Patient discussions
Before starting therapy, it is important to discuss realistic expectations with patients. It can take at least 4-8 weeks before a response is seen with any acne therapy; the full effects of treatment may take several months and symptoms may flare after initiating treatment.
Counsel patients on the importance of adherence to treatment, even if they are not seeing an early response.[34] Even with the best treatment, patients may continue to get occasional acne lesions.
Patients should be advised that there is insufficient evidence to support specific diets for treating acne.[34]
Isotretinoin
Before treatment with isotretinoin, patients require counselling about the possibility of adverse effects and the need for liver function and lipid tests.[34][36]
Severe headaches, decreased night vision, significant liver enzyme or lipid elevations, or signs of adverse psychiatric events should prompt the patient to seek medical attention. Instruct patients not to donate blood during treatment or 30 days thereafter. Advise women that isotretinoin causes birth defects; they should undergo pregnancy tests before starting, and monthly while taking the drug.
Dry skin and chapped lips are very common, and lip and skin moisturisers may be considered.[89]
Occasionally, more than one course of isotretinoin is needed for desired results.
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