We all go through it at some point in our lives: acne — the red, angry-looking, pus-filled bumps on our faces, right in plain sight for everyone to see. Sometimes, acne can be managed by using over-the-counter treatments, but often we require help from doctors.
Severe acne can be difficult for teenagers and young adults and can have a damaging effect on self-esteem. When acne becomes this severe and difficult to manage, dermatologists often consider Accutane therapy as the next step.
What Is Accutane?
Isotretinoin — commonly referred to as Accutane, a previous brand-name — is a pill often prescribed to treat severe acne. The Accutane brand of isotretinoin is no longer on the market, but many other brand-name versions of isotretinoin are currently available.
“Isotretinoin is related to the vitamin A molecule and works on multiple factors leading to acne,” said Anar Mikailov, MD, an American Board of Dermatology certified dermatologist with Lahey Hospital & Medical Center. “Among other factors, isotretinoin shrinks oil glands, which is unique to isotretinoin and critical to the dramatic benefit seen with this therapy.”
Isotretinoin may be recommended for anyone who has large cysts on their face, chest or back, acne that is scarring, or acne that is resistant to many other treatments. It may also be prescribed to someone with less severe acne, that is ongoing for many months and not improving with traditional therapies.
A typical course of isotretinoin is six to twelve months. This course of treatment leads to full or near full resolution of acne for about 75 percent of patients, Dr. Mikailov says, adding that some people may require a second course of treatment.
What About the Side Effects?
Parents and individuals taking the medication often wonder about the side effects of isotretinoin for acne treatment. For example, a cursory Google search can lead you to numerous horror stories about the medication.
Dr. Mikailov recommends avoiding such online searches and going straight to your doctor to talk about the treatment and its potential side effects. Find a board-certified dermatologist to ensure that you are speaking with a highly-trained professional.
“Every patient is different and can respond differently to a medication,” Dr. Mikailov said. “As with all medications, there are side effects. The most common side effect is dry skin and lips.”
The medication can also worsen gastrointestinal symptoms, so if you have been diagnosed with ulcerative colitis, Crohn’s disease, or another condition affecting your gastrointestinal tract, talk with your doctor about whether isotretinoin would be right for you.
One of the major concerns about isotretinoin is that it will cause birth defects or a loss of pregnancy. Isotretinoin should never be used if a woman is pregnant or pursuing pregnancy due to severe effects on fetal development. Consequently, everyone who begins treatment with isotretinoin must sign up for the iPledge program, a monitoring program intended to eliminate fetal exposure to isotretinoin. The program requires regular doctor visits and two negative pregnancy tests before isotretinoin can be prescribed.
There are also concerns about isotretinoin leading to depression and suicidal thoughts, however research has not shown any direct relationship. If you’re concerned about mood changes while on the medication, keep an open dialogue with your doctor.
Your dermatologist can discuss the most likely side effects, along with the risks and benefits of treatment. He or she will also monitor you closely throughout treatment and be available to address your concerns.
“Isotretinoin is an effective and successful medication,” Dr. Mikailov said. “My patients have said they feel significant improvement in their self-esteem after this medication.”
If you still have questions — such as “What is isotretinoin?” and “Is it right for my child?” — Dr. Mikailov stresses discussing those concerns with a professional.
“It’s best to see your doctor to discuss treatment sooner rather than later to prevent scarring from severe acne,” he said.