If you’re considering Accutane, it’s probably because you’ve tried every other acne treatment with little to no success.
Severe acne can have a devastating effect on your self-esteem. For many people, acne does not clear up after their teen years. Some people’s acne even gets worse in their 20s. However, you don’t have to keep suffering from acne. Clear skin is possible.
Isotretinoin is a potent prescription medicine with strict monitoring guidelines for patients, doctors, and pharmacists. Let’s look at what isotretinoin is, how it works, side effects, and potential results so that you can decide if it’s the right acne treatment for you.
What Is Isotretinoin (Accutane)?
Accutane is the brand name for the drug isotretinoin. Even though the manufacturer no longer sells Accutane in the United States, the generic versions are still commonly referred to as Accutane.
The medicine is used to treat severe cystic and nodular acne. Deep, painful, and long-lasting acne lesions are characteristics of cystic acne. Often, this type of acne covers the face and body and is resistant to treatment by most prescription topicals and oral antibiotics.
Isotretinoin is in a class of drugs called retinoids, which also includes tretinoin and Retin-A. It is a synthetic vitamin A derivative that patients take orally.
The primary cause of acne is excessive oil production that leads to clogged pores. Isotretinoin’s high dose of vitamin A treats acne in two main ways: it reduces sebum (oil) production and reduces cell shedding and stickiness. These two results lead to less material that can clog pores and a reduced propensity for cells to hold onto those pore-clogging materials.
Who Is A Good Candidate?
Good candidates for isotretinoin are people who have not had success with other acne medications. Your dermatologist may prescribe medications such as salicylic acid or erythromycin if you have not already used them. If none of those clear your acne, it may be time to try isotretinoin. Patients with severe cystic acne who are in otherwise good health are likely to tolerate isotretinoin well.
Women who are pregnant or who may become pregnant are NOT good candidates for Accutane.
What To Expect During Treatment
Your dermatologist will determine the appropriate treatment length and dose based upon your height, weight, and the severity of your acne. Most patients see dramatic improvements after 4 – 6 months of treatment. About 1 in 5 patients will experience a slight increase in acne lesions during the first month on the medication, commonly referred to as a “purge.”
Before you begin your treatment, you must register with the iPLEDGE online program. iPLEDGE is a risk management system that strives to prevent pregnancy in patients taking isotretinoin. One of the known side effects of the medicine is birth defects in fetuses whose mothers took isotretinoin while pregnant.
Women of childbearing age must commit to using two forms of birth control while taking isotretinoin. They must begin at least one month before starting treatment and continue until at least one month after stopping the drug. Before they begin their first month of treatment, women must have two negative pregnancy tests. They must also take a pregnancy test each month before they can fill their prescription.
Men must participate in the iPLEDGE program because of distribution reporting requirements. All doctors, patients, and pharmacists in the distribution chain must register with the iPLEDGE program. Each person has to participate in the program each month before you can fill your prescription.
The medication can increase a user’s blood cholesterol, lipids, triglycerides, and abnormal liver enzymes. All patients must have their blood drawn each month so that their dermatologist can monitor how well they are tolerating the medication.
Side Effects of Isotretinoin
Side effects are common among isotretinoin users, but most are minor and easy to manage. While taking the medicine, you may experience:
- Chapped, cracked lips
- Dry and cracked skin
- Dry eyes (contact wearers may not tolerate their lenses well while taking isotretinoin)
- Nosebleeds from a dry nasal lining
- Peeling of palms and soles of feet
- Sensitivity to the sun (be sure to wear sunscreen and limit your sun exposure while taking isotretinoin)
- Hair thinning (does not persist after stopping treatment)
Some patients start on a low dose for their first month of isotretinoin to minimize the intensity of their side effects. Your dermatologist can offer product recommendations to help manage any symptoms that you experience. For most patients, the side effects are very manageable and are an acceptable trade-off for clear skin.
Some rare but serious side effects can occur while taking isotretinoin. Contact your doctor immediately if you experience any of the following:
- Joint, back, or muscle pain
- Loss of bone density
- Difficulty swallowing
- Severe chest or abdominal pain
The side effect that worries patients the most is mood changes and thoughts of suicide. Less than 1% of patients experience mood changes, and there is not a consensus among researchers about whether isotretinoin is to blame. The vast majority of users tolerate the medicine very well and never experience psychological changes.
As a precaution, patients should have a friend or relative monitor their behavior while taking the drug. Immediately alert your doctor to any changes.
Isotretinoin is known to cause severe birth defects in fetuses of pregnant women. It is essential that you not become pregnant while taking isotretinoin. If you suspect that you may have become pregnant, stop taking the medication immediately, and contact your physician. It may also be possible for the medicine to pass to an infant through its mother’s milk, so women should not breastfeed while taking isotretinoin.
While taking the medication, your skin may become more sensitive. Do not have waxing, laser treatments, or dermabrasion while taking isotretinoin. You should wait for at least six months after completing treatment to resume these procedures. You should also avoid drinking, especially to excess, while taking the medication as it increases your risk for pancreatitis.
Success varies from person to person, but 85% of patients are clear at the end of treatment. Your skin may continue to improve in the months following your use. Many patients stay clear forever with no further need for acne treatment.
It is rare, but some patients may need a second round of isotretinoin. A benefit of taking isotretinoin is that your skin usually responds better to conventional acne treatments afterward.
Is Accutane Right for Me?
Only you and your dermatologist can determine whether isotretinoin is the right acne treatment for you. Isotretinoin is highly regulated, and filling your prescription is more complicated than other drugs. However, clear skin can be truly life-changing for people who have struggled with severe acne.
Schedule your appointment with Brentwood Dermatology today to learn more about isotretinoin.
Learn More About Brentwood Dermatology.
The trusted physicians at Brentwood Dermatology can assist you with all of your general, surgical, and cosmetic dermatology needs. If you would like to learn more about our services or schedule an appointment, visit our website or give us a call at (615) 377-3448.