Benzoyl peroxide and Isotretinoin

Benzoyl peroxide is found in many over-the-counter acne products that are applied to the skin, such as Benoxyl, Neutrogena Acne, PanOxyl, and some formulations of Clean & Clear, Clearasil, and Oxy. Some benzoyl peroxide products are available without a physician’s prescription; others require a prescription. Acne treatments that can dry the skin should be used with caution by people with skin of color.
Tretinoin (Retin-A) is available only with a physician’s prescription. It comes in liquid, cream, and gel forms, which are applied to the skin. Isotretinoin (Accutane), which is taken by mouth in capsule form, is available only with a physician’s prescription. Only physicians experienced in diagnosing and treating severe acne, such as dermatologists, should prescribe isotretinoin.
Recommended Dosages

The recommended dosage depends on the type of antiacne drug. These drugs usually come with written directions for patients and should be used only as directed by the prescribing physician. Teens who have questions about how to use the medicine should check with their physician or pharmacist.

Patients who use isotretinoin usually take the medicine for a few months, then stop for at least two months. Their acne may continue to improve even after they stop taking the medicine. If the condition is still severe after several months of treatment and a two-month break, the physician may prescribe a second course of treatment.
Precautions

Isotretinoin

Isotretinoin can cause serious birth defects, including mental retardation and physical deformities. This medicine should not be used during pregnancy. Females who are able to bear children should not use isotretinoin unless they have very severe acne that has not cleared up with the use of other antiacne drugs. In that case, a woman who uses this drug must have a pregnancy test two weeks before beginning treatment and each month she is taking the drug. Another pregnancy test must be done one month after treatment ends. The woman must use an effective birth control method for one month before treatment begins and must continue using it throughout treatment and for one month after treatment ends.

Females who are able to bear children and who want to use this medicine should discuss this information with their healthcare providers. Before using the medicine, they will be asked to sign a consent form stating that they understand the danger of taking isotretinoin during pregnancy and that they agree to use effective birth control.
People using this drug should not donate blood to a blood bank while taking isotretinoin or for 30 days after treatment with the drug ends. This will help reduce the chance of a pregnant woman receiving blood containing isotretinoin, which could cause birth defects.
Isotretinoin may cause a sudden decrease in night vision. If this happens, users should not drive or do anything else that could be dangerous until vision returns to normal. They should also let the physician know about the problem.

This medicine may also make the eyes, nose, and mouth dry. Ask the physician about using special eye drops to relieve eye dryness. To temporarily relieve the dry mouth, chew sugarless gum, suck on sugarless candy or ice chips, or use saliva substitutes, which come in liquid and tablet forms and are available without a prescription. If the problem continues for more than two weeks, check with a physician or dentist. Mouth dryness that continues over a long time may contribute to tooth decay and other dental problems.
Isotretinoin may increase sensitivity to sunlight. Patients being treated with this medicine should avoid exposure to the sun and should not use tanning beds, tanning booths, or sunlamps until they know how the drug affects them.

In the early stages of treatment with isotretinoin, some people’s acne seems to get worse before it starts getting better. If the condition becomes much worse or if the skin is very irritated, they should check with the physician who prescribed the medicine.

Side Effects and Conditions Caused By Isotretinoin

Minor discomforts such as dry mouth or nose, dry eyes, dry skin, or itching usually go away as the body adjusts to the drug and do not require medical attention unless they continue or are bothersome.

Other side effects should be brought to a physician’s attention. These include:
•    burning, redness, or itching of the eyes
•    nosebleeds
•    signs of inflammation of the lips, such as peeling, burning, redness or pain

Bowel inflammation is not a common side effect, but it may occur. If any of the following signs of bowel inflammation occur, stop taking isotretinoin immediately and check with a physician:
•    pain in the abdomen
•    bleeding from the rectum
•    severe diarrhea

Conditions Caused By Benzoyl Peroxide and Tretinoin

The most common side effects of antiacne drugs applied to the skin are slight redness, dryness, peeling, and stinging, and a warm feeling to the skin. These problems usually go away as the body adjusts to the drug and do not require medical treatment.
Other side effects should be brought to a physician’s attention. Check with a physician as soon as possible if any of the following side effects occur:

•    blistering, crusting, or swelling of the skin
•    severe burning or redness of the skin>
•    darkening or lightening of the skin (This effect will eventually go away after treatment with an antiacne drug ends.)
•    skin rash

Other side effects are possible with any type of antiacne drug. Anyone who has unusual symptoms while using antiacne drugs should get in touch with his or her physician.
Interactions

Patients using antiacne drugs on their skin should tell their physicians if they are using any other prescription or nonprescription (over-the-counter) medicine that they apply to the skin in the same area as the antiacne drug.

Isotretinoin may interact with other medicines. When this happens, the effects of one or both drugs may change or the risk of side effects may be greater. Anyone who takes isotretinoin should let the physician know about all other medicines being used and should ask whether the possible interactions can interfere with drug therapy.

Among the drugs that may interact with isotretinoin are listed below:
•    Etretinate (Tegison), used to treat severe psoriasis. Using this medicine with isotretinoin increases side effects.
•    Tretinoin (Retin-A, Renova). Using this medicine with isotretinoin increases side effects.
•    Vitamin A or any medicine containing vitamin A. Using any vitamin A preparations with isotretinoin increases side effects. Do not take vitamin supplements containing vitamin A while taking isotretinoin.
•    Tetracyclines (used to treat infections). Using these medicines with isotretinoin increases the chance of swelling of the brain. Make sure the physician knows if tetracycline is being used to treat acne or another infection.

Parental Concerns

Acne comes at a difficult time, the adolescent years. While mild acne can be treated with over-the-counter medications, more severe acne needs medical attention. Experts advise against a wait-and-see attitude. Treatment options can help control acne and avoid scarring.

Isotretinoin can cause serious birth defects, including mental retardation and physical deformities. This medicine should not be used during pregnancy. Sexually active adolescent females who are able to bear children should not use isotretinoin unless they have very severe acne that has not cleared up with the use of other antiacne drugs. In addition, acne treatments that can dry the skin should be used with caution by people with skin of color.