accutaneAccutane is a product name, and its common name is isotretinoin. In addition to Accutane, isotretinoin’s product names are Roaccutane, Isotroin, Absorica, Amnesteem, Claravis, Myorisan, Sotret, Zenatane and others.

In our clinic, we have performed acne treatment with isotretinoin for over 12 years. Our clinic has the largest number of patients receiving the accutane treatment in Japan.

Isotretinoin is a treatment which is most effective and has the lowest recurrence rate among acne treatments that are used worldwide. The effective rate of isotretinoin treatment for acne is 98% or higher and the recurrence rate is only 30% (*).

Transient acne exacerbation is seen in about 30% of patients during the first month. Patients should see a dramatic improvement within 2 to 3 months if they take the adequate dosage of medicine consistently. Even after the acne improve, it is necessary to continue the treatment to prevent recurrence. A regular course of treatment is 6 months. If there is little improvement, it can be extended to 8 months.

* Regarding the recurrence rate, compared with the condition before the treatment, the case where the number of acne recurs more than one-third is called recurrence.

How much accutane should you take per day?

At our clinic the treatment starts from 0.5 mg to 1 mg per body weight a day. The patient weighing 60 kg, which is 130 pounds, should take 30 mg to 60 mg per day. If there is little improvement within 2 to 3 months, we should increase the dosage of the medicine. The maximum dosage is 2 mg per body weight. In other words, for the patient weighing 60 kg (130 pounds), they can take up to 120 mg per day.

If you have already taken isotretinoin at another clinic and you didn’t get a good result, the dosage of medicine may not be enough. A higher dosage of isotretinoin increases the effect and prevents your acne from coming back. If you take isotretinoin with a higher dosage, you should achieve a better result, but side effects may increase, so we must be careful with that issue.

If acne recurs, you should take another course of treatment. A rest period of at least 2 months, preferably 4 months after the first course of treatment is required. Even if the acne recurs, the degree of recurrence gradually decreases while you are taking the treatment several courses.

Accutane (Isotretinoin) is a very effective medicine, but it is not a perfect medicine for acne. This medicine is 98% effective and has 30% recurrence rate. It’s effective for most people, however, it may not work for everyone.

Mechanism of action.

Isotretinoin is a stereo-isomer of all-trans retinoic acid. The exact mechanism of action of isotretinoin has not yet been elucidated in detail.

Hyper-cornification of the epithelial lining of the pilosebaceous unit leads to shedding of corneocytes into the duct and blockage by excess sebum and keratin. This is followed by formation of a comedo and inflammatory acne. Isotretinoin inhibits proliferation of sebocytes by re-setting the orderly program of differentiation. Therefore this medicine prevent corneocytes from shedding into the duct and prevent duct and pore from blockage.

Sebum is a major substrate for the growth of P. acnes which is the bacteria causing inflammation of acne. Isotretinoin reduced sebum production, so that it inhibits bacterial colonization of the duct. This is the second mechanism of action. But this action works only during the treatment. After stopping the medicine, sebum production will increase to  almost the same level as before the treatment within 2 months, so the first action is more important than the second action to prevent recurrence.

Side effects of Isotretinoin.

The most frequent side effect of isotretinoin is dryness of the skin and lips. Patients should moisturize their skin frequently during the treatment.

All patients must understand the teratogenic risk of isotretinoin. Pregnancy is an absolute contraindication to treatment with isotretinoin. Women of childbearing potential have to use effective contraception during and up to one month after treatment. If pregnancy does occur during the treatment or in the month following in spite of these precautions, there is a great risk of very severe and serious malformation of the fetus.

In Japan, we instruct patients to prevent pregnancy for up to 6 months after the treatment. The reason why we set up to 6 months is that we get a safety margin because the treatment data of the Japanese was small.

There are also other side effects such as bone, muscle, and joint pain, headache, redness of your face and so on. We will perform a blood test every month because various blood abnormality such as hepatic function disorder may occur.

Since various other side effects have been reported, at our clinic, we will give you an information sheet “About the side effects of isotretinoin” to patients and explain them on your first examination.

Treatment cases of Isotretinoin

isotretinoin-treatment_before-after

These pictures were taken before the treatment and after 5 months from the start of treatment at our clinic. The patient is in his twenties. His acne broke out since he was 15 years old and took various treatment such as systemic antibiotics, topical therapy, vitamins and herbal medicine for a long time.

We started the isotretinoin treatment and continued for 6 months. He achieved a fantastic improvement and no recurrence.

This patient is in his late teens. He began to suffer from acne from 4 years ago and had been treated with systemic antibacterials, topical therapy (including antibiotics, adapalene, benzoyl peroxide and steroids) and herbal medicine in dermatology for 3 years, but he did not improve. The inflammation of acne on his face got worse and worse, then he was introduced to the university hospital. Unfortunately, the doctor at the university hospital also treated him with antibiotics and topical benzoyl peroxide because acne treatments covered by insurance in Japan are limited. Of course, his acne did not improve at all, so his parents questioned the treatment policy and visited our clinic with him.

The patient weighed 57 kg, so we treated him with isotretinoin 40 mg a day. Ordinarily a regular course is finished for 6 months, his acne was severe, so we treated him for 8 months. We also treated him with peeling using salicylic-acid-macrogol and our medical cosmetics containing human placenta and growth factors to moisturize his skin and prevent red marks after having acne.

If you would like to see more treatment case photos, please go to “Treatment cases.(Japanese site.)

Treatment cost

Our clinic offers the a treatment price because the number of acne treatment cases with isotretinoin is the largest in Japan. However, the acne treatment with isotretinoin is not covered by insurance, so it may be expensive. Please check the prices before visiting our clinic.

Treatment cost of Isotretinoin 20 mg
Examination fee
2,900 yen. (* Initial visit is 5,800 yen.)
Pharmaceutical charge (28 days.)10,640 yen. (Isotretinoin 20 mg for 28 days.)
Inspection fee Blood test 3,280 yen.
Urine test only for women 960 yen.
Total (excluding tax.) (28 days.)
First visit. 19,720 yen to 20,680 yen.
Return visit. 16,820 yen to 17,780 yen.
Treatment cost of Isotretinoin 40 mg
Examination fee
2,900 yen. (* Initial visit is 5,800 yen.)
Pharmaceutical charge (28 days.)21,280 yen. (Isotretinoin 40 mg for 28 days.)
Inspection fee Blood test 3,280 yen.
Urine test only for women 960 yen.
Total (excluding tax.) (28 days.)
First visit. 30,360 yen to 31,320 yen.
Return visit. 27,460 yen to 28,420 yen.
Treatment cost of Isotretinoin 60 mg
Examination fee
2,900 yen. (* Initial visit is 5,800 yen.)
Pharmaceutical charge (28 days.)31,920 yen. (Isotretinoin 60 mg for 28 days.)
Inspection fee Blood test 3,280 yen.
Urine test only for women 960 yen.
Total (excluding tax.) (28 days.)
First visit. 41,000 yen to 41,960 yen.
Return visit. 38,100 yen to 39,060 yen.

※Fee for women includes additional 960 yen for urine analysis.

Those who can not receive treatment with Isotretinoin.

The following people can not receive acne treatment with isotretinoin.

1. Person who imports isotretinoin individually.
Individual import of Accutane is prohibited by the Ministry of Health, Labor and Welfare. Please note that our clinic is conducting medical treatment only for patients who can receive the prescription and treatment under the responsibility of the doctor.

2. People with mild acne.
Isotretinoin is prescribed only for people with refractory moderate to severe acne.

3. People under the age of 15.
This medicine may stop bones from growing.

4. People under the age of 18.
Those under the age of 18 years old can not be prescribed medicine unless accompanied by parents at the time of the first visit. From the second visit, the patient can visit our clinic alone.

5. People suffering from mental illness.
Those suffering from mental disorders such as depression and schizophrenia can not receive treatment. If you have a history but are currently in remission, you may take the medicine, so please consult us.

6. Person who is pregnant, breastfeeding.
Those pregnant, breastfeeding or planning to become pregnant within 1 year can not take isotretinoin.

7. Person undergoing laser treatment.
You can not receive laser treatment including laser hair removal during treatment and for 6 months after the treatment.

8. People who are allergic to parabens and gelatin.
The medicine contains parabens as preservatives in a gelatin capsule.

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