Isotretinoin may definitely cause muscle pain and back pain. It seems that my patients who run marathons or are otherwise athletic seem to have been bothered by this the most. My marathon runner had to stop the medication in the months preceeding the big race day then restart after the race was completed. Some of the athletic patients have decreased dosage and this has helped.
If the Retin-A product applied induces too much skin irritation, it is possible that skin hyperpigmentation could be a side effect. However, Retin-A is also used as a skin lightening agent. If your skin concerns require a retinoid and your skin is sensitive, the best solution would be to talk to your doctor about using the lowest potency retinoid on the market. Whenever irritation is a concern, it is best to increase use of these products slowly. This means that some patients have to start using them twice weekly and they increase frequency slowly as tolerated to daily. Some patients can only use these three times a week and while results are slower the patients often do just as well in the end.
Isotretinoin side effects may last two to three months after the last dose of the medication. Any back pain, joint pain, muscle aches, chapped lips, and skin redness should decrease in intensity slowly with time.
Patients with fertility concerns, increased body hair, irregular menstrual periods, and acne should raise a red flag to pursue a hormone work-up. Patients with polycystic ovarian syndrome or congenital adrenal hyperplasia may have difficult to treat acne unless the underlying medical condition is addressed. I suggest you discuss this concern with a dermatologist, primary care doctor, or endocrinologist. Isotretinoin 20mg is a fairly low dose but should be having some positive effect on acne. It does often take 2-4 months for isotretinoin to work for some patients. Occasionally, patients do flare when we start isotretinoin and prednisone can be added to help decrease inflammation. Absorption of isotretinoin is best when taking the medication with a fatty meal. If you are not doing this, the medication not be working well. Absorica is a brand only version of isotretinoin that doesn't require the fatty meal. If you can't take the generic version with a fatty meal, ask your doctor to write for the Absorica. Lastly, patients who eat a great deal of high glycemic diet foods and skim milk are reported to have more acne than those who eat a low glycemic diet and drink no milk, 2% milk or whole milk.
Isotretinoin is absorbed best when taken with a fatty meal. If the patient is on a low fat diet the isotretinoin may not get absorbed resulting in decreased efficacy. There is a branded isotretinoin called Absorica that is approved to be taken without regard to food. Each Absorica isotretinoin capsule is created using Lidose Technology. With this technology, the body is able to absorb the medication without food. Once the medication is properly absorbed, it can better help clear acne. Even if you are taking the medication with a fatty meal and you are taking the generic isotretinoin, it can take 2-3 months for many patients to see results. Some patients do have an acne flare in the first month and your doctor should be contacted and made aware of your concerns so he or she can help you better.
