, discontinuation should be considered.

In some cases, acne may temporarily worsen at the beginning of treatment. This is more likely to occur with a high starting dose.5

Before prescription, liver function tests and lipid tests are checked. For liver function, AST and ALT are examined, and for lipid tests, triglycerides and total cholesterol are observed. For women of childbearing age, a pregnancy test is also conducted.6

The cost of the tests is 50,000 won including the pregnancy test, and 40,000 won excluding it.

If liver enzyme or lipid levels are high in the tests, depending on the levels, regular monitoring while taking Isotretinoin or considering other treatment methods may be necessary. Particularly, if triglyceride levels are significantly high or uncontrolled, discontinuation of the medication is required due to the risk of pancreatitis.

8. Conclusion

For dermatitis patients, rich moisturizers greatly help protect the barrier, but they can also clog pores and cause acne. Opening the pores with Isotretinoin and then transitioning to topical retinoids to prevent pore occlusion can be a solution to this dilemma.

References

  1. Yoon J, Bhatt LR, Yoo HJ, et al. Retinoid Induces the Degradation of Corneodesmosomes and Inhibits Corneocyte Cohesion in the Stratum Corneum. J Dermatol Sci. 2011;65(3):233-5.
  2. Layton AM. The use of isotretinoin in acne. Dermatoendocrinol. 2009;1(3):162-9.
  3. Sadeghzadeh-Bazargan A, Ghassemi M, Goodarzi A, et al. Systematic review and meta-analysis comparing low-dose and conventional-dose isotretinoin in acne treatment. J Dermatolog Treat. 2022;33(1):130-141.
  4. Sardana K, Garg VK. Efficacy of low-dose isotretinoin in acne vulgaris. Indian J Dermatol Venereol Leprol. 2010;76(1):7-13.
  5. Demircay Z, Kus S, Sur H. Predictive factors for acne flare during isotretinoin treatment. Eur J Dermatol. 2008;18(4):452-6.
  6. Pharmaceutical Information Service. Isotretinoin Soft Capsule 10mg Product Approval Information.

Frequently Asked Questions

My skin is sensitive; can I still take Isotretinoin?

Isotretinoin acts through the bloodstream, so there is no direct topical irritation to the skin. However, as a retinoid, it can thin the stratum corneum and weaken the skin barrier. Strict moisturizing must be maintained during treatment. If the skin barrier is severely weakened, the drying side effects may be burdensome, so it may be introduced after barrier recovery.

My lips are very dry and cracked.

This is a reaction that occurs in almost all patients. Apply lip balm frequently, and moisturize your face and body more than usual. If dryness is too severe, a consultation is needed to check if dose adjustment is required.

My acne worsened after taking the medication.

Acne may temporarily worsen during the first few weeks of treatment. This could be a process where already blocked pores and comedones emerge as inflammatory lesions. However, if severe pain, bleeding lesions, ulcers, fever, or joint pain accompany it, medical attention is required.

Do I really need a blood test?

Liver function tests and lipid tests are checked before prescription. For women of childbearing age, a pregnancy test is also conducted. The cost of tests at our clinic is 50,000 won including the pregnancy test, and 40,000 won excluding it. If liver enzyme or lipid levels are high in the tests, medication may be postponed or the dose adjusted.

I’m planning a pregnancy; when should I stop taking the medication?

Isotretinoin carries a risk of birth defects. You should stop taking the medication at least 1 month, and preferably 2 months, before planning to conceive.

Can I get laser treatments or peels while taking the medication?

Since the skin barrier is thinned during treatment, it is best to avoid strong peels or scrubs. Laser procedures should be decided after consulting with a doctor during your appointment.