Isotretinoin, aka Accutane/ Acnotin/ Roaccutane, is “The Nuclear Option” for treatment of Severe Acne.
This is the medicine that I prescribe when literally nothing else works for severe cystic acne in hot, sunny, humid Singapore.
It’s powerful, effective, and… somewhat dangerous.
Why is it so effective? Because it basically stops your body from producing oil — like, at all.
Isotretinoin treatments usually last from months to years.
Hence, you should know EVERYTHING about this medicine. The Good, The Bad and The Ugly…
What is Isotretinoin/ Accutane?
Accutane (or isotretinoin) is a synthetic derivative of vitamin A primarily used to treat severe cases of acne which don’t respond to anything else.
It’s a prescription-only drug that is taken orally.
Dosage highly depends on the severity of acne, but ranges from 0.5 mg to 2 mg daily, with low-dose recommendations becoming the prioritized standard.
Despite it having a very high success rate (about 90%) a course of Accutane can last anywhere from 3 to 10 months!(1)
How does Isotretinoin/ Accutane Work?
Isotretinoin works by limiting the amount of oil your body produces (about an 80% reduction).
Because acne in the most basic sense is simply an overgrowth of bacteria in a clogged pore, you can imagine why this is so effective — less oil means less room for bacteria to thrive.
It also significantly reduces oil gland size, regulates cell-turnover rate, and has anti-inflammatory properties. (3)
In other words, it kicks some serious ass by addressing every possible cause of acne. This badassery however, doesn’t come without its share of side effects.
Side Effects of Isotretinoin/ Accutane.
Long Term Side Effects
Isotretinoin is a “category X” drug, meaning it is known to cause birth defects if taken during pregnancy. (4) This safety concern has made it mandatory for females to take birth control while on Accutane to minimize the chances of unwanted pregnancy. And we’re just getting started…
Long term side effects occur in 7.2% of patients and can include crohn’s disease (i.e. inflammatory bowel disease), abnormal bone growth, dry eye syndrome, arthralgia, xeroderma, and exacerbation of eczema — though all of these are considered mild in nature. (5, 6, 7, 8)
Short Term Side Effects
Common side effects include dry lips, dry skin, nosebleed (caused by dry skin), eczema (dry rash), cheilitis (inflamed dry cracking lips), increased photosensitivity, and dry mouth. (9)
Essentially, Isotretinoin dries you up – everywhere.
What to Expect on Isotretinoin/ Accutane.
The process begins with discussions about sexual and menstrual history, education about contraception, blood work, pregnancy tests, and follow up visits every month.
Mood change, especially depression isn’t unheard of while on Accutane. The science and research on this is all over the place, but one of the most reliable studies found that depression occurs in 0.4% of users, with a relative risk ratio of 2.68. (10, 11)
In other words, someone who takes Accutane is 2.68 times more likely to develop depression than someone who doesn’t.
There’s a dreaded “purging period” during Accutane when acne gets worse initially. One study found it happens in 32% of patients and typically lasts 3-4 weeks. (12) If this happens to you don’t be discouraged, it simply means the medication is working its magic. These side effects will subside soon enough.
Nearly all Accutane users destroy their acne! Up to 95% of patients see excellent results, with results often being permanent. (13)
A reduction in anxiety and depression among cystic acne patients is very common after a successful bout of Accutane. (14)
It goes without saying, but finally clearing acne has a huge and lovely impact on your confidence and wellbeing.
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