Severe Acne Treatment: The Truth about Isotretinoin (Accutane)

“ACCUTANE” vs. “ISOTRETINOIN”

Accutane was created and marketed for decades by Roche Pharmaceuticals. However, the “name brand” Accutane is no longer available and instead, new formulations of the same medication have been developed of its generically known name: isotretinoin. For the purposes of discussion, however, I will use the name “Accutane” because of its name recognition.

Accutane is the most effective medication for the treatment of severe acne. Severe acne (cystic or nodular acne) is classified as painful breakouts deep in the skin and if left untreated, it can cause permanent scarring. You are most likely to have severe acne in your teens or early 20s with most breakouts on your face, chest, or back – however; acne is frustrating no matter what age.

HOW DOES ACCUTANE WORK?

Accutane is a vitamin A-based medication that reduces sebum (your body’s natural oil) production by shrinking oil glands, slowing down cell production inside pores and killing acne-causing bacteria. It prevents new acne from forming, while healing current breakouts. Treatment with isotretinoin often results in prolonged clearance of acne, which can be permanent for some patients.

IF IT WORKS SO WELL, WHY CAN’T EVERYONE TAKE IT?

Since Accutane essentially halts oil production, dry skin and chapped lips are almost a given. However, there are serious side effects that can happen if not used safely. Because it is such a powerful medication, Accutane is dispensed only under the rules of iPledge, a government regulated prescription program.

SIDE EFFECTS

Before prescribing isotretinoin, an assessment of the patient’s physical and mental health is documented. An important determining factor when considering Accutane is to consider how the side affects of may interact with health issues that you already experience. The most common side effects include:

SEVERE BIRTH DEFECTS*

• Increases the risk of experiencing depression and/or anxiety *

• Increases the risk of liver damage, high triglycerides, and pancreatitis.

• Headaches and vision changes.

• Muscle aches after exercising may be more pronounced.

• Accutane can cause severe dryness of the skin. Accutane patients are advised to use a moisturizer and avoid direct contact with the sun.

PATIENT MONITORING & SIDE EFFECTS

While on Accutane, patients are required an office visit every 30 days, plus lab monitoring (blood work) before they can receive their next 30 day supply of medication. Monthly office visits allow examining for early warning signs of possible side effects and determine how well the medicine is working. Most of the side effects are manageable, however, pregnancy and isotretinoin are non-negotiable. Women must not get pregnant right before starting Accutane, while taking it AND for one month after your last dose. Even if you are not sexually active, you will still need to follow all the requirements of the iPLEDGE program in which they promise to use both a primary and secondary method of birth control for the duration of their treatment and a minimum of 30 days post treatment. Even one dose of can cause severe birth defects.

The second most important side effect: Depression/Suicide. Many people worry that isotretinoin can cause mental health conditions. There have been reports of patients developing depression, having thoughts of suicide while taking isotretinoin, and unfortunately acting on those thoughts. We, as dermatologists, take these reports very seriously, which is why research studies are being conducted to find out whether isotretinoin is directly responsible for feelings of depression.

One reason is- research shows that people who have severe acne often become depressed whether they have taken Accutane or not. Because we do not have enough evidence to tell whether this medicine IS the cause of depression and other mental health conditions, we carefully monitor our patients for warning signs of depression and other mental health conditions. Fun Fact: Patients treated for their acne often reported a higher quality of life and a boost in self-esteem once their skin began to improve.

TAKEWAYS

Acne is one of the most frequent skin conditions I see in my office on a daily basis and treating it is a relatively slow process- there is no overnight remedy. Although highly effective, Accutane has received a bad reputation through publicity that is frequently exaggerated. Dermatologists have been prescribing this medicine for years. In fact, dermatologists led many of the clinical trials for isotretinoin, making dermatologists very familiar with the medicine and knowledgeable about whom it can help. Dermatologists are committed to the safe and responsible use of this medicine. Patient safety is our first priority when prescribing isotretinoin.

If you would like to schedule a consultation to see if Accutane is a treatment option for you, please call our office today: 985-400-2756

Any concerns about changes in mood, signs of depression, or suicidal thoughts. Concerns about suicide should be considered a medical emergency.