ACCUTANE (Isotretinoin) for Treatment of Severe Acne

Accutane, or more correctly known by its generic name, Isotretinoin, is a prescription medication used for acne treatment. The medication is prescribed to those with severe acne or acne that is very resistant to standard therapies.

The exact mechanism of action of the medication is unknown. On the simplest level, we do know that it helps decrease oil and sebum production by impeding the function of the sebaceous glands (microscopic glands in the skin that secrete a waxy matter called sebum that contributes to acne).  The results are often-times no less than astounding; dramatically altering the disease course for the better and, for a large number of patients, curing them of their acne.

As wonderful as Isotretinoin treatment is, it is a serious medication with some controversy and can potentially have negative side effects and associations.

Here are some of the basic, more common, controversial and detrimental.

  • Dry Skin: Most people experience very dry skin, dry eyes, dry mouth, dry lips.  So much so, that I tell patients to carry a travel moisturizer and a lip balm wherever they go.
  • Stomach Upset: Stomach upset can be common. Several studies have associated the use of Isotretinoin with some form of Irritable Bowel Syndrome (most likely ulcerative colitis).  This is a concern, but more complete studies must be done to determine an actual causation.
  • Impact on the Liver: The medication is metabolized by the liver and can be damaging. Liver enzymes, along with other blood tests, are checked on a monthly basis while on the medication to make sure there is no abnormal activity. Liver enzymes can be affected if too much of the medication passes through the system, if the patient is drinking alcohol, or if they are on other concurrent medications that also create stress on the liver.
  • Monthly Monitoring: The treatment is contraindicated for females while pregnant or trying to get pregnant due to the high likelihood that the medication will cause birth defects. This is such a concern, that the medication is monitored by a government run program called iPledge (www.ipledgeprogram.com) which aims to protect patients from becoming pregnant while taking the medication by monitoring results through a monthly blood test. This does not mean that children will have birth defects if they are conceived after the treatment period has ended.  It is however recommended to wait a month before trying to get pregnant afterwards.
  • Impact on Mood: The potential to cause depression and the increased risk of suicide are arguably the most controversial and detrimental side effects associated with Isotretinoin.  It is always our goal to treat the whole patient and keep our patients safe. We recommend that our patients tell their family and friends that they are on the medication, communicate with them regularly so they can alert us if any mood swings occur.  We also require those with any previous psychiatric history to be concurrently seen by a therapist or psychiatrist.  We recommend that all patients keep their monthly visits so we can check in with them personally to detect any subtle changes in mood.  In addition, we encourage patients to call us during the month so that if there is ever a concern about this medication that they know they can reach out to our health care team and we will promptly respond.

Isotretinoin is not for everyone. It requires commitment and determination by way of monthly blood testing, monthly office visits, attention to alcohol consumption, acute awareness of emotional state, open communication with family, friends, and your practitioner. Having said that, it should be something that is discussed with your dermatology provider if you are experiencing severe acne or your acne is resistant to all other treatments.

 

Dominic Moccia, RPA-C

Chelsea Skin & Laser