Severe acne can be a painful, embarrassing condition that may cause scarring. If other medications fail to control your acne, your doctor may recommend isotretinoin (Absorica, Amnesteem, Claravis, Myorisan, Zenatane). While usually effective for clearing acne, this powerful medication is associated with side effects and potentially serious risks, including birth defects if taken during pregnancy. Isotretinoin might also increase your risk for depression and serious bowel disease. As with any medication, weighing the risks and benefits is important in deciding whether this treatment is a good option for you.
Isotretinoin and Pregnancy Don't Mix
Isotretinoin is a pregnancy category X drug, which means there is clear evidence the drug can harm a developing baby if taken during pregnancy, and that risk outweighs any possible medication benefits. Isotretinoin use during pregnancy increases the risk for miscarriage, stillbirth, premature birth and serious birth defects. Because of these risks, your doctor cannot prescribe isotretinoin unless you register with iPLEDGE, a program designed to make sure women are not pregnant and do not get pregnant while taking isotretinoin. Women who can get pregnant must take monthly pregnancy tests. You must also use two forms of birth control during treatment, or abstain from sex.
Treatment May Be Associated With Mental Health Problems
Published research studies indicate a link between isotretinoin use and depression or suicide, report the authors of an October 2013 "Journal of Clinical Psychiatry" review article -- although these treatment side effects are uncommon. The U.S. Food and Drug Administration-approved prescribing information for isotretinoin includes a warning about possible mental health side effects, including depression, suicide, aggression, and suicidal thoughts or attempts. However, some standalone studies -- such one reported in November 2013 in "Acta Dermato-Venereologica" -- indicate that successful treatment of mild to moderate acne might lead to reduced depression and anxiety symptoms. Because mental health issues are a possibility, report any new or worsening psychological symptoms to your doctor. Seek immediate help if you experience suicidal thoughts.
Treatment May Be Associated With Ulcerative Colitis
According to research published in the September 2010 issue of the "American Journal of Gastroenterology," people who had previously used isotretinoin were found to have a slightly increased risk of developing ulcerative colitis -- a serious disease that causes inflammation of the bowels. In contrast, a study published in the April 2013 issue of the "Journal of Investigative Dermatology" found no association between isotretinoin use and inflammatory bowel disease. More research is needed to better understand these conflicting findings, although the prescribing information includes a warning about the possibility of inflammatory bowel disease associated with isotretinoin use. If you take isotretinoin and develop symptoms such as severe abdominal pain, diarrhea or rectal bleeding, contact your doctor immediately.
Isotretinoin Is Effective, but Not Immediately
A course of isotretinoin treatment typically lasts 4 to 5 months. Your doctor may adjust your dose based on your response to treatment. It typically takes a few weeks of treatment before your acne begins to improve, and some people experience temporary worsening of their acne before their skin begins to clear. Although your acne may not improve as quickly as you'd like, about 85 percent of people experience long-term skin clearing after one course of treatment, according to the American Academy of Dermatology. Your doctor may recommend a second course of treatment if your skin is not completely clear after initial treatment or if your acne returns after stopping isotretinoin therapy.
Skin-Related Side Effects Are Common
Because isotretinoin reduces oil production, there is a good chance you'll experience some skin dryness and possibly chapped lips and dry eyes during treatment. Lip balm, moisturizers and lubricating eye drops can help alleviate your discomfort from these side effects. Isotretinoin also makes your skin more sensitive to ultraviolet light, so it's important to avoid unnecessary or prolonged exposure to the sun and tanning. Wearing protective clothing, sunscreen and sunglasses when you're outdoors will help protect your skin. Because your skin may be more fragile while you're taking isotretinoin, it's also important to avoid abrasive skin cleansers and limit your exposure to potentially irritating chemicals.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases: Questions and Answers About Acne
- DailyMed: Claravis - Isotretinoin Capsule
- American Academy of Dermatology: Why Dermatologists Prescribe Isotretinoin
- iPLEDGE: About iPLEDGE
- Acta Dermato-Venereologica: Anxiety, Depression, Quality of LIfe and Patient Satisfaction in Acne Patients Treated With Oral Isotretinoin
- American Academy of Dermatology: Position Paper on Isotretinoin
- Journal of Investigative Dermatology: Isotretinoin Use and the Risk of Inflammatory Bowel Disease: A Population-Based Cohort Study
- Journal of Clinical Psychiatry: Retinoic Acid and Affective Disorders: The Evidence for an Association
- American Journal of Gastroenterology: Isotretinoin Use and the Risk of Inflammatory Bowel Disease: a Case-Control Study
- American Family Physician: Using Isotretinoin the Right Way for Acne