Roaccutane

Use during pregnancy and breastfeeding

Pregnancy is an absolute contraindication for Roaccutane therapy.
If pregnancy occurs, despite warnings, during treatment or within a month after the end of therapy, there is a very high risk of giving birth to a child with severe malformations. Isotretinoin is a drug with a strong teratogenic effect. If pregnancy occurs during a period when a woman takes isotretinoin orally (at any dose and even for a short time), there is a very high risk of giving birth to a child with developmental defects.

Roaccutane is contraindicated in women of childbearing potential unless the woman's condition meets all of the following criteria:

she must suffer from severe acne that is resistant to conventional treatments;
she must certainly understand and follow the doctor’s instructions;
she must be informed by the doctor about the danger of pregnancy during treatment with Roaccutane, within one month after it, and urgent consultation if pregnancy is suspected;
she should be warned about the possible ineffectiveness of contraceptives;
she must confirm that she understands the precautions;
she must understand the need and continuously use effective methods of contraception for one month before treatment with Roaccutane, during treatment and for a month after its completion (see section “Interaction with other drugs”); it is advisable to use 2 different methods of contraception at the same time, including barrier;
she must have received a negative result from a reliable pregnancy test within 11 days before starting the drug; A pregnancy test is strongly recommended monthly during treatment and 5 weeks after the end of therapy;
she should start treatment with Roaccutane only on the 2-3 day of the next normal menstrual cycle;
she must understand the need for mandatory visits to the doctor every month;
when treated for relapse of the disease, she must constantly use the same effective methods of contraception for one month before starting treatment with Roaccutane, during treatment and for a month after its completion, and also undergo the same reliable pregnancy test;
she must fully understand the need for precautions and confirm her understanding and desire to use reliable methods of contraception as explained to her by the doctor.

Use of contraception as directed above during treatment with isotretinoin should be recommended even in women who do not routinely use contraception due to infertility (except in patients who have had a hysterectomy), amenorrhea, or who report not being sexually active.

The doctor must be sure that:

the patient suffers from a severe form of acne (nodulocystic, conglobate acne or acne with a risk of scarring); acne that does not respond to other types of therapy;
a negative result from a reliable pregnancy test was obtained before starting the drug, during therapy and 5 weeks after the end of therapy; the dates and results of the pregnancy test must be documented;
the patient uses at least 1, preferably 2 effective methods of contraception, including a barrier method, for one month before starting treatment with Roaccutane, during treatment and for a month after its completion;
the patient is able to understand and fulfill all of the above requirements for pregnancy protection;
the patient meets all of the above conditions.

Pregnancy test

According to current practice, a pregnancy test with a minimum sensitivity of 25 mIU/ml should be performed in the first 3 days of the menstrual cycle:

Before starting therapy

To rule out possible pregnancy, the result and date of the initial pregnancy test must be recorded by a doctor before starting contraception. In patients with irregular menstruation, the timing of a pregnancy test depends on sexual activity and should be performed 3 weeks after unprotected intercourse. The doctor should inform the patient about contraceptive methods.

A pregnancy test is carried out on the day of Roaccutane's prescription or 3 days before the patient's visit to the doctor. The specialist should record the test results. The drug can only be prescribed to patients receiving effective contraception for at least 1 month before starting Roaccutane therapy.

During therapy

The patient must visit the doctor every 28 days. The need for monthly pregnancy testing is determined in accordance with local practice and taking into account sexual activity and previous menstrual irregularities. If indicated, a pregnancy test is performed on the day of the visit or three days before the visit to the doctor, the test results must be recorded.

End of therapy

5 weeks after the end of therapy, a test is performed to exclude pregnancy.

A prescription for Roaccutane for a woman capable of childbearing can be issued only for 30 days of treatment; continuation of therapy requires a new prescription of the drug by a doctor. It is recommended that a pregnancy test, writing a prescription and receiving the drug be carried out on the same day.

Roaccutane should be dispensed at a pharmacy only within 7 days from the date of issuing the prescription.

To help doctors, pharmacists and patients avoid the risk of fetal exposure to Roaccutane, the company aims to warn about the drug's teratogenicity and emphasize the absolute mandatory use of reliable contraceptive measures for women of childbearing age. The program contains the following materials:

for doctors:

a doctor's guide to prescribing Roaccutane to women;
informed consent form for the patient;
form for recording drug prescriptions for women.

for the patient:

patient information leaflet;
what you need to know about contraception.

for the pharmacist:

A pharmacist's guide to dispensing Roaccutane.

Full information about teratogenic risk and strict adherence to measures to prevent pregnancy should be provided to both men and women.

For male patients

Existing data suggest that in women, exposure to the drug from the semen and seminal fluid of men taking Roaccutane is not sufficient to cause the teratogenic effects of Roaccutane.

Men should exclude the possibility of taking the drug by other persons, especially women.

If, despite the precautions taken, pregnancy does occur during treatment with Roaccutane or within a month after its end, there is a high risk of very severe fetal malformations (in particular, from the central nervous system, heart and large blood vessels). In addition, the risk of spontaneous miscarriage increases.

If pregnancy occurs, Roaccutane therapy is discontinued. The advisability of maintaining it should be discussed with a doctor specializing in teratology.

Severe congenital malformations of the fetus in humans associated with the use of Roaccutane have been documented, including hydrocephalus, microcephaly, cerebellar malformations, anomalies of the external ear (microtia, narrowing or absence of the external auditory canal), microphthalmia, cardiovascular anomalies (tetralogy of Fallot, transposition of the great vessels, septal defects), malformations of the face (cleft palate), thymus gland, pathology of the parathyroid glands.

Because isotretinoin is highly lipophilic, it is very likely that it passes into breast milk. Due to possible side effects, Roaccutane should not be prescribed to nursing mothers.

Use for liver dysfunction

Contraindication: liver failure.

Use for renal impairment

In patients with severe renal impairment, treatment should be started with a lower dose (eg, 10 mg/day) and further increased to 1 mg/kg/day or the maximum tolerated.

Use in children

Contraindication: children under 12 years of age.

special instructions

To avoid accidental exposure of the drug to the body of other people, donated blood should not be taken from patients who are receiving or have recently (1 month) received Roaccutane.

It is recommended to monitor liver function and liver enzymes before treatment, 1 month after treatment, and then every 3 months or as indicated. A transient and reversible increase in liver transaminases was noted, in most cases within normal values. If the level of liver transaminases exceeds the norm, it is necessary to reduce the dose of the drug or discontinue it.

Fasting serum lipid levels should also be determined before treatment, 1 month after initiation, and then every 3 months or as indicated. Typically, lipid concentrations normalize after dose reduction or discontinuation of the drug, as well as with diet. It is necessary to monitor a clinically significant increase in triglyceride levels, since their rise above 800 mg/dL or 9 mmol/L can be accompanied by the development of acute pancreatitis, possibly fatal. In case of persistent hypertriglyceridemia or symptoms of pancreatitis, Roaccutane should be discontinued.

In rare cases, depression, psychotic symptoms, and very rarely, suicide attempts have been described in patients treated with Roaccutane. Although their causal relationship with the use of the drug has not been established, special caution should be exercised in patients with a history of depression and all patients should be monitored for the occurrence of depression during treatment with the drug, if necessary, referring them to an appropriate specialist. However, discontinuation of Roaccutane may not lead to the disappearance of symptoms and further observation and treatment by a specialist may be required.

In rare cases, at the beginning of therapy, an exacerbation of acne is observed, which resolves within 7-10 days without adjusting the dose of the drug.

Several years after the use of Roaccutane for the treatment of dyskeratosis, at a total course dose and duration of therapy higher than those recommended for the treatment of acne, bone changes developed, including premature closure of the epiphyseal growth plates, hyperostosis, calcification of ligaments and tendons. Therefore, when prescribing the drug to any patient, the ratio of possible benefits and risks should first be carefully assessed.

Patients receiving Roaccutane are recommended to use moisturizing ointment or body cream, lip balm to reduce dry skin and mucous membranes at the beginning of therapy.

During post-marketing surveillance with the use of the drug Roaccutane, cases of severe skin reactions, such as erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis, have been described. These events can be serious and can lead to disability, life-threatening conditions, hospitalization or death. Patients receiving Roaccutane require careful monitoring to identify severe skin reactions and, if necessary, consider discontinuing the drug.

While taking Roaccutane, pain in muscles and joints and an increase in serum creatinine phosphokinase are possible, which may be accompanied by a decrease in tolerance to intense physical activity.

Deep chemical dermoabrasion and laser treatment should be avoided in patients receiving Roaccutane, as well as for 5-6 months after the end of treatment due to the possibility of increased scarring in atypical places and the occurrence of hyper- and hypopigmentation. During treatment with Roaccutane and for 6 months after it, hair removal using wax applications cannot be performed due to the risk of epidermal detachment, scar development and dermatitis.

Since some patients may experience a decrease in night vision acuity, which sometimes persists even after the end of therapy, patients should be informed about the possibility of this condition, advising them to exercise caution when driving at night. Visual acuity must be carefully monitored.

Dryness of the conjunctiva of the eyes, corneal opacities, deterioration of night vision and keratitis usually disappear after discontinuation of the drug. If the mucous membrane of the eyes is dry, you can use applications of a moisturizing eye ointment or an artificial tear preparation. Patients with dry conjunctiva should be monitored for possible development of keratitis. Patients with vision complaints should be referred to an ophthalmologist and consider the advisability of discontinuing Roaccutane. If you are intolerant to contact lenses, you should use glasses during therapy.

Exposure to sunlight and UV rays should be limited. If necessary, use sunscreen with a high protection factor of at least 15 SPF.

Rare cases of the development of benign intracranial hypertension (“pseudotumor cerebri”) have been described, incl. when used in combination with tetracyclines. In such patients, Roaccutane should be discontinued immediately.

During therapy with Roaccutane, inflammatory bowel disease may occur. In patients with severe hemorrhagic diarrhea, Roaccutane should be immediately discontinued.

Rare cases of anaphylactic reactions that occurred only after previous external use of retinoids have been described. Severe allergic reactions dictate the need to discontinue the drug and carefully monitor the patient.

Patients at high risk (with diabetes, obesity, chronic alcoholism or lipid metabolism disorders) may require more frequent laboratory monitoring of glucose and lipid levels when treated with Roaccutane.

If diabetes is present or suspected, more frequent monitoring of glycemia is recommended.

Roaccutane®

Pregnancy is an absolute contraindication for therapy with Roaccutane®. If pregnancy occurs, despite warnings, during treatment or within a month after the end of therapy, there is a very high risk of giving birth to a child with severe malformations.

Isotretinoin is a drug with a strong teratogenic effect. If pregnancy occurs during a period when a woman takes isotretinoin orally (at any dose and even for a short time), there is a very high risk of giving birth to a child with developmental defects.

Roaccutane® is contraindicated in women of childbearing potential unless the woman's condition meets all of the following criteria:

- she must have severe acne that is resistant to conventional treatments;

- she must accurately understand and follow the doctor’s instructions;

- she must be informed by the doctor about the danger of pregnancy during treatment with Roaccutane® within one month after it and urgent consultation if pregnancy is suspected;

- she should be warned about the possible ineffectiveness of contraceptives;

— she must confirm that she understands the essence of the precautionary measures;

- she must understand the need and continuously use effective methods of contraception for one month before treatment with Roaccutane®, during treatment and for a month after its completion (see section “Interaction with other drugs”); it is advisable to use 2 different methods of contraception at the same time, including barrier;

- she must have received a negative result from a reliable pregnancy test within 11 days before starting the drug; A pregnancy test is strongly recommended monthly during treatment and 5 weeks after the end of therapy;

- she should start treatment with Roaccutane® only on the 2-3 day of the next normal menstrual cycle;

- she must understand the need for mandatory visits to the doctor every month;

- when being treated for a relapse of the disease, she must constantly use the same effective methods of contraception for one month before starting treatment with Roaccutane®, during treatment and for a month after its completion, as well as undergo the same reliable pregnancy test;

- She must fully understand the need for precautions and confirm her understanding and desire to use reliable methods of contraception as explained to her by the doctor.

The doctor must be sure that:

— the patient has a severe form of acne (nodulocystic, conglobate acne or acne with a risk of scarring); acne that does not respond to other types of therapy;

- a negative result from a reliable pregnancy test was obtained before starting the drug, during therapy and 5 weeks after the end of therapy; the dates and results of the pregnancy test must be documented;

- the patient uses at least 1, preferably 2 effective methods of contraception, including a barrier method, for one month before starting treatment with Roaccutane®, during treatment and for a month after its completion;

— the patient is able to understand and fulfill all of the above requirements for pregnancy protection;

— the patient meets all of the above conditions.

Pregnancy test

According to current practice, a pregnancy test with a minimum sensitivity of 25 mIU/ml should be performed in the first 3 days of the menstrual cycle:

Before starting therapy:

— To exclude possible pregnancy, before starting contraception, the result and date of the initial pregnancy test must be recorded by a doctor. In patients with irregular menstruation, the timing of a pregnancy test depends on sexual activity and should be performed 3 weeks after unprotected intercourse. The doctor should inform the patient about contraceptive methods.

— A pregnancy test is carried out on the day of prescription of the drug Roaccutane® or 3 days before the patient’s visit to the doctor. The specialist should record the test results. The drug can only be prescribed to patients receiving effective contraception for at least 1 month before starting therapy with Roaccutane®.

During therapy:

— The patient must visit the doctor every 28 days. The need for monthly pregnancy testing is determined in accordance with local practice and taking into account sexual activity and previous menstrual irregularities. If indicated, a pregnancy test is performed on the day of the visit or three days before the visit to the doctor, the test results must be recorded.

End of therapy:

- 5 weeks after the end of therapy, a test is performed to exclude pregnancy.

A prescription for Roaccutane® for a woman capable of childbearing can be issued only for 30 days of treatment; continuation of therapy requires a new prescription of the drug by a doctor. It is recommended that a pregnancy test, writing a prescription and receiving the drug be carried out on the same day.

The drug Roaccutane® should be dispensed at the pharmacy only within 7 days from the date of issuing the prescription.

To help physicians, pharmacists and patients avoid the risk of fetal exposure to Roaccutane®, the company aims to warn about the drug's teratogenicity and emphasize the absolute mandatory use of reliable contraceptive measures for women of childbearing age. The program contains the following materials:

for doctors:

— a doctor’s guide to prescribing Roaccutane® to women

— informed consent form for the patient

— form for recording the prescription of the drug to women for the patient:

— patient information brochure

- what you need to know about contraception

— for the pharmacist:

— a guide for the pharmacist on the dispensing of the drug Roaccutane®.

Full information about teratogenic risk and strict adherence to measures to prevent pregnancy should be provided to both men and women.

For male patients

Existing data indicate that in women, exposure to the drug from the semen and seminal fluid of men taking Roaccutane® is not sufficient to cause the teratogenic effects of Roaccutane®.

Men should exclude the possibility of other persons, especially women, taking the drug.

If, despite the precautions taken, pregnancy does occur during treatment with Roaccutane® or within a month after its end, there is a high risk of very severe fetal malformations (in particular, from the central nervous system, heart and large blood vessels) . In addition, the risk of spontaneous miscarriage increases.

If pregnancy occurs, therapy with Roaccutane® is discontinued. The advisability of maintaining it should be discussed with a doctor specializing in teratology. Severe congenital malformations of the fetus in humans associated with the use of Roaccutane® have been documented, including hydrocephalus, microcephaly, cerebellar malformations, anomalies of the external ear (microtia, narrowing or absence of the external auditory canal), microphthalmia, cardiovascular anomalies (tetrad Fallot, transposition of the great vessels, septal defects), malformations of the face (cleft palate), thymus gland, pathology of the parathyroid glands. Because isotretinoin is highly lipophilic, it is very likely that it passes into breast milk. Due to possible side effects, Roaccutane® should not be prescribed to nursing mothers.

Roaccutane caps 20mg N30 (Hoffman-La Roche)

Roaccutane should only be prescribed by physicians, preferably dermatologists, who are experienced in the use of systemic retinoids and are aware of the drug's teratogenicity risk. Both female and male patients should be given a copy of the Patient Information Leaflet. To avoid accidental exposure of the drug to the body of other people, donated blood should not be taken from patients who are receiving or have recently (1 month) received Roaccutane. It is recommended to monitor liver function and liver enzymes before treatment, 1 month after treatment, and then every 3 months or as indicated. A transient and reversible increase in liver transaminases was noted, in most cases within normal values. If the level of liver transaminases exceeds the norm, it is necessary to reduce the dose of the drug or discontinue it. Fasting serum lipid levels should also be determined before treatment, 1 month after initiation, and then every 3 months or as indicated. Typically, lipid concentrations normalize after dose reduction or discontinuation of the drug, as well as with diet. It is necessary to monitor a clinically significant increase in triglyceride levels, since their rise above 800 mg/dL or 9 mmol/L can be accompanied by the development of acute pancreatitis, possibly fatal. In case of persistent hypertriglyceridemia or symptoms of pancreatitis, Roaccutane should be discontinued. In rare cases, depression, psychotic symptoms, and very rarely, suicide attempts have been described in patients treated with Roaccutane. Although their causal relationship with the use of the drug has not been established, special caution should be exercised in patients with a history of depression and all patients should be monitored for the occurrence of depression during treatment with the drug, if necessary, referring them to an appropriate specialist. However, discontinuation of Roaccutane may not lead to the disappearance of symptoms and further observation and treatment by a specialist may be required. In rare cases, at the beginning of therapy, an exacerbation of acne is observed, which resolves within 7-10 days without adjusting the dose of the drug. Several years after the use of Roaccutane for the treatment of dyskeratosis, at a total course dose and duration of therapy higher than those recommended for the treatment of acne, bone changes developed, including premature closure of the epiphyseal growth plates, hyperostosis, calcification of ligaments and tendons. Therefore, when prescribing the drug to any patient, the ratio of possible benefits and risks should first be carefully assessed. Patients receiving Roaccutane are recommended to use moisturizing ointment or body cream, lip balm to reduce dry skin and mucous membranes at the beginning of therapy. During post-marketing surveillance with the use of the drug Roaccutane, cases of severe skin reactions, such as erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis, have been described. These events can be serious and can lead to disability, life-threatening conditions, hospitalization or death. Patients receiving Roaccutane require careful monitoring to identify severe skin reactions and, if necessary, consider discontinuing the drug. While taking Roaccutane, pain in muscles and joints and an increase in serum creatinine phosphokinase are possible, which may be accompanied by a decrease in tolerance to intense physical activity. Deep chemical dermoabrasion and laser treatment should be avoided in patients receiving Roaccutane, as well as for 5-6 months after the end of treatment due to the possibility of increased scarring in atypical places and the occurrence of hyper- and hypopigmentation. During treatment with Roaccutane and for 6 months after it, hair removal using wax applications cannot be performed due to the risk of epidermal detachment, scar development and dermatitis. Since some patients may experience a decrease in night vision acuity, which sometimes persists even after the end of therapy, patients should be informed about the possibility of this condition, advising them to exercise caution when driving at night. Visual acuity must be carefully monitored. Dryness of the conjunctiva of the eyes, corneal opacities, deterioration of night vision and keratitis usually disappear after discontinuation of the drug. If the mucous membrane of the eyes is dry, you can use applications of a moisturizing eye ointment or an artificial tear preparation. Patients with dry conjunctiva should be monitored for possible development of keratitis. Patients with vision complaints should be referred to an ophthalmologist and consider the advisability of discontinuing Roaccutane. If you are intolerant to contact lenses, you should use glasses during therapy. Exposure to sunlight and UV rays should be limited. If necessary, use sunscreen with a high protection factor of at least 15 SPF. Rare cases of the development of benign intracranial hypertension (“pseudotumor cerebri”) have been described, incl. when used in combination with tetracyclines. In such patients, Roaccutane should be discontinued immediately. During therapy with Roaccutane, inflammatory bowel disease may occur. In patients with severe hemorrhagic diarrhea, Roaccutane should be immediately discontinued. Rare cases of anaphylactic reactions that occurred only after previous external use of retinoids have been described. Severe allergic reactions dictate the need to discontinue the drug and carefully monitor the patient. Patients at high risk (with diabetes, obesity, chronic alcoholism or lipid metabolism disorders) may require more frequent laboratory monitoring of glucose and lipid levels when treated with Roaccutane. If diabetes is present or suspected, more frequent monitoring of glycemia is recommended.

The use of roaccutane for the treatment of acne in cosmetology

Korchevaya T.A.

Acne is a disease of the hair follicles and sebaceous glands. In the pathogenesis of acne, four interrelated factors are important: pathological follicular hyperkeratosis, excessive secretion of the sebaceous glands, proliferation of Propionibactertum acnes (P. acnes) and inflammation. In addition, the nature and volume of secretion of the sebaceous glands is influenced by androgens, which can also play an important role in the pathogenesis of acne.

Excess sebum production plays an additional role in the pathogenesis of acne. In patients suffering from acne, sebum production increases significantly, which usually correlates with the severity of the disease. The secretion of the sebaceous glands is a substrate for the proliferation of P. acnes. In this case, lipolysis of sebum occurs by bacterial lipases to free fatty acids, which in turn contribute to inflammation and the formation of comedones.

In patients with acne, P. acnes multiplies and plays a key role in the inflammatory phase of the disease. When the contents of the follicle enter the skin itself, aseptic inflammation occurs. Depending on the location and extent of inflammation, papules, pustules and cysts are formed.

In connection with the above, for rational treatment of acne, it is important for us to solve the following main tasks:

reduce the effect of androgens on the sebaceous glands,
reduce sebum formation,
reduce inflammation,
reduce the number of P. acnes,
normalize the mitotic activity of the skin.

Rational treatment is based on correct clinical assessment. The duration of acne, the maximum severity and location of the lesion should be determined.

Topical treatment alone may be indicated for mild to moderate noninflammatory acne, mild superficial inflammatory acne without scarring, and as an adjunct to oral therapy for moderate to severe acne.

Systemic therapy is necessarily combined with local therapy and is indicated for the treatment of patients with moderate to severe acne, especially in cases of scarring or a tendency to psychosocial disorders.

Currently, Roaccutane is the most effective drug for the treatment of severe forms of acne. Clinical experience shows that it can cause long-term remissions or cures in most patients. Roaccutane reduces sebum production by 80%. There is a significant reduction in comedogenesis and P. acnes counts within 4 to 8 weeks after initiation of treatment.

Roaccutane is teratogenic. When prescribing it to women of childbearing age, it is necessary to exclude pregnancy two weeks before treatment. But the drug does not stay in the tissues for a long time and therefore, 1-2 months after treatment with Roaccutane, pregnancy is not prohibited. The opinion of some gynecologists and a number of other specialists who do not recommend getting pregnant for the entire first year after treatment with Roaccutane is erroneous: the level of the drug in the blood returns to the physiological norm within two weeks after discontinuation of the drug. And for men, in terms of childbearing, it has no contraindications, since it has no effect on sperm.

Economic efficiency. The cost of a course of treatment with Roaccutane is not always clearly perceived not only by the patient, but even by the doctor. But we must remember the high effectiveness of the drug, its surprisingly lasting effect on severe cystic, atheromatous acne, which, unfortunately, has always been considered a chronic recurrent skin disease. And here the doctor is faced with a choice: either he offers the patient treatment for a long time followed by numerous cosmetic procedures to prevent relapse; carry out repeated courses of treatment in case of relapse of inflammation, which, especially in cystic forms, is almost inevitable. With this tactic for treating acne, the total costs of treatment extended over time without the use of Roaccutane will undoubtedly be higher. Doctors are attracted to treatment with Roaccutane, of course, by the result itself: “I receive deep satisfaction from the results of treatment with this drug, as the patient’s skin improves and evens out almost without much effort on the part of the doctor.” Indeed, often even with the most complex cosmetic procedures we cannot achieve the same cosmetic effect on the skin that Roaccutane treatment provides. And most importantly, clinical cure is observed in the vast majority of patients. We understand that investing money in a temporary effect such as we often see from antibiotics for acne would, of course, be inappropriate. Therefore, the patient asks about guarantees. According to various authors, the percentage of effectiveness is very high: from 80% to 95%.

We have noticed that treating foci of chronic infection increases the effectiveness of treatment and reduces the percentage of relapses.

We begin to prepare the patient for taking Roaccutane already at the stage of a standard examination for the drug:

1. Sanitation of foci of chronic infection (gastrointestinal tract, ENT organs, etc.), 2. Sanitation of the skin with concomitant demodicosis: - Delex-acne gel (contains sulfur), - Metrogyl jelly (contains metronidazole).

We believe that it is not always advisable to carry out monotherapy with Roaccutane. To improve skin smoothing, enhance the anti-inflammatory effect, accelerate healing, eliminate post-acne defects in the early stages, when they are more susceptible to influence, we recommend combining Roaccutane at different stages of treatment with a number of medications and cosmetic procedures:

vitamin E (taken orally in a prophylactic dosage),
homeopathy and antihomotoxicology,
Skinoren,
oxygen ozone therapy,
mesotherapy,
myostimulation,
enzymatic peeling (to remove possible peeling of facial skin),
diathermocoagulation of abscesses,
massotherapy.

Among antihomotoxic drugs, I would like to especially highlight the use of Traumeel in complex therapy with Roaccutane.

The use of Traumeel S and Roaccutane in the treatment of severe forms of acne (240 patients)

Roaccutane	Roaccutane and Traumeel S
Stopping new items from appearing	5-8 weeks	After 2-4 weeks
Duration of treatment	12-16 weeks	After 10-12 weeks
Anti-scarring effect	Moderate	Expressed

The table shows that when Roaccutane is combined with the antihomotoxic drug Traumeel, the effect of treatment occurs much earlier and the smoothing of scars is more pronounced.

Unfortunately, Roaccutane does not combine well with liquid nitrogen, cosmetic cleansing, dermabrasion, chemical and acid peels. After completion of treatment with this drug for different periods of 3 months. up to 6 months if necessary, chemical and acid peeling and dermabrasion can be performed. Cosmetic cleansing - earlier: after 1-2 weeks, and with small dosages - at the end of the Roaccutane course.

Conclusion.

Roaccutane acts on the most important mechanism of acne - increased sebum secretion. Gradually, the sebaceous glands decrease in size, sebaceous cysts disappear, and therefore, inflammation in the area of these glands decreases. It is with the restructuring of the sebaceous glands that a lasting effect or clinical recovery is associated with treatment with Roaccutane.

It is possible to combine Roaccutane at different stages of treatment with anti-scarring and anti-inflammatory homeopathy, as well as with a number of cosmetic procedures.