Acne Treatment | Isotretinoin, Topical and Oral Medications

Acne medication is prescribed through online consultation.

From topical medications and oral medications to isotretinoin. Consultations are available daily from 9:00 to 22:00, with same-day shipping possible.

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Acne medications (topical, oral, isotretinoin) are prescribed after you purchase your desired medication, undergo a medical questionnaire and a video consultation with a doctor, and if deemed appropriate for prescription (private medical care).

What is acne (acne vulgaris)?

Acne (acne vulgaris) is a chronic skin condition caused by clogged pores with sebum, proliferation of acne bacteria, and inflammation. Recent advances in acne treatment mean that many people can aim for symptom improvement with appropriate topical and oral treatments (individual results may vary).

Self-care and over-the-counter drugs have limitations

There are many cases where acne worsens due to excessive face washing, insufficient moisturizing, or ineffective over-the-counter drugs. Prescription drugs (such as adapalene and benzoyl peroxide) can be used under a doctor's supervision for acne that is difficult to treat with over-the-counter drugs, and appropriate treatment can lead to improvement (individual results may vary).

Mechanism of acne formation

Acne occurs when the following four factors overlap:

• Excessive sebum secretion (hormones, stress, genetics)
• Clogged pores (keratinization abnormalities block pores)
• Proliferation of P. acnes (proliferates in anaerobic environments, feeding on sebum)
• Inflammation (immune response to P. acnes)

Types and stages of acne progression

The ideal time for treatment is at the "comedone (whitehead/blackhead)" stage, before inflammation occurs. As acne progresses to red pimples, the risk of scarring increases, so consider treatment appropriate for your symptoms as soon as you notice small pimples.

Acne severity classification and overall treatment approach

Acne treatment options vary depending on the severity. Let's first organize the overall picture.

You can start treatment that matches your stage.

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Treatment Options

Topical medications (daily basic treatment)

Adapalene and benzoyl peroxide can cause redness, peeling, and dryness in the first 1-2 weeks. This usually improves within about 2 weeks as the skin adjusts. The key is to start with a small amount applied once a night, while moisturizing thoroughly.

Oral Medications

Long-term use of antibiotics carries a risk of antibiotic resistance, so use for a maximum of 3 months is generally recommended. Combining them with topical medications (especially benzoyl peroxide) can help prevent resistance.

Options for severe and intractable cases: Isotretinoin

For moderate to severe acne that shows insufficient improvement with topical medications or oral antibiotics, or extensive nodular acne with a high risk of scarring, we offer isotretinoin as a private treatment. Isotretinoin is an unapproved drug for acne treatment in Japan and is not covered by insurance. At our clinic, under the responsibility of the doctor, we will provide a thorough explanation of its contents, effectiveness, and serious risks (especially teratogenicity) before offering it as a self-pay treatment. Effects and side effects vary from person to person.

What is Isotretinoin?

Isotretinoin works by suppressing sebum production and shrinking the size of sebaceous glands. It is also believed to be effective for moderate to severe acne due to its ability to normalize keratinization and its anti-inflammatory effects. It has been used as a standard treatment for severe acne in many countries, including the US and Europe, since the 1980s.

Who is recommended to use it?

• Individuals with extensive nodular acne (to minimize scarring)
• Individuals suffering from moderate to severe acne
• Individuals whose acne treatment with antibiotics covered by insurance has been ineffective
• Individuals with excessively oily skin
• Individuals experiencing mental or physical discomfort due to acne

Who cannot use it or requires careful consideration?

• Those who are pregnant or may become pregnant
• Those planning conception (including men) or who are breastfeeding
• Those with allergies to this drug or vitamin A
• Those with severe liver or kidney dysfunction
• Those with high triglycerides, those undergoing treatment for dyslipidemia, or those with a history of pancreatitis
• Those currently taking tetracycline-based antibiotics (doxycycline, minocycline, etc.)
• Those with a history of mental illness such as depression (will be carefully evaluated)
• Those with a history of inflammatory bowel disease (Crohn's disease, ulcerative colitis)
• Those scheduled for major surgery
• As per our clinic's policy, individuals under 18 or over 70 years old

Pre-treatment and during-treatment examinations

Isotretinoin can affect triglyceride levels and liver function, so blood tests will be conducted before and during treatment. Pregnancy tests will also be performed for those who may be pregnant. Information on testing methods will be provided during your consultation.

Important considerations when using

Isotretinoin is teratogenic (there is a risk of birth defects if taken during pregnancy). It should never be used by pregnant women or those who may become pregnant during treatment.

• Strict contraception must be practiced for at least one month before starting, during treatment, and for one month after treatment.
• It is recommended to start taking the medication on the 2nd or 3rd day of a normal menstrual cycle.
• Avoid taking supplements containing vitamin A (as their combined effects can lead to stronger side effects).
• Limit alcohol consumption during treatment as it can increase triglycerides.
• About 10-20% of individuals may experience a temporary worsening of acne at the beginning of treatment, but it usually improves within about one month.
• During and after treatment, discomfort with contact lenses may increase due to dry mucous membranes.
• The skin becomes thinner and more susceptible to injury, so avoid waxing, strong chemical peels, and laser treatments during treatment.
• Do not donate blood during treatment and for one month after discontinuation.
• Symptoms such as depression, psychiatric symptoms, and rarely suicidal ideation have been reported (the mechanism of action is unclear). If you experience changes in mood, seek medical attention immediately.

Avoid co-administration with tetracycline antibiotics

Concomitant use of isotretinoin and tetracycline antibiotics (doxycycline = Vibramycin, minocycline = Minomycin, etc.) is known to increase the risk of intracranial hypertension (pseudotumor cerebri). If you are prescribed antibiotics by another clinic, please be sure to inform us.

The following symptoms are early signs of intracranial hypertension. If they appear, stop taking the medication and contact us immediately for a consultation.

• Severe or persistent headache
• Nausea/vomiting
• Blurred vision, visual field abnormalities

Main side effects

Side effects are dose-dependent and can sometimes be reduced by lowering the dose (excluding teratogenicity).

• Teratogenicity
• Temporary worsening of acne in the initial stage of treatment (approx. 10-20%)
• Dryness or dermatitis of the lips and face, dry nose and nosebleeds, dry eyes, light sensitivity (protect with lip balm, moisturizer, artificial tears, sunscreen)
• Temporary hair loss, reduced night vision, muscle and joint pain
• Increase in triglyceride levels and liver function values (confirmed by blood test)
• Potential for pancreatitis due to high triglycerides
• Intracranial hypertension (see above)
• Depressive symptoms, suicidal ideation
• Worsening of inflammatory bowel disease, diarrhea

Dosage目安

*The dosage will be determined individually by the doctor, so please consult us via official LINE. The following is a general guideline:

• Initial: 0.5-1mg per kg of body weight, divided into two doses per day (maximum 2mg per kg of body weight).
• Maintenance: 0.5-2mg per kg of body weight, divided into two doses per day. Treatment duration is 16-20 weeks (may be terminated earlier if the number of nodules decreases by 70%).
• Cumulative dose is considered important, with a cumulative dose of 120mg/kg or more associated with better long-term remission (achieved with 1mg/kg of body weight in approximately 4 months).
• If re-treatment is necessary, it is determined at least 8 weeks after the previous treatment ends (because improvement can continue even after discontinuation).

How effects manifest

For those suffering from severe and recurring acne.

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Precautions regarding unapproved pharmaceuticals, etc. (Isotretinoin)

• Unapproved drug: Isotretinoin is an unapproved drug in Japan for the treatment of acne.
• Method of acquisition: The physician imports the drug after completing the necessary procedures for personal import (obtaining a Yakkan Shoumei from the Ministry of Health, Labour and Welfare).
• Availability of approved domestic drugs: Approved acne treatments in Japan include adapalene, benzoyl peroxide, topical antibiotics, and oral antibiotics. There are no domestically approved oral medications with the same active ingredient.
• Information on safety, etc., in other countries: Isotretinoin is approved as a treatment for severe acne in many countries, including the United States and Europe, and has been in use since the 1980s. However, due to its strong teratogenicity, it is managed under strict pregnancy management programs in various countries, and reports of depression, suicidal ideation, intracranial hypertension, and inflammatory bowel disease have been noted.
• Health damage relief system: Health damage caused by the use of unapproved drugs is not covered by the Pharmaceutical Side Effect Relief System.
• Cost/Effectiveness: Since this is an out-of-pocket treatment, health insurance does not apply, and you are responsible for the full cost. The degree of effectiveness varies from person to person.

Characteristics and Causes of Adult Acne

Adult acne, which occurs after the age of 20, has different characteristics than adolescent acne.

Characteristics

• Commonly found around the jaw, mouth, and jawline (U-zone)
• Difficult to cure and prone to recurrence
• Often worsens before menstruation
• Worsens with stress, lack of sleep, and an unbalanced diet
• Involves hormonal balance (PCOS, stress-related)

Aggravating Factors

• Hormonal imbalances (menstruation, pregnancy, changes in birth control pills, etc.)
• Stress and lack of sleep
• Excessive intake of high-GI foods and dairy products
• Irritation from cosmetics and skincare products
• Dry skin (excessive washing, insufficient moisturizing)
• Humidity and friction from masks (maskne)
• Drug-induced (steroids, lithium, etc.)

For those whose acne consistently worsens before menstruation, low-dose birth control pills may lead to an improvement in acne. Please consult us during your examination.

Addressing Acne Scars

Acne scars are broadly divided into three types, each requiring a different treatment approach.

Once crater-like scars form, they are difficult to treat, so the best prevention is to treat the acne early to avoid scarring. Begin treatment at the red acne stage.

Basic Correct Skincare

Face Washing

• Wash twice a day (morning and night) gently, using plenty of lather created with a foaming net.
• Rinse thoroughly with lukewarm water.
• Do not scrub or wash too frequently (this can lead to excessive sebum secretion).
• After washing, gently pat your face dry with a towel.

Moisturizing

• Moisturizing is essential even for acne-prone skin (dryness can actually increase sebum production).
• Choose non-comedogenic products that are low in oil and high in moisture.
• Use lotions and emulsions containing ceramides and hyaluronic acid.
• Avoid oil-based products as they can clog pores.

Sunscreen

• Sunscreen is essential, especially during acne treatment, as UV rays worsen hyperpigmentation.
• Choose non-comedogenic, low-oil formulas.
• Use SPF 30 or higher and PA++ or higher daily.

Acne Prevention through Lifestyle Habits

Diet

• Limit high-GI foods (white rice, bread, sugar).
• Avoid excessive intake of dairy products (especially skim milk).
• Eat a balanced diet of vegetables, fish, soybeans, and fermented foods.
• Focus on B vitamins, zinc, and dietary fiber.
• Drink over 1.5 liters of water daily.

There is no established evidence that chocolate or fried foods directly cause acne. Rather, high-GI foods (foods that rapidly raise blood sugar) are considered to have a higher correlation. Extreme dietary restrictions are not necessary, but limit refined sugars and sugary drinks.

Lifestyle Habits

• Sleep 7 hours or more, avoiding staying up late if possible.
• Promote metabolism with moderate exercise.
• Manage stress (yoga, deep breathing, hobbies).
• Wash pillowcases and towels frequently.
• Keep hair away from your face.

Actions to Avoid that Worsen Acne

• Popping pimples (spreads inflammation, causes scarring)
• Touching or picking with fingernails
• Washing face multiple times a day
• Using alcohol-based disinfectants on the face
• Daily use of strong scrubs or peels
• Neglecting to moisturize
• Trying multiple over-the-counter medications or supplements
• Applying topical steroids to acne (worsens it)

Prescription Process at Our Clinic

You can start today.

Acne treatment medications are prescribed via online consultation.

Order Online

Acne treatment medications (topical, oral, isotretinoin) will be prescribed after you purchase your desired medication, complete a medical questionnaire, and undergo a video consultation with a doctor who determines if it is appropriate for prescription (out-of-pocket treatment).

Frequently Asked Questions

Reference

Based on guidelines such as the Japanese Dermatological Association's "Guideline for the Treatment of Acne Vulgaris and Rosacea".

Related Pages

• Isotretinoin (Product Page)
• About Beauty Skin Oral Medications and Skincare
• About Whitening (Pigmentation Care)
• Low-Dose Birth Control Pills and Emergency Contraception
• About Online Consultations／About Pricing