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If you’ve struggled with moderate to severe acne, including cystic or nodular acne, you know that many common acne treatments aren’t effective for everyone. Fortunately, the physicians at U.S. Dermatology Partners commonly prescribe Accutane (isotretinoin) for the treatment of those patients with acne that is unresponsive to other therapeutic options.
Accutane is the brand name that most people use when referring to the oral acne medication isotretinoin. Isotretinoin is a derivative of vitamin A, which naturally occurs in our own bodies. This medication has been around for decades and continues to be the absolute best treatment for acne, particularly for moderate to severe cases. The original medication brand, Accutane, is actually no longer available, but the name has stuck. When you receive your Accutane prescription, you may see it listed simply as isotretinoin or a number of other brand names, including Asorica®, Claravis®, Sotret®, Amnesteem®, Myorisan®, and Zenatane®.
While there are known potential side effects of Accutane, short-term use is effective in clearing moderate to severe acne. Many patients have limited side effects from this medication, and your doctor will discuss those with you prior to treatment. Accutane is a safer and more effective long-term option compared to the use of antibiotics and other acne medications.
Isotretinoin has been used in treating moderate to severe acne since the early 1980s. It’s a powerful medication that is effective for any type of acne breakout. It is typically recommended for those who have acne breakouts that aren’t responding to other treatments as well as for those who struggle with severe cystic and nodular acne. These moderate to severe forms of acne are often painful, and they have the greatest risk for scarring and other adverse health risks associated with acne. For these reasons, it’s essential that patients partner with a dermatologist when utilizing a treatment option like Accutane.
Patients will be closely monitored when first starting the medication by their doctor, and they may need to adjust other medications to avoid complications. To ensure your health and safety, a dermatologist will ask you to take a number of steps while using isotretinoin in order to avoid potentially adverse effects, including scheduling regular follow up visits and avoiding pregnancy. When taking Accutane, patients of childbearing potential must be monitored with monthly pregnancy tests. Accutane causes significant birth defects and should never be used in patients who are pregnant or trying to become pregnant.
In addition to acne management, isotretinoin may be used to treat other skin conditions, including hidradenitis suppurativa (acne inversa), rosacea, sebaceous hyperplasia, lamellar ichthyosis, and gram-negative folliculitis.
Accutane is an oral, prescription medication that is typically completed over a course of six to nine months, depending on the patient’s acne improvement and total dose of the medication administered over time. Administration of isotretinoin is based on weight, so your treatment time will fluctuate. Your doctor will balance your daily dose with the side effects you may experience. Side effects of this medication are related strictly to the dose. If you lower the dose, your side effects will improve. However, the overall success of this medication in treating your acne is related to how much total medication you take. If you lower the daily dose, you will need to complete treatment over a longer period of time to receive the total dose. Your doctor will work with you to balance this out. During your initial consultation with the dermatologist, they will provide treatment guidelines, but these initial recommendations can be continually updated depending on your response to treatment.
You will take the prescription medication one to two times a day, depending on your dermatologist’s recommendation. Accutane is proven to be more easily absorbed when taken with fatty food, so it’s typically recommended that you take your medication with fatty food (ice cream, peanut butter, etc.). In the first month, some patients may feel their acne is becoming worse. This flaring is common in the first month. The most noticeable changes in the condition are seen around the third or fourth month of treatment.
Throughout the time you’re taking isotretinoin, you will need to visit the dermatology office for follow up visits at monthly intervals. This frequency of visits is mandated by the government program which regulates the dispensing of the medication. Studies indicate that about 95% of patients who complete their prescribed isotretinoin treatment will see clearance. Of the 5% who do not achieve their desired result after one course of treatment, 50% are able to achieve acne clearance after a second round of medication.
Vitamin A is not water-soluble, so excess levels of vitamin A can build up in the body’s tissues, sometimes causing health concerns. When taken in appropriate doses, Accutane is removed from the body within nine days and has no long-term health effects.
There are multiple potential side effects of Accutane treatment that your physician will review with you. It is currently recommended that patients who are initiating treatment with Accutane (isotretinoin) should have their liver and cholesterol numbers checked prior to starting, 1-2 months into starting, and anytime there is an increase in the dosage of the medication during their treatment course. As is the case with other medications, most side effects of treatment are mild, but there are some more serious adverse effects that need to be addressed right away.
The most common side effects, which almost every patient will experience, are dry/chapped lips and dry skin.
Other common, mild side effects of isotretinoin treatment include:
If you notice any of these mild symptoms, your dermatologist will be able to help you manage them during treatment, and the majority of patients see total symptom relief once their course of treatment ends. In rare cases (less than 1%), isotretinoin users reported emotional and mental health side effects, including mood swings, irritability, suicidal ideation, and depression. While this is not common, if you do experience these types of issues, you should contact your dermatologist and/or a physician or mental health care provider immediately. It may be required that you decrease your dose of the medication or come off of the medication entirely.
Liver damage due to increased blood fats is also possible while taking Accutane. For this reason, it’s important to avoid consuming alcohol during your isotretinoin treatment as processing alcohol is also very taxing and possibly damaging to your liver. Blood tests during isotretinoin treatment will help to detect these issues.
For women, it’s important to avoid becoming pregnant while taking Accutane since this drug causes birth defects. During treatment, you will be asked to take a pregnancy test each month before starting your next round of medication. This testing helps to minimize the risk of birth defects and other pregnancy complications. Additionally, women are asked to agree to use two forms of preventive birth control to further minimize risk during treatment and for at least one month after discontinuing isotretinoin use.
Other considerations to minimize side effect risk from Accutane treatment include, limiting sun exposure and using sun protection to offset the increased photosensitivity. Headaches are common, but they are typically mild and respond to over the counter pain relief medications. Due to muscle and joint pain that may occur, exercise routines should be minimized or adjusted to avoid unnecessary strain and discomfort.
After the six to nine month treatment period, most patients see long-term acne clearance. For about one-third of patients, this clearance is permanent. For another third of patients, they will see long-term clearance of moderate to severe acne, but they will have milder acne return which can easily be treated with topical medications. While patients may still develop a few pimples periodically, they typically do not experience severe breakouts. Some may experience more serious flareups again after a few years, and uncommonly, some patients may need another round of Accutane treatment to fully control their acne. Because Accutane is a treatment option that offers long-lasting results, it may be considered a good alternative for daily, prolonged use of antibiotics and other drugs to control acne.
*Results may vary by individual