Question: My acne is so bad I’m desperate to try Accutane – but I’ve heard scary things about its side effects. What’s the truth about this medication and how can I get rid of this acne once and for all?
Answer: First of all, the brand “Accutane” is no longer available so we should speak about it using its generic name which is isotretinoin. Isotretinoin is an acne medication that does resolve acne in most patients once and for all.
Isotretinoin is more mainstream than you think. While we do use it for severe acne and acne that just doesn’t resolve after we’ve tried many other well-known combinations of medication, both topical, oral and in combination; we also use it in patients who need to have perfect skin such as models, actresses, those in the public eye and in patients who are (frankly) really sick of having to deal with and look at their acne on a daily basis.
Although isotrentioin is approved only for severe cystic acne, it is really useful in less severe forms of acne to prevent the need for continuous treatment and repeated office visits those patients require. In my opinion, oral isotrentioin is warranted for severe acne, poorly responsive acne (acne that improves by less than 50% after 6 months of therapy with combined oral and topical antibiotics), acne that relapses off oral treatment or acne that induces scarring and psychological distress.
Isotretinoin is the only thing that I can tell you will cure a patient of acne. Generally speaking, a patient who we have treated with isotretinoin will almost certainly never break out to the same degree again. Most patients are pretty clear for usually up to 5 years after finishing the course. For those with acne and rosacea, oral isotretinoin has been shown to induce a full remission in many cases.
How I prescribe isotretinoin
I usually start patients at a half-dose (20-40 mg daily) to decrease flare-ups of the cystic acne and then increase it on a monthly based on the patient’s response. A higher dose based on a patient’s weight, increases the likelihood of a prolonged remission. While a usual course may be around 5 months, sometimes I extend the length, again, based on the patient’s response.
The major advantage to choosing isotretinoin treatment is reliability in almost all patients.
A course of isotretinoin leads to a remission that may last many months or years. Approximately 40-60% of patients remain acne-free after a single course of isotretinoin. About one-third of patients who relapse will need only topical therapy; the others sometimes need oral therapy. I often retreat patients with isotretinoin again because it is reliably effective and we can predict their side effects.
What you can expect while taking isotretinoin
Isotretinoin is a potent teratogen (affects a developing fetus) and causes severe birth defects if taken while a woman is pregnant. For this reason the medication is tightly regulated; both the prescriber and the patient need to be registered with the iPledge program in order for us to write the prescriptions and for the patient to receive them. What is important to remember is that use of isotretinoin does not affect future pregnancies; however, pregnancy is absolutely contraindicated while the patient is taking isotretinoin.
Although you may experience any of the physical side effects such as dryness, inflammation of the lips (chelitis), nosebleeds (epistaxis), sensitivity to the sun (photosensitivity), itchy skin, and many others, most are extremely manageable.
There have been many claims of adverse events from patients while taking this medication, so we monitor patients thoroughly during their course of treatment. These include elevations in blood cholesterol, gastrointestinal disorders, liver enzyme elevations, psychiatric disorders, visual and hearing impairment and others.
However, in all my years of prescribing the medication, I have rarely stopped the drug because of the side effects.
I do tell patients taking isotretinoin to:
- Avoid the sun due to hypersensitivity
- Avoid waxing and electrolysis due to skin sensitivity
- Use two effective forms of contraception
The truth is, when the patient is thoroughly monitored and all precautions are managed, isotretinoin is an extremely effective option for patients with the worst cases of acne and for those patients who acne is negatively affecting their lives.
I’ve even taken it myself – twice!