What is Accutane?

Accutane or Isotretinoin is a prescription medication prescribed by dermatologists to treat “severe, disfiguring nodular acne”. (mayo) Nodular acne is more commonly known as cystic acne. This medication is normally prescribed if the patient has not responded to ALL other treatment options. It is a type of retinoid and works to decrease facial oil(sebum) production. Cystic acne can lead to permanent scarring and disfiguring if left untreated as well as decreased self-esteem. Isotretinoin has long been a controversial medication due to risks involved in its use as well as a long list of side effects. Isotretinoin is a last resort. Dermatologists and skincare professionals can assist in determining the need. 

How does it work?

The brand name Accutane was discontinued in 2009. The generic version (Isotretinoin) is now marketed as various labels including Abscorbica, Claravis, etc. Isotretinoin is a strong form of Vitamin A. It works by decreasing sebum production in your entire body by decreasing the size of oil glands. This includes neck, back and chest. This decreases the occurrence of acne causing bacteria. It is extremely effective in the treatment of acne and allows for long-lasting effects. Most courses of treatment are 15-20 weeks. If severe acne returns, a second course may be started. However, there is a limit to treatment courses. 

As powerful as it may be, Isotretinoin has the potential to cause serious side effects. Huge benefits vs serious risks. For those prescribed this drug, close monitoring is a must! Monthly check-ins are required and enrollment in the government registry iPLEDGE. iPLEDGE is a program designed to prevent women from becoming pregnant while on this drug as it can cause SEVERE birth defects. Female patients must promise to use 2 types of birth control with monthly blood tests to check for pregnancy. Male patients also sign onto iPLEDGE but to monitor liver function monthly with a blood draw. Monthly prescriptions are only given if the above is followed. 

What are the risks?

Psychiatric risks including depression and suicide are amongst the most concerning side effects experienced by some taking Isotretinoin. High doses of vitamin A can cause headache, depression, irritability, aggression, and psychosis. This is a syndrome called hypervitaminosis A. Several studies and clinical trials are continuously researching the possible link between this drug and depression. The FDA does report a high frequency of individual case reports of depression and suicide linked to Isotretinoin. Other studies argue the fact that severe acne itself often lowers mood and damages self-esteem. Emotional or psychosocial scarring resulting from untreated cystic acne alone can cause depression, suicide ideation and suicide.   

In general, patients taking isotretinoin and have symptoms of depression should immediately notify their physician. Close monitoring monthly and the use of iPLEDGE aid in seeing changes in patients mood or mental well being. For so many acne sufferers, this is the ONE treatment that works and can be life changing. It is not a decision to be made lightly. Having a trusting relationship with your dermatologist and professional skincare team, helps to determine when and if the patient truly needs Isotretinoin. Again, do the benefits outweigh the risks? 

Most common side effects:

• Dry lips/mouth or cracked skin on lips
• Minor swelling of eyelids 
• Nosebleeds
• Upset stomach 
• Thinning of hair

Severe, less common side effects:

• Highly teratogenic (causes severe birth defects)
• Mental/mood changes such as depression, anxiety or thoughts of suicide
• Painful swallowing
• Peeling skin on palms/soles of feet
• Back/joint/muscle pain 
• Signs of infection
• Liver function issues
  

While the physical experience of severe cystic acne is painful and frustrating the mental aspect of remaining confident can be a hard path to navigate. Check out our blog about self esteem and remaining confident in a world emphasizing unrealistic beauty standards through the 24/7 media cycle.

References

Mayoclinic.org

 Drugwatch.com

 Health.harvard.edu

 Healthline.com

Fda.gov

WebMD

Sciencedaily.com