As the new school year approaches, now’s the perfect time to get your teenager’s acne under control. Or maybe yours, too. Adult acne is more common than you might realize. Dermatologists utilize an arsenal of ways to manage acne, from over the counter benzoyl peroxide wash to prescribed topical medications and oral antibiotics. One of the most successful treatments to attack acne is an oral medication called Accutane.
What is Accutane?
Accutane, also known as Isotretinoin, is a Vitamin A derivative that was approved in 1982 by the U.S. Food and Drug Administration to treat severe acne. Severe acne refers to deep, nodular and painful, cystic acne that can leave behind scarring. Other methods of treatment are often not as effective in treating this type of acne, but Isotretinoin is a possible solution.
According to the American Academy of Dermatology, there are four main factors that cause acne:
- Inflammation
- Propionibacterium acnes, or P. acnes for short (a known bacteria linked to acne)
- Clogged pores
- Sebum, or oil production from sebaceous glands
Other acne treatments actively work to reduce one or a few of these factors, but Isotreintoin is an effective treatment for counteracting all four of these factors.[1] This makes Accutane one of the best treatment options for severe acne.
“Typically, patients with treatment-resistant acne are placed on a 5-month course of Accutane, and after usually 2 to 3 months, most patients will begin to see a dramatic decline in the number of nodules and deep cystic lesions,” says Dr. David Pariser, our senior physician at Pariser Dermatology Specialists. However, the length of treatment can vary based on the patient. Oftentimes, individuals only need one round of treatment to resolve their acne and maintain this clearance. For some, a second round of Accutane might be necessary. This is not unusual for severe acne on the chest and back since these areas can be more difficult to treat.
Side Effects and Safety
Like any medication, Accutane has potential side effects. Isotretinoin works by reducing oil secretion. Some common side effects include:
- Dry Lips
- Dry Skin
- Nosebleeds
- Dry Eyes
- Joint Pain
- Increased Sun Sensitivity
However, most of these side effects are manageable with over-the-counter moisturizers, such as CeraVe and Cetaphil, and artificial tears, as recommended by the American Academy of Dermatology. For dry lips, Dr. Dan’s Cortibalm is a medicated lip balm that is excellent at keeping your lips hydrated. To prevent nosebleeds, placing Vaseline® in your nose can keep your nasal passages moist while taking Isotretinoin. In addition to helping your body maintain moisture while on Accutane, sunscreens of SPF 30 or higher should be applied during periods of prolonged sun exposure to protect your skin. All of these side effects should subside when you complete your course of treatment.
Headaches, night vision changes, and muscle aches are some rare side effects of Isotretinoin, as reported by the Mayo Clinic. When beginning the Accutane treatment, patients are required to enroll in the iPledge Program. Patients taking Accutane must see their dermatologist once a month. At every visit, your dermatologist will screen you for side effects, making sure you are tolerating Accutane well. If you are experiencing unusual side effects, your dermatologist will then be able to catch them early on and act accordingly.
While on Isotretinoin, there is also a possibility of increased levels of triglycerides and other liver enzymes (AST, ALT) in your body. Therefore, your dermatologist will order liver function labs before or at the start of your Accutane treatment to get a baseline. Then, labs will be completed again after 2 months of being on Accutane to ensure these levels are within the normal range.
Is Accutane Linked to Depression?
In the past, there were concerns that there might be a link between Isotretinoin treatment and depression. However, our senior physician Dr. David Pariser, and former President of the American Academy of Dermatology, testified in front of Congress in 2000 in support of Accutane as a safe treatment for severe acne. Moreover, the American Academy of Dermatology (AAD) reports that there is no proof of an evidence-based correlation between depression and Accutane. In fact, several studies have demonstrated that Isotretinoin treatment improves anxiety and depressive symptoms along with a patient’s quality of life.[2,3] Thus, the AAD strongly supports the use of Isotreitnoin as a treatment for acne.
Special Precautions for Female Patients Using Accutane
Accutane is a known human teratogen, meaning this medication can cause severe birth defects. Infants can be born with physical malformations and neurocognitive impairments if they are exposed to Isotreintoin during pregnancy.[4] So, “women who are pregnant or may become pregnant during therapy must never take the drug. To ensure this, there is a pregnancy program that has been developed by the manufacturer of the drug,” says Dr. David Pariser. The program, known as the iPLEDGE system, requires a negative pregnancy test from female patients 30 days before they begin treatment and every month during their course of treatment. A female patient will not be able to receive their medication until their pregnancy test is complete for the month. Additionally, women must pledge to use two forms of birth control, such as an oral contraceptive, IUD, male latex condom, and abstinence, for the entire time they are taking Accutane. Female patients are also strongly advised to avoid getting pregnant for one month after treatment is complete, allowing time for Isotretinoin to clear the body. These conditions of the iPLEDGE program guarantee no pregnancy is jeopardized due to Isotreintoin treatment.
Key Take-Aways
Accutane is a powerful weapon used by dermatologists to treat cystic acne. The requirements of the iPLEDGE program serve to minimize risk from uncommon side effects and teratogenic properties of Isotretinoin. You are required to follow the guidelines if you choose undergo Accutane treatment:
- Monthly Visits
- Lab Work (before/at the start of treatment and 2 months into treatment)
- Monthly Pregnancy Test (for females)
- Two Forms of Contraception (for females)
All of this can seem overwhelming, but do not worry. We are here to help! Each year, the physicians and medical practitioners at Pariser Dermatology Specialists guide hundreds of patients through their Accutane treatments. Call us at 757-622-6315 to schedule an appointment and find out if your dermatologist thinks Accutane is right for you.
Additional References
1.Layton A. (2009). The use of isotretinoin in acne. Dermato-endocrinology, 1(3), 162–169. https://doi.org/10.4161/derm.1.3.9364
2. Kaymak, Y., Taner, E., & Taner, Y. (2009). Comparison of depression, anxiety and life quality in acne vulgaris patients who were treated with either isotretinoin or topical agents. International journal of dermatology, 48(1), 41–46. https://doi.org/10.1111/j.1365-4632.2009.03806.x
3. Hahm, B. J., Min, S. U., Yoon, M. Y., Shin, Y. W., Kim, J. S., Jung, J. Y., & Suh, D. H. (2009). Changes of psychiatric parameters and their relationships by oral isotretinoin in acne patients. The Journal of dermatology, 36(5), 255–261. https://doi.org/10.1111/j.1346-8138.2009.00635.x
4. Choi, J. S., Koren, G., & Nulman, I. (2013). Pregnancy and isotretinoin therapy. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 185(5), 411–413. https://doi.org/10.1503/cmaj.120729
