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用異維 A 酸前,你要知的八件事 8 Things You Need To Know Before Starting Roaccutane

2015/11/28 — 10:34

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靚女博客 Claire 受暗瘡問題困擾,試過多種方法亦未能痊癒,最終向皮膚科醫生求診,服用異維 A 酸。不過,異維 A 酸有多種副作用, Claire 特此寫下本篇,讓讀者了解當中風險。

*注意,如有任何皮膚問題,請先向自己的醫生查詢。

廣告

The dreaded R word. The word may trigger your mind to think of many acne-cursed teenagers, but in reality, many adults well into their twenties or even forties are going on it. It’s a very potent drug, so today I’m here to share everything you need to know about this medication with anyone considering going on it.

This is going to be a lengthy post, so get comfortable, grab a cuppa tea and a biscuit or two.

廣告

Before I delve more into the drug itself, let me give you a little backstory about my struggles with acne. I’ve been plagued by breakouts pretty much my whole adult life – nothing cystic or too painful, but just enough to bring my self-esteem way down and to be a gigantic pain in my ass. It mainly started when I started University, so I just assumed it had to do with stress – the stress of moving to a new city, the stress of starting my course, the stress of being away from everyone I know.

3 years go by and nothing has changed. In these three years, I have tried everything. I’ve cut out dairy from my diet (which I probably should anyway, considering I’m lactose intolerant), I’ve tried to cut down gluten, and I’ve cut down my alcohol intake. I’ve tried birth control pills, adapalene gel, anti-androgen pills, chemical peels, and 3 courses of antibiotics. Nothing. I’ve even been desperate enough to try herbal medicine and acupuncture. What the heck!? You can imagine my frustration. I decide it’s time to go to a dermatologist. Maybe it is time to bring out the big guns.

You know your acne is bad when your dermatologist says he feels sorry for you. After asking some questions about my past medical history, he says that I am an ideal candidate for Roaccutane.

But wait, what is Roaccutane?

He tells me that this is a drug used for severe recalcitrant nodular acne. In other words, people with severe acne that scar and is resistant to all other forms of treatment. In terms of how it works… Well, for all the medics and the pharmacists out there, Roaccutane – also known as isotretinoin – is a retinoid (a synthetic compound that is chemically related to vitamin A). Clinical improvement in acne patients is caused by a reduction in sebum secretion. This decrease is only temporary and is dose and duration dependent. Roaccutane causes a reduction in sebaceous gland size, and inhibits sebaceous gland differentiation. The exact mechanism of action is unknown, but it is known to alter DNA transcription. [1]

In laymen’s terms, Roaccutane does two things: one, speeds up the flow of dead skin sloughing off the body as opposed to being stuck in the follicle; two, decreases oil production.

What do you mean I am ‘an ideal candidate’?

My dermatologist says that this drug is ideal for anyone who has severe, scarring acne, or those whose acne is unresponsive to all other treatment combinations. More importantly, women who are considering getting pregnant or is pregnant should not be put on the drug, as isotretinoin is teratogenic (i.e. – it causes severebirth defects). Before going on the drug, I have to sign a bunch of consent forms that you understand the side effects and that you – all you gals out there – WILL NOT get pregnant whilst on this drug.

How long will I be on Roaccutane?

The duration you are on the drug is determined by your weight and the dose you are on per day. Typically a course of the drug is 120mg/kg in total. Taking myself as an example: I weigh 57kg, which means I need 6840mg of isotretinoin. If I take 40mg a day, that means I’d be on the drug for 171 days (roughly 6 months).

What kind of side effects can I expect?

Most patients experience dryness, especially of the eyes and lips. My dermatologist warns that I’ll need to be hyper-vigilant about moisturizing and reapplying throughout the day. And yes, he adds, that means I probably will have to give up lipstick for the duration of the treatment. Bummer.

Another thing that most people will get is an initial breakout. He tells me that he would put me on clarithromycin (an antibiotic) to try to control this as much as possible, but most people will still experience worsening of their acne for 2-3 weeks before they start to notice a more positive change. He also listed other common side effects such as joint pain, heartburn and nosebleeds, but these should go away once the treatment ends.

More severe side effects include hepatitis (inflammation of the liver), and hypercholesterolemia (increased levels of fat in the blood). These will need to be monitored by monthly blood tests. He adds that isotretinoin may also affect a person’s moods, ranging from depression to anxiety to erratic mood changes. Those who already suffer from mental health problems will have a significantly increased likelihood of getting depression.

But I already have mental health problems, is it safe to go on this medication?

For those who don’t know, I have generalised anxiety disorder. It’s not severe enough for me to be on medication, but it certainly interferes with my day-to-day life. This in turn sometimes causes me to have significantly low mood (I hesitate to use the word depression as I have never been diagnosed with it).

Yes, my dermatologist says, it is still safe. But he urges that I make more frequent appointments with my therapist and make them aware that I am on Roaccutane, and that should I have any, any, thoughts of harming myself, I should stop the treatment immediately. He also says that it would be a good idea to let my closest friends and family know about my treatment, and ask them to keep an eye out for any mood changes that I may have.

I think my concerns were etched deeply on my face. He quickly adds that since the drug doesn’t cross the blood-brain-barrier, he doesn’t feel that the drug itself will be responsible for causing or worsening of any mental health problems. This makes me feel better. Perhaps it is more of a placebo/ mass-hysteria-type side effect after all, since Reddit has plenty ‘Roaccutane made my son suicidal – DON’T GO ON IT’ threads.

Can I drink while on Roaccutane?

One or two should be fine, but there isn’t enough research out there to allow the doctor to give me a definitive answer. However, since both Roaccutane and alcohol are metabolised by the liver, he says he wouldn’t recommend it.

Is there a time of year that’s better to take the drug?

Apparently that’s completely up to you. The dryness may be unbearable in the colder months, but you may not want to have to stay indoors throughout summer due to increased sun sensitivity. In my case, due to the risk of depression, I would not want to be on the drug between April and July, seeing as my medical school finals are around that time.

Will my acne come back?

My dermatologist says that one in every 20 or 30 may require a second treatment, but most make it through without a relapse.

Roaccutane is ‘the king of acne treatments’, my dermatologist claims. A little creep on tumblr or YouTube may show you lots of Roaccutane success stories that support what my doctor says, but please bear in mind that this is a very potent drug. You should definitely research seriously before considering the Roaccutane regimen for yourself.

So, in summary, the 8 things you should know before starting on Roaccutane are:

  1. Roaccutane is for severe acne that is resistant to all other treatments. It works by decreasing oil production and speeding up the sloughing of dead skin.
  2. You CANNOT get pregnant whilst on the drug (and up to two months after you’re off the drug)
  3. The duration of the treatment depends on your weight and dose. Typically 6 – 10 months.
  4. Side effects include: an initial breakout, skin/lip/eye dryness, joint pain, nose bleeds, stomach pain due to acid reflux, hepatitis, hypercholesterolaemia, and may or may not lead to depression
  5. Yes, it is still safe to take the drug even if you have pre-existing mental illness. Just be responsible and vigilant on monitoring your moods. Stop the drug if you start having suicidal thoughts.
  6. You probably shouldn’t drink whilst on Roaccutane.
  7. It’s up to you if which time of year you want to take the drug.
  8. Most people will not need a second treatment.

——————

After much deliberation, I have decided to give it a shot. As I mentioned before, I’d rather have the bulk of my treatment early on in the academic year in the hopes that, should I have any negative psychological side effects, I will have them now rather than when I have to sit my finals. I had my blood tested and as soon as the results came back and my doctor deemed them satisfactory, I went back to his practice to sign two consent forms – one to say I understand the potential side effects, and one to swear with all my heart that I will not get pregnant whilst on the drug – and picked up the drugs. Now I am well into my second week (20mg and 30mg on alternative days), and so far all I have experienced are extremely dry lips. Nothing a kick-ass lip balm can’t handle just yet. Fingers crossed that soon, I won’t have randoms coming up to me telling me I have to fix my face anymore.

Until next time,

[1] – http://www.drugbank.ca/drugs/DB00982

原刊於 Water & Bay

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