Isotretinoin (Roaccutane): Side Effects And Complications

Written by Dr. K on 24 March 2021

Side Effects

Isotretinoin has a wide array of side effects which are dose-related, meaning that the higher the dose, the greater the likelihood and more severe the side effects.

 
  • Temporary increased flare of acne for the first 1-4 months of treatment
  • Sore, cracked, bleeding and dry lips
  • Dry skin, very fragile
  • Dry nostrils, occasional nose bleeds
  • Dry, itchy, watery eyes
  • Dry anal mucosa, bleeding when opening bowels
  • Dry genitals, painful and dry sexual intercourse
  • Facial redness
  • Sunburn when exposed to sun
  • Temporary hair loss
  • Fragile and brittle nails

The other side effects of Isotretinoin are broken down into a list of very common and common side effects, to rare side effects, as well as side effects whose frequency is not known.

Common or very common side effects
  • alopecia – hair loss
  • anaemia – low iron and haemoglobin levels
  • arthralgia – joint aches and pains
  • back pain
  • cheilitis – inflammation of the lips
  • dry eyes and eye discomfort
  • inflammation of the eyes
  • haemorrhage – bleeding
  • headaches
  • increased risk of infections
  • myalgia – muscle aches
  • nasal dryness
  • nose bleeds
  • neutropaenia – low white blood cells
  • proteinuria – increased levels of protein in the urine
  • skin fragility – easily cuts and tears
  • skin reactions
  • thrombocytopaenia – low platelet count
  • thrombocytosis – too high platelet count
 
Rare or very rare
  • anxiety
  • arthritis
  • abnormal behaviour
  • bone disorders
  • bronchospasm – airway narrowing
  • cataract
  • depression
  • diabetes mellitus
  • dizziness
  • drowsiness
  • dry throat
  • gastrointestinal disorders
  • glomerulonephritis – a type kidney inflammation
  • hair changes
  • hearing impairment
  • hepatitis – liver inflammation
  • hoarseness
  • hyperhidrosis – excessive sweating
  • hyperuricaemia – high uric acids levels that can cause gout
  • idiopathic intracranial hypertension – high pressure in the brain
  • inflammatory bowel disease
  • lymphadenopathy – lymph node disease
  • malaise – general feeling of discomfort
  • altered mood
  • nail dystrophy – distortion of the nails
  • nausea
  • pancreatitis – inflammation of the pancreas
  • photosensitivity – sensitivity to sunlight
  • psychotic disorders
  • pyogenic granuloma – skin lesions
  • seizure
  • suicidal behaviours
  • tendinitis – inflamed tendons
  • vasculitis – inflammation of blood vessels
  • vision disorders

Frequency unknown side effects
  • psychiatric disorders
  • rhabdomyolysis – breakdown of muscles
  • severe cutaneous adverse reactions
  • sexual dysfunction
  • vulvovaginal dryness

If you are experiencing any of the above side effects, please speak to your doctor. They will be able to advise you further regarding your management.

 

Treatment of Side Effects

Despite the long list of side effects that comes along with a treatment course of Isotretinoin, many of the skin related side effects can be managed well.

  • Speak to your doctor about reducing the dosage of Isotretinoin.
  • Washing your body with a mild and gentle body wash. Soap free would work best, try using an emollient body wash.
  • Use mild shampoos and conditioners for your hair.
  • Minimise heat products for your hair styling.
  • Use regular lip balms or lip emollients.
  • Stay hydrated with water.
  • Use emollients or body moisturisers after every shower or bath.
  • Avoid any lasers or skin treatments – they can cause irreversible skin reactions and scarring.
  • Avoid waxing, try shaving instead,
  • Always use sunscreen of at least SPF 50+ on facial areas, and SPF 30+ on your body.
  • Treat dermatitis with topical steroids – you can discuss this with your doctor.
  • Exercise regular to strengthen joints and muscles, to reduce aches and pains.
  • Avoid alcohol. Alcohol consumption during Isotretinoin treatment can cause liver failure, pancreatitis, hypertriglyceridemia, liver toxicity and in extreme cases even be fatal.
  • Take paracetamol for headaches and joint aches and pains.
  • Follow a healthy sleep schedule.
  • Consume a balanced diet rich in protein, healthy fats and low-GI carbohydrates, alongside antioxidants.

Sources

References:

  1. Advice on the safe introduction and continued use of isotretinoin in acne in the UK 2010 – MJD Goodfield, NH Cox, A Bowser, JC McMillan, LG Millard, NB Simpson, AD Ormerod, BJD, Vol. 162, No. 5, June 2010 (p1172-1179)
  2. Mollan SP, Woodcock M, Siddiqi R, Huntbach J, Good P, Scott RA. Does use of isotretinoin rule out a career in flying? Br J Ophthalmol. 2006 Aug;90(8):957-9. PubMed.
  3. Accessed on 24.3.2021 https://www.aad.org/public/diseases/acne/derm-treat/isotretinoin/safety
  4. NICE BNF UK – Isotretinoin

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