1. Isotretinoin is Highly Effective
Isotretinoin (also called Accutane) is the most effective treatment for severe acne, known as cystic acne. Since cystic acne does not respond well to typical acne therapy such as oral antibiotics and topical creams, isotretinoin can be a miracle drug for cystic acne sufferers. Used for over 30 years, isotretinoin is a powerful vitamin A derivative that attacks the three main causes of acne: it reduces the production of sebum (oil) in the skin, it prevents skin pores from clogging, and it inhibits the growth of Propionibacterium acnes (P. acnes), the bacteria responsible for acne. There is no treatment for acne that has ever been shown to be more effective than isotretinoin.
2. Common Side Effects
The most common side effects of isotretinoin are dry skin and lips. Virtually everyone who takes the drug experiences this; in fact, if patients don't get significant peeling and dryness, then we question if they are actually taking the medication or if their dose is too low. To alleviate this dryness, most patients on isotretinoin carry lip balm and apply it frequently throughout the day. Facial dryness can be controlled by using noncomedogenic (non-acne forming) moisturizers once or twice a day.
Isotretinoin sensitizes skin to ultraviolet light, so it is important to have good sun protection. The same sun exposure that would produce just a little redness before isotretinoi, can produce a severe sunburn if it occurs while taking the medication. Therefore, if you are taking isotretinoin, avoid sun exposure and wear a SPF 30 sunscreen when spending time outdoors.
Acne usually gets worse for the first 1 to 2 months on isotretinoin; fortunately, it gets much better by the third month and beyond.
Taking isotretinoin also increases cholesterol levels. The increase caused by the medication is usually of no significance and will drop back to normal levels once the course of treatment is complete.
Other side effects for some people on the medication include decreased night vision, headaches and muscle aches. These are usually minor and often do not require any changes to the therapy.
3. Uncommon Side Effects
In some patients, especially young men with bad, cystic acne, isotretinoin can cause a severe flare-up. This is controlled by giving an oral steroid such as prednisone for the first few weeks. Bone abnormalities including osteoporosis and development of bony spurs can rarely occur. This side effect seems to occur in people who are on high does of the medication or on it for prolonged periods of time, longer than for most acne patients.
4. iPLEDGE and Pregnancy
The most serious side effect of isotretinoin is that it causes birth defects. Taking the drug while pregnant causes the fetus to have malformations of the brain, face and heart. It can also cause the mother to lose the baby. As a result, it is critically important that girls and women taking the drug not get pregnant. In the U.S., there is an intense registration and approval process called iPLEDGE to reduce the chances that this happens. For a female of child bearing age to receive isotretinoin, she has to be registered with the program, use two forms of birth control, and have a pregnancy test every month. In addition, every physician prescribing isotretinoin, as well as the pharmacy giving the medication, must also be registered with iPLEDGE. Males, and females who cannot get pregnant, must also register for the program to use the drug.
5. Isotretinoin and Depression
Does isotretinoin cause depression or increase the risk of suicide? This is a common question from parents. The answer is most likely not. Unfortunately, there was a high-profile case involving the son of a U.S. Representative who took his own life while he was on isotretinoin. This tragedy raised awareness about potential side effects of isotretinoin; however, it does not mean that isotretinoin was the cause. A number of studies have looked at whether or not isotretinoin increases the risk of suicide or depression, especially in teenagers. The studies had mixed results: a few showed a possible increase in depression, several showed the drug has no effect on depression or suicide, and some showed that isotretinoin actually decreases the risk of depression. Patients and parents should discuss these risks with the prescribing physician before starting treatment and during their visits while on the therapy. There are some people for whom isotretinoin might not be recommended.
Having severe, cystic acne can be traumatic for anyone, especially teenagers. Some patients have acne so severe that they spend most of the school year at home to avoid being seen. There is no medication or treatment that is nearly as effective as isotretinoin is for such patients. It is a powerful anti-acne medication that can change a teenager's life and prevent permanent pitted scars on his face.
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