Accutane - Isotretinoin

Isotretinoin (also known as Accutane) is a commonly used and effective acne medication.  It is available only from a physician with a prescription.  It is used primarily for severe, nodular or cystic acne, but may also be used in more moderate cases where the individual has shown resistance to other acne medications.

Accutane It is a synthetic (formulated rather than naturally occuring) retinoid derived from vitamin-A (retinoic acid).  The compound occurs naturally in the body (it is made in the liver), but the one taken for acne treatment is man made.  Accutane is typically taken once or twice per day for a period of 16 to 30 weeks (or 4 to 7 months).  Although this is the average treatment regimen, some may require a longer treatment schedule.  Accutane is suitable for use in children and adults.

To learn more about this treatment, contact your local acne physician.

How does accutane work?

• Accutane reduces sebum oil production and shrinks the sebaceous glands.
• Accutane reduces the occurrence of comedones and prevents new pimples from developing.
• Accutane dries out the treated skin, which stifles the growth of acne bacteria.
• Accutane also has anti-inflammatory properties to control acne infection.

When would my doctor prescribe accutane?

Acne physicians typically prescribe accutane in the following situations:

• Accutane may be prescribed when nodular or nodulocystic acne (i.e. where there are large deep lumps) is present.  This is severe acne.
• Accutane may be prescribed for very severe acne such as acne conglobata and acne fulminans.
• Accutane may be prescribed for severe inflammatory acne vulgaris.
• Accutane may be prescribed in cases which are resulting in acne scarring.
• Accutane may be prescribed in cases that have failed to respond to topical agents & oral antibiotics combined, or in hormonal treatments for women.
• Accutane may be prescribed in cases where relapses occur rapidly when another acne treatment is discontinued.
• Accutane may be prescribed when the acne condition has persisted for several years. 
• Accutane may be prescribed for problem acne in individual over 25 years old.
• Accutane may be prescribed when acne is having a significant adverse occupational, social or psychological effect on the individual.

Side Effects

Most or all of those treated with accutane experience some side effects.  Although Accutane is an effective drug for controlling acne, side effects can be severe.  The range and severity of side effects depends on the individual being treated and the dosage.  Those with contact lenses can have problems with dry eyes.  If you have eczema you may find that accutane worsens your condition.  Light skinned individuals get sunburned more easily, and athletes can have more than the usual muscle aches and joint pain. 

If side effects are too severe to take, normally the remedy is to adjust the dosage of the accutane.  In some cases, side effects may be severe enough that the individual needs to discontinue the use of the Accutane, and in this case, side effects will normally clear up within a few days to a month after the medication has been discontinued.   Discuss your side effects with your local acne physician.

Accutane (isotretinoin) can initially make your acne symptopms worse, but this is common with several other acne reatments as well.  Usually the initial flare-up lasts only a couple of weeks, but in cases it can last for several months. 

The majority of Accutane side effects affect the skin and/or mucous membranes:

• Dry and cracked lips (cheilitis) occurs in many accutane patients.
• Dry skin around the face, neck, arms, and hands occurs in many accutane patients.
• Dry nostrils occurs in many accutane patients.  Nosebleeds may also occur.
• Dry eyes occurs in many accutane patients.  Conjunctivitis and/or keratitis, an inflammatory condition of the cornea may also occur.  Those on accutane should not start wearing prescription contacts.

• Dry genitals and anal mucosa may occur.  Bleeding when having a bowel movement and a dry vagina may occur.
• Minor cuts and scrapes occur more readily and heal more slowly.  Accutane patients should shave rather than wax, because waxing can cause the top layer of skin to peel off.
• Some patients experience increased sweating.
• Facial redness and flushing: occurs in fair skinned accutane patients.
• Sunburn occurs much more easily especially for fair skinned patients.  Accutane patients should not be exposed to sun beds or sun lamps.
• Eczema (red itchy patches) may develop in some accutane patients.
• Impetigo may develop.  Impetigo, also known as "school sores", are yellow crusty patches around the lips and nostrils.
• Some hair loss may be experienced.  The condition is temporary and can be reversed after going off the accutane.
• Nail may become brittle and will grwo slowly.

• Mild headaches may occur.
• Muscle aches, especially after exercise, may occur. Backaches and joint pain are aslo common.
• Tiredness and lethargy are sometimes seen in accutane patients.
• Mood changes are sometims seen and in rare cases, depression.
• Patients may have eye problems at night.  Drivers may experience increased glare and it takes longer for eyes to adjust to light changes.
• Diarrhea is rare but can occur.
• Irregular or heavier menstrual periods can sometimes occur.

Drug Interactions

• Accutane should not be taken with Vitamin-A (retinoic acid) - side effects can be severe - but it can be taken with Beta-carotene (provitamin-A).
• Accutane should not be taken with tetracyclines (including doxycycline, minocycline, and tetracycline) - these may increase the risk of headaches and blurred vision due.

Other Considerations

Pregnancy - Accutane cannot be taken during pregnancy because of the very high risk of serious growth abnormalities in the baby.  It also cannot be taken while breastfeeding.

Blood Donation - Those on accutane should not give blood while they are on the drug and for four weeks afterward.

Some 50% of accutane patients respond well enough to the medication that the problem acne resolves.  Unfortunately, in the other half of patients, acne can recur anywhere from afew months to a few years after the accutane has been discontinued.