Mucocutaneous side effects are the most common seen in
accutane treatment. More than 90% of people treated
experience cheilitis, usually within the first two weeks of
treatment. This is most easily treated with bland emolliation. A
generalized xerosis is very common, but frequently acne patients
view this as a beneficial rather than adverse effect. Should
xerosis become problematic, the use of a noncomedogenic emollient
lotion can be employed. Frequently patients develop nose bleeds
and non-infectious conjunctivitis. Symptomatic treatment of these
problems is all that is indicated. Less than 30% of patients
notice temporary thinning of the hair. Less than 10% of these
have clinically apparent hair loss, and hair density returns to
normal after treatment is discontinued.
Approximately 20% of patients on accutane have musculo-
skeletal pains. These tend to be minor, and are relieved by non-
steroidal anti-inflammatory agents. More worrisome are the
skeletal abnormalities seen in patients on long term accutane
treatment for various keratinizing disorders (7). These patients
however , were usually treated with higher doses of 2mg/kg/day
for more than two years. The ossification disorder seen in these
patients resembles diffuse idiopathic skeletal hypostosis.
Children being treated for these disoreders had x-ray findings
suggesting premature closure of the epiphyses of the knees.
More recently, in a small prospective study of patients on
doses of 2 mg/kg/day of accutane for the treatment of
keratinizing disorders, radiologically documented skeletal
changes were noted after only 6-12 months of therapy. These
changes consisted of slightly increased bone formation in areas
of ligament attachment. It is not yet known whether this is
reversible.
A small number of patients may have a temporary flare of acne
at the onset of treatment. Some clinincians feel that this can be
minimized by the administration of low dose prednisone or oral
antibiotics.
Pseudotumor cerebri ( benign intracranial hypertension) has
occurred in patients treated with accutane. Patients with
headache, nausea, vomitting or visual disturbances should be
screened for papilledema. The drug should be stopped immediately
if papilledema is present.
Patients with visual disturbances should also be checked for
corneal opacities. Corneal opacities occur more frequently in
those patients receiving higher doses of accutane for
keratinizing disorders but has also been reported in patients
treated for cystic acne. The opacities resolve six to seven weeks
after discontinuation of the drug.
There have been rare reports of inflammatory bowel disease in
patients treated with accutane. Occasional patients report
fatigue or lassitude.
Wash the skin
Avoid oily substances
Shampoo the hair daily
Don`t "pop" pimples
Exercise regularly
Don't stop the acne medicine
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