Isotretinoin is a western drug that is widely used in the treatment of severe acne. This drug has definite efficacy in the treatment of acne, but it also has many side effects. When used properly, it can be a good treatment for the disease, but when used inappropriately, it can be harmful. Recently, the media has widely reported an extreme case of side effects of isotretinoin: a male patient from Sihong, Jiangsu Province, aged 23, suffered from acne and took isotretinoin for more than 3 years from May 2005 to July 2008, which eventually led to depression and suicide. This incident has attracted a lot of attention from the media, society and experts!
What lessons should we (including doctors and patients) learn from this incident? I think we should start from the following aspects, in order to effectively treat the disease, while avoiding or reducing the side effects of drugs, and improve the safety of medication!
First, strictly according to the drug instructions to use drugs
Drugs are the weapons of treatment, most drugs in the treatment of disease at the same time will inevitably produce some side effects. Especially western drugs have more side effects, and sometimes even very serious. Therefore, both doctors and patients, especially doctors, should fully understand the efficacy, indications, side effects and precautions of drugs and use them strictly according to the instructions, so as to ensure effective and safe treatment of diseases. Only in this way can we ensure that the disease is treated effectively and safely. In the end, the disease is cured and the patient’s body is severely damaged!
The main pharmacological effects, indications and side effects of isotretinoin are listed below.
Isotretinoin is also known as 13-cis retinoic acid.
Pharmacology] It is used to treat acne by reducing sebaceous gland tissue, inhibiting sebaceous gland activity, reducing sebum secretion, reducing epithelial cell keratinization and keratin plugging at the mouth of the follicle sebaceous gland, and inhibiting the growth and reproduction of Propionibacterium acnes. Recent studies have also shown that this drug can modulate the inflammatory immune mediators associated with the pathogenesis of acne and selectively bind to the nuclear receptors of retinoic acid to exert therapeutic effects.
Toxicology】Tests have shown serious teratogenic effects.
Indications】It is suitable for severe acne, especially for nodular cystic acne, and can also be used for hair erysipelas and other diseases.
Adverse effects
1. The side effects of this drug are similar to the clinical manifestations of vitamin A overdose. Common side effects include dryness of the mouth and lips and skin, labyrinthitis, desquamation, pruritus, pain, rash, increased skin fragility, palmoplantar peeling, petechiae, and also secondary infections.
2. conjunctivitis, corneal clouding in severe cases, visual impairment, optic papillary edema, headache, dizziness, psychiatric symptoms, depression, increased benign brain pressure.
3. laxity of hair, softening of nails.
4. osteoporosis, muscle weakness, pain, gastrointestinal symptoms, epistaxis
5. pregnancy dosing can lead to spontaneous abortion and fetal developmental malformations
6. Laboratory tests may cause rapid blood sedimentation, elevated liver enzymes, elevated blood lipids, elevated blood glucose, decreased platelets, etc.
Most of the above side effects are reversible and can be gradually recovered after stopping the drug. The severity of side effects is related to the dose, duration of treatment and individual tolerance of the drug.
Mild adverse reactions may not need to stop the drug, or reduce the amount of use, serious adverse reactions should immediately stop the drug, and go to the hospital by the doctor for appropriate treatment. Most of the above-mentioned adverse reactions are reversible and can be gradually recovered after discontinuation of the drug.
Contraindications】Pregnant women, lactating women, hepatic and renal insufficiency, vitamin A overdose and hyperlipidemia patients are prohibited.
Caution
1. Avoid taking this drug together with vitamin A and tetracycline.
2. Pregnancy test should be performed before and after discontinuation of the drug for women of childbearing age, and blood donation is not allowed during and within three months after discontinuation of the drug.
3. Avoid excessive exposure to sunlight and UV rays.
4. Use with caution in cases of diabetes, obesity, alcoholism, hyperlipidemia and lipid metabolism disorders.
5. If there is no other abnormality, the medication can be continued under close observation. It is not advisable to take other keratolytic or epidermolytic anti-acne drugs at the same time.
6. If necessary, mild topical medication can be used as an adjunctive treatment.
Pregnant women and nursing mothers】Pregnant women and nursing mothers are prohibited. Women of childbearing age or their spouses should use strict contraception during and for three months after discontinuation of the drug.
The safety of the drug in children is not known. Overdose may result in changes in bone structure, including premature fusion of the epiphyseal disc in children.
Use in Elderly Patients】Discontinued in patients with hepatic or renal insufficiency.
Drug Interactions
The combination of isotretinoin and tetracycline antibiotics may lead to benign brain pressure elevation due to pseudo-brain tumor, which may manifest as hypertension with headache, vertigo and visual disturbance.
2. Isotretinoin and vitamin A together can produce symptoms similar to those seen with vitamin A overdose.
3. Concomitant use of isotretinoin with Carbamazepine may result in a decrease in the blood concentration of Carbamazepine, and concomitant use with Warfarin may enhance the therapeutic effect of Warfarin, and concomitant use with Methotrexate (MTX) may increase the damage to the liver due to an increase in the blood concentration of MTX.
Reading the instructions of this drug and referring to other medical literature, there are two points that deserve extra attention: 1. Pregnant women and women who want to get pregnant in the near future are prohibited from taking this drug because it may cause malformation to the fetus during pregnancy; female patients should use contraception during and 6 months after stopping the drug; female patients should perform pregnancy tests before and during the drug to exclude the possibility of pregnancy. 2. Patients with depression should not use this medication because of its possible psychological effects. Close monitoring of the patient’s depressive state, adequate education of the patient, and seeking help from roommates or family members to change mood are all ways to assess the psychological status of patients with isotretinoin. Other adverse reactions to isotretinoin are dose-dependent and are usually not serious.
Second, follow the doctor’s instructions
On the basis of the correct prescription of the doctor, the patient should also cooperate with the doctor to take the drug correctly, only in this way can give full play to the efficacy of the drug, reduce the side effects of the drug, and finally achieve the purpose of “safe and effective” treatment. Do not arbitrarily change the method of medication such as: each dose, the number of times to take the method, the course of medication and so on. If you reduce the dosage, it will be ineffective, and if you overdose, it will produce side effects or toxicity. Similarly, the number of doses and the course of treatment are different, the efficacy and safety will be different!
Third, the emergence of drug side effects immediately stop the drug, and take appropriate treatment measures.
Once the side effects that have been indicated or not indicated in the instructions appear, stop the drug immediately and consult your doctor to take appropriate treatment measures. Most of the side effects will disappear after stopping the drug, or will recover after treatment!
Fourth, the clinic must focus on “efficacy, safety” two aspects, sometimes safety is more important than efficacy.
In the clinical care, the focus is on two aspects, namely “efficacy and safety”, in order to fully improve the efficacy of the drug at the same time, but also pay special attention to reduce the side effects of drugs. Therefore, in clinical work, I try to use Chinese herbal medicine instead of western medicine with more side effects if the disease can be cured by Chinese herbal medicine. In some cases, if western medicine is really effective and has fewer side effects, I will also “use foreign medicine for Chinese medicine” and choose to use it.
The treatment of certain chronic diseases should not pursue short, flat, fast, and ignore the side effects of drugs.
Some chronic diseases, especially many skin diseases such as psoriasis, vitiligo, acne, etc., at this stage there is no immediate effect of the special drugs and methods of treatment, some of the cure may also have a relapse of the situation. For these diseases, you should not just pursue short, flat and fast treatments and use some drugs with serious side effects. Instead, we should use methods of treatment that are both effective and have few side effects, especially using Chinese medicine or a combination of Chinese and Western medicine to ensure the unity of efficacy and safety. These treatments, although the efficacy is a little slower, or slightly worse, but the body will not cause a major impact! In short, human life comes first!
Sixth, give full play to the characteristic advantages of Chinese medicine in the treatment of acne
Through nearly thirty years of clinical experience, the treatment of acne with Chinese herbal medicine has the characteristics of good efficacy and few side effects. For this reason, I have come up with several prescriptions for the treatment of acne, such as the “Clear the lungs and eliminate acne”, “Clear the liver and eliminate acne”, “Clear the stomach and eliminate acne”, “Detoxify and eliminate acne”, and “Dermatitis 1”, which have been used to treat acne with good results. Patients who do not want to take western medicine may want to use Chinese medicine to treat acne. The following is a brief introduction.
Chinese medicine for internal use
1, acne lung meridian wind-heat evidence: red papules on the face, acne, pustules, irritability and thirst, red tongue, thin yellow coating, floating pulse.
Treatment: Clearing the lung and removing heat
Recipe: Clearing the lung and eliminating acne
2, acne damp-heat evidence of the liver meridian: red papules, pimples, pustules on the face, the condition is related to emotions, the rash is aggravated before menstruation in women, irritability and anxiety, swelling and pain in the liver meridian, bitterness in the mouth, red tongue, thin yellow moss, or yellow greasy moss, string or smooth pulse.
Treatment: Clearing the liver and removing heat
Formula: Clearing the liver and eliminating acne
3.Gastrointestinal damp heat evidence: red papules, pimples, pustules on the face, with constipation, yellow urine, dullness, abdominal distension, yellow tongue coating, slippery pulse.
Treatment: Clearing the stomach and removing heat
Recipe: Stomach clearing and acne elimination formula
4. Heat poisoning and blood stasis: red papules, acne, pustules on the face, mainly characterized by cysts and nodules on the face, with red tongue, yellow greasy coating and slippery pulse. It is seen in cystic, nodular, aggregated acne and follicular obstruction triad.
Treatment: Detoxify and resolve blood stasis
Formulas: Detoxifying and eliminating acne formula
External treatment with Chinese medicine: Use the Chinese medicine Dermatitis 1 Inverted Film, or with red and blue light irradiation, which has a better effect on the treatment of acne.