Thursday, December 2, 2021

How to Use It, Safety, Side Effects and More

  • Brand name Accutane is no longer on the market, but is available in its generic form, isotretinoin
  • Isotretinoin is a powerful prescription oral medication that is prescribed for moderate-to- severe acne, and for acne that is treatment-resistant
  • This medication is associated with a number of side effects, some severe, therefore patients are monitored while on this therapy 

What Is Accutane? 

Accutane is the brand name for isotretinoin which is a powerful vitamin A derivative (retinoid) used to treat a number of serious skin conditions including skin cancers, psoriasis, rosacea, lupus and lichen planus. This medication has strong antitumor, anti-inflammatory and immunomodulatory properties making Accutane for acne a very effective treatment. 

The U.S. Food and Drug Administration (FDA) first approved Accutane in 1982. While this brand is longer on the market, other forms of FDA-approved isotretinoin are available in brands Absorica, Amnesteem, Claravis, Myorisan and Sotret.

Does Accutane for Acne Work?

Accutane is very effective in treating acne and does so in a number of ways. It’s greatest strength is reducing sebum production – the oil produced by sebaceous glands which is a primary instigator of acne. Less oil on the surface of skin results in a reduction in Cutibacterium acnes (formerly Propionibacterium acnes), another precursor to acne development. 

This medication also encourages skin cell renewal and apoptosis, the process that rids the body of damaged skin cells. Lastly, it has anti-inflammatory qualities.

In a recent study review of clinical trials on isotretinoin and moderate-to-severe acne, evidence shows this medication consistently and effectively reduced lesions, and performed better than oral antibiotics. Of note is that adverse events were a common feature among all trials.

Another literature review examined acne treatment with low-dose isotretinoin to determine if efficacy could be maintained while reducing the risk of adverse side effects. Researchers found that a number of studies showed evidence that lower doses were effective in improving moderate acne, and importantly, had fewer side effects than the typically prescribed dose.  

This medication is highly effective in clearing acne, with long-term remission seen in 70–80% of patients – with just one course of treatment.

How to use it

Accutane and other isotretinoin medications are typically prescribed after first-line treatments (such as topical benzoyl peroxide or oral antibiotics such as clindamycin) have been tried and proven unsuccessful in relieving acne symptoms.

This medication is prescribed for moderate-to-severe acne as well as milder forms of acne that have not responded to treatments. Cystic or nodular acne would also fall within this category.

Accutane is an oral medication that is available only by prescription, and is usually taken twice daily with food. The dose will be determined by your care provider and will be based upon your treatment history as well as the condition of your skin. Your dose will likely be adjusted during your treatment according to your skin’s response and if adverse side effects occur. 

The length of therapy will depend on the dose you receive; the range is usually 16–30 weeks.

The standard dose is 1 mg/kg a day, medium dose is 0.5 mg/kg and a low-dose regimen, 0.1 mg/kg.

When first starting Accutane you may experience what is known as the Accutane Purge. This affects a small percentage of patients and describes what appears to be an acne flareup. This is a common response of retinoids and is related to the skin shedding abnormal skin cells. Within 4–6 weeks, your skin should clear; if not, see your care provider.

Acne before and after Accutane

Who Should Take Accutane for Acne?

Accutane is prescribed only for moderate-to-severe acne, for cystic or nodular acne, and for acne that has not responded to standard acne therapies.  

Accutane can cause severe birth defects and must not be taken by women who are pregnant or thinking of becoming pregnant. 

Accutane is a very effective medication but is associated with many adverse side effects. It is important to share your complete medical history with your prescriber as this will help them make an informed decision about your treatment regimen. 

You will be closely followed during your course of therapy to monitor your skin’s progress and development of any side effects; you will be asked to take periodic blood tests to monitor your health.

Safety and Side Effects

Since its introduction, Accutane has been recognized as an effective acne treatment. However, there is much controversy surrounding its side effects, with inconsistent reportings of increased suicide and depression, inflammatory bowel disease and liver disease. 

A study review concluded that there was no increased risk of these health issues with  isotretinoin use.

Another study found this medication to be safe with mild side effects and no serious long-term effects. Another study examined the link between depression and isotretinoin and found no increased risk.

Contradicting these outcomes, a large 5-year study found the most commonly reported mild side effects were dry lips (100%), followed by xerosis (rough, dry scaly skin) (95%) and facial erythema (refness) (66%). More severe adverse effects were psychiatric symptoms (25%) and eye lesions (9%). 

Regardless of the contradictory evidence, it is important to be mindful of potential side effects and to report any irregularities to your care provider.  

Possible mild side effects

  • Dizziness
  • Drowsiness
  • Dry mouth and lips
  • Dry nasal passages
  • Erythema
  • Eye inflammation
  • Joint and muscle pain
  • Nose bleeds
  • Xerosis 

Possible severe side effects

  • Chest pain
  • Depression
  • Hearing loss
  • Increased cholesterol
  • Increased triglycerides
  • Inflammatory bowel disease
  • Liver disease
  • Severe headaches
  • Severe diarrhea 
  • Suicide thoughts
  • Vision changes
  • Yellowing of eyes or skin

One established fact is that Accutane causes severe birth defects. Female patients should take a pregnancy test before starting a course of Accutane. And for women who are sexually active, birth control is imperative. 

It is also important to not take vitamin A supplements as this could increase your risk of side effects.

Alternatives 

If isotretinoin medications aren’t right for you, there are several effective options to choose from.

Other vitamin A derivatives, tazarotene (Tazorac) or adapalene (Differin) are prescription topicals that can successfully treat acne and are commonly paired with benzoyl peroxide for greater efficacy.

Oral antibiotics are a mainstay treatment for moderate-to-severe acne and are particularly effective due to their anti-inflammatory properties. Antibiotics are typically prescribed for the shortest time possible and paired with another medication to combat antibiotic resistance.

Antibiotics within this class include clindamycin, minocycline, doxycycline, tetracycline, azithromycin and erythromycin.

For cystic acne, steroid injections can reduce inflammation and shrink large cysts and swollen nodules that develop beneath the skin.

Takeaway 

Accutane is a powerful medication that is reserved for moderate-to-severe acne and for acne that fails to respond to conventional acne treatments.

There is controversy surrounding the possible side effects of this medication; some studies report mild-to-severe side effects while others do not. For your safety, you will be monitored by your care provider. Women must practice birth control as this medication can cause serious birth defects.

If Accutane is not right for you, there are several established and safe alternatives including oral antibiotics, topical applications and steroid injections to treat moderate-to-severe acne.

Sources

  • Vallerand IA, Lewinson RT, Farris MS, et al. Efficacy and adverse events of oral isotretinoin for acne: a systematic review. Br J Dermatol. 2018;178(1):76–85. doi:10.1111/bjd.15668
  • Torzecka, J. D., Dziankowska-Bartkowiak, B., Gerlicz-Kowalczuk, Z., & Wozniacka, A. (2017). The use of isotretinoin in low doses and unconventional treatment regimens in different types of acne: a literature review. Postepy dermatologii i alergologii34(1), 1–5. doi:10.5114/ada.2017.65614

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