When Stronger treatment is right for You?

You probably haven't been prescribed Roaccutane earlier because it's generally considered a good idea that more conventional treatments such as antibiotics and creams are tried first.
You do have to be careful whilst on your Roaccutane treatment, and follow the dosing guidelines very carefully. However, by following Dr Freeman's advice and the instructions in this notebook you should be able to break the vicious recurrent acne cycle with relative ease. Roaccutane is successful in curing acne in a large percentage of patients where other therapies have failed.

Acne is a common complaint

80% of Australians have at one time suffered from some form of acne. Of these, 5% suffer from very severe acne.
There are many misconceptions about acne, the main being that it's caused by junk foods and uncleanliness. Acne is a skin disease, and should be treated as such.
Recurrent acne can be treated and stopped. This isn't just so you can enjoy life today. You can also prevent long term scarring and pitting which may affect your life in the future.

What is ROACCUTANE?

The medical term for Roaccutane is isotretinoin and it is the only known cure for acne. It is essentially a substance that is similar to Vitamin A, but has a very different action. In short, Roaccutane works by reducing the oily substances in your skin, caused by oil producing glands. In turn, this reduces the amount of bacteria in the skin which is the cause of the inflammation and 'pus' associated with acne.
Roaccutane has also been shown to have an anti-inflammatory effect on the skin.

How long will I be taking ROACCUTANE for my Acne Treatment?

A full course of Roaccutane will vary from person to person. In most cases, treatment lasts for around 20 weeks. It may take longer. In over 80% of cases acne will be completely cleared so long as the dosage instructions are strictly followed.
In cases where a cure is incomplete, a second course of Roaccutane may be prescribed. However, this will only be considered after a two-month break. This is because the healing process often continues after Roaccutane is stopped.

Be aware of some expected side effects of your Acne Treatment.

Whilst on Roaccutane, you will experience some side effects. These include dryness in several parts of the body and possible tiredness of the muscles and bones. Side effect concerns are dealt with at length in the side effect section of this notebook.

ROACCUTANE can cause birth defects.

Under absolutely no circumstances should Roaccutane be used by pregnant women or by women who intend to become pregnant - during treatment and for one month after stopping Roaccutane therapy.
All possibility of pregnancy must be ruled out one month before and after you start your Roaccutane treatment. This should include the strict birth control methods.
One month after you've finished your treatment, life can continue as normal, only better.

Who's suitable for ROACCUTANE

Roaccutane is suitable for any person (male or female) with acne, regardless of age. The only people who shouldn't take Roaccutane are pregnant women or women who are breast feeding.
Dosage instructions you must follow on Roaccutane.

To gain the most from Roaccutane, it's important to follow your dosage instructions. It's also important that you do not miss your medication, or take too much. You should also try to follow the information given to you in the Lifestyle section in this notebook. This will help maximise the benefits of Roaccutane.

Follow Dr Freeman's Directions.

Dr Freeman has prescribed the dosage that is right for you, according to your weight and the severity of your acne.
To help you remember to take your Roaccutane treatment we have enclosed a fridge magnet.
This will remind you to take your Roaccutane. Remember, Roaccutane should always be taken with food.

Dosage and length of Therapy.

Your treatment with Roaccutane will usually last around 20 weeks, although it may be longer. You must:
· take Roaccutane with meals
· swallow the capsule whole and unchewed - either with water or a non-alcoholic drink
If you forget to take one dose, you should not make up for the missing does by taking double the medication the next time. You should always take your prescribed dose.
Dr Freeman has prescribed a specific dose for good reason. You must not alter the prescribed dosage because you think it is too weak or strong without consulting Dr Freeman.
Depending upon how you respond to Roaccutane, Dr Freeman may choose to increase or decrease your dosage. Only he or she should do this!

When you finish your ROACCUTANE Course.

It's important that you return any remaining capsules to Dr Freeman and not give Roaccutane to anyone else.
At the conclusion of your Roaccutane course, your skin should have cleared up significantly and your life will be all the better for it.
Birth control is vital for women on Roaccutane.

You must prevent yourself from getting Pregnant.

Whilst not every women taking Roaccutane will be sexually active, it is a vital issue that every woman or girl should know about regardless.
Roaccutane is teratogenic. Basically that means women of child bearing potential must use strict birth control methods to protect themselves against pregnancy whilst on Roaccutane treatment and for one month after stopping. This is because (as with many other medicines) there is a risk that an unborn child may become deformed. It also means if you were to become pregnant, you may be advised to have a termination.

Some Strict Guidelines.

Before you can begin your Roaccutane treatment, certain preventative measures must be taken:
· you will be required to take a pregnancy test before your Roaccutane course begins
· you must use strict birth control for at least one month before you start treatment and one month after stopping treatment.
· you should wait until the 2nd or 3rd day of your next menstrual period before you start your Roaccutane treatment.
· in the event that you do become pregnant whilst on Roaccutane treatment, stop taking it immediately and tell Dr Freeman.
Roaccutane has no effect whatsoever upon fertility as it does not affect the reproductive organs. (It is the developing baby, not you, that is at risk.)

Protecting Yourself.

It is your responsibility to not become pregnant whilst on your Roaccutane treatment.
To be sure, prior to the commencement of your Roaccutane treatment, Dr Freeman will request that you have a pregnancy test.
In this day and age, it's really quite easy to prevent yourself from getting pregnant if you are sexually active. If you're unsure, you should ring your doctor or your local Family Planning Clinic who are experts in this field. (Numbers are in this book.)
The most effective method of contraception is the oral contraceptive pill plus a barrier method (condom or diaphragm).

After your acne treatment, life returns to normal, only better.

One month after you've finished your course of Roaccutane, you will be free to conceive again, should you wish.
The small sacrifices you have made will pale in comparison to the improvements in your skin and general well being.

Expected short term side effects on Roaccutane.

Some short term readjustments.
With Roaccutane, you will probably experience some side effects. To what extent, varies from individual to individual.
However, in most cases side effects are minimal, particularly if you follow the advice of Dr Freeman and the information contained in this notebook.
The most obvious and frequent side effect of your Roaccutane treatment is dryness. This is dealt with thoroughly in the Lifestyle section.
Compared to the advantages of breaking the acne cycle, putting up with some of the side effects for a short period of time is really worth the effort.

Side effects are a positive sign.

If you do experience some of the expected side effects it proves that your Roaccutane treatment is working. Side effects are a normal part of the healing process.
You may suffer from an initial acne flare up. This is also an indication that your Roaccutane treatment is working. It is normal for your condition to get a little worse before it gets much better.
In the unlikely event that you do experience side effects that become intolerable, it could mean that your dose has to be altered. Do not do this yourself. You should consult Dr Freeman.

What are the Side Effects?

The most common and expected side effects are cracked lips and dryness of the skin. It is important that you take steps to manage this occurrence so as to avoid complications. How to manage this is dealt with thoroughly in the Skin Care section.
Other less common side effects resulting from your Roaccutane treatment are nose bleeds and dry eyes. Dryness of the eye can result in conjunctivitis. For this reason, people who wear contact lenses should change them regularly and avoid wearing them overnight or for too long.

Some rarely felt side effects you should know about.

Though most patients can carry on as normal, in a few cases some people have reported tenderness or stiffness in the bones and muscles. This can hamper strenuous physical exercise.
Other more serious (but rarely experienced) side effects include skin infections, peeling of the palms and soles, bleeding and inflammation of the gums, headache, weight loss, diarrhoea and an abnormal menstrual cycle. In some cases a thinning of the hair may occur. This is more prevalent in men.
All these conditions are important for you to know about, but will rarely happen. If they do, you should advise Dr Freeman.
It is important to remember that whilst there are some less common side effects, they are not permanent, and will reverse once treatment has stopped.

Pregancy and ROACCUTANE

The one thing that you absolutely must not do is get pregnant whilst on your Roaccutane treatment. This is because babies can experience birth defects. You must take all precautions to ensure that this does not happen.
However, one month after your treatment has ended, you will be able to conceive children again.

Skin care with Roaccutane.

This may cause pain on intercourse so a lubricant will help.

Dry Eyes.

You may find that during Roaccutane Treatment and for a time after you may suffer from dry eyes. This condition may be a problem if you wear contact lenses or work in an air-conditioned environment. Preservative free eye drops in convenient single use vials e.g. REFRESH(tm) are recommended for dry eye and helps soothe dry, irritated and tired eye and can be used whilst wearing contact lens.

Dry Skin.

Dry skin is an expected symptom and can occur all over the body. Keep showers short (if possible less than 2 minutes) and make them luke warm as hot water can irritate the skin. You should also try to avoid soaps. Consider using bath oils as an alternative.

Sun Sensitivity.

Roaccutane makes your skin more sensitive to the sun so you may burn more easily. You need to be properly protected. Cover up, wear a rimmed hat and a 30+ sunscreen (oil/alcohol free varieties). Don't sunbake or use a solarium.

Dry Scalp.

Dryness of the scalp and hair may also be experienced. To counteract this you should wash your hair with mild shampoo designed for dry hair. A conditioner should always be used. If dandruff becomes a problem, a medicated shampoo (tar based) may help. Avoid using hair dye products particularly those containing peroxide, as they may cause additional drying effects to the hair or possibly irritate the scalp.

Cosmetic for your condition.

It's advisable to use oil-free products while on Roaccutane. Most face powders are suitable, as are cover sticks.

COSMETIC SURGERY
If you're considering cosmetic surgery, it's advisable to wait 6-12 months after treatment is complete.

Dry Anus.

You may experience some dryness and irritation of the anal area. Apply Vaseline to relieve and reduce the symptoms several times daily.
Looking after yourself with Roaccutane.

Some Lifestyle adjustments to be made. There could be some general lifestyle changes that you may have to make whilst taking Roaccutane. However, with some minor modifications your life can run as normal.
Whilst on your Roaccutane treatment, it's important that you look after yourself and eat sensibly. This is so you can achieve the most successful therapy possible.
Some dos and dont's:
Don't drink an excess of alcohol.
Don't donate blood until at least four weeks after stopping treatment.
Don't take any Vitamin A supplements.
As with everyone going out in the sun, ensure you use a sunscreen. A 15+ or stronger product is best as your skin may be particularly dry and hence more sensitive than usual.

Some other factors to consider.

During your Roaccutane treatment, you should not take any tetracyclines. These are antibiotic products which you may have used in the past (including Doryx®, Minomycin® and Vibra-Tabs®).
Roaccutane can also affect you if you're involved in physical training. You may suffer muscle fatigue which can result in poor performance. As a result, you may want to delay your Roaccutane course until a more convenient time, or after a specific sports event you may be training for.
As a general rule, you should try to avoid contact sports as much as possible. You should also avoid applying preparations to your skin which could cause irritation. These include sports gels and arthritis creams.

Diet Information.

A guide to lower cholesterol and triglyceride levels.
Follow good eating habits. Broadly speaking, you need to:
¨ choose a nutritious diet from a variety of foods
¨ avoid eating too much fat
¨ eat more breads and cereals (preferably wholegrain), vegetables and fruits
¨ avoid eating too much sugar
¨ limit alcohol consumption
¨ use less salt
The National Heart Foundation of Australia makes the following recommendations as a guide to healthy eating by avoiding an excess of foods, which may raise blood cholesterol and or/ triglycerides.
1. Eat a Variety of Foods
Include a variety of foods in your diet, meals will be more interesting and you can take advantage of "in season" specials. By including foods from each of the following groups every day, you will benefit from nutritious eating:
¨ cereal and grain products (bread, breakfast cereal, oatmeal, rice, spaghetti)
¨ fruits and vegetables
¨ fish, lean meats, poultry, dried beans, peas and lentils
¨ low fat dairy products
¨ oils and spreadable fats (but only minimal amounts)
2. Maintain Normal Weight
Check your weight regularly to ensure you are not overweight. To help prevent and control overweight:
¨ eat less fat and fatty foods, sugar, confectionery and other sugar-containing foods and drinks
¨ limit alcohol intake
¨ fill-up with low kilojoule foods such as steamed vegetables, salads and water
¨ avoid "fad" or "crash" diets - they do not work long term
¨ say NO to seconds
¨ keep physically active
¨ read the National Heart Foundation's booklet "Guide to Losing Weight"
3. Eat Less Fats and Dietary Cholesterol
The amount of fat in the average Australian diet should be reduced by 25%. Particularly the amount of saturated (animal) fat and cholesterol.
¨ choose lean meat and poultry, trim excess fat
¨ use more fish or vegetarian dishes based on dried beans, peas or lentils
¨ use more low fat dairy products instead of full cream varieties
¨ eat fewer high fat foods; fried foods, fatty take-away foods, cakes, biscuits, pastries, chocolates, salad dressings, sauces
¨ select polyunsaturated oils and margarines
¨ only eat these foods sparingly - offal meats, prawns, squid, fish roe, eggs
4. Eat Less Salt
Most Australians use much more salt than is needed.
A reduction in salt intake may help prevent high blood pressure.
¨ add no salt to cooking or at the table; table salt, sea salt, rock salt, vegetable salt
¨ limit your intake of high salt foods; cured, corned, canned, luncheon meats, salami and meat pastes, smoked and canned fish, cheese, vegetable extracts, commercial sauces, MSG, many take-away and snack foods
¨ CHECK LABELS for salt or sodium - if available, choose brands containing "no added salt" (or sodium)
5. Eat More High Fibre Foods
Dietary fibre helps fill you up and high fibre foods are usually rich in many other nutrients.
¨ wholemeal breads and pastas
¨ wholegrain breakfast cereals
¨ wholewheat, corn, oats, barley, brown rice
¨ vegetables (especially dried beans, peas and lentils)
¨ fruits
¨ nuts and seeds (in moderation)
6. Eat Less Sugar
Sugar contains only non-essential kilojoules and may replace other more nutritious foods.
Limit the following:
¨ white, brown and raw sugar
¨ honey, jams, syrups
¨ confectionery, soft drinks
¨ cakes, biscuits, pastries, puddings, ice-creams
¨ fruits canned in syrup
¨ beer and sweet wines
It is recommended that you contact your nearest National Heart Foundation office for further information and ideas on how to put these suggestions into practice by using the National Heart Foundation Cookbook.

On ROACCUTANE your life is pretty much the same.

It's okay to do most things - unless told not to, by Dr Freeman, or advised against it, in the Roaccutane starter pack. (Driving, diving and flying are not a problem.)
It's important that you familiarise yourself with all the possible side effects (which are discussed in a separate section). To gain maximum benefits from Roaccutane, you must finish the entire course to cure your acne.

Contact Us at The Skin Centre.
By Telephone: +61 7 5597 7170
By  Fax:         +61 7 5597 7370