Everything You Need to Know Before Starting Accutane (Isotretinoin) by Dermatologists
Author: David G. Li, MD, MBA
Contributors: John Barbieri MD, MBA; Arash Mostaghimi, MD, MPH, MPA
Table of Contents
What Exactly is Accutane and How Does it Work?
Who is a Good Candidate for Taking Accutane?
What are Possible Side Effects of Isotretinoin?
Recommended Products to Manage Accutane Side Effects
What Tests, Procedures are Needed?
What Results Can I Expect from My Accutane Course?
How Long is an Average Course of Accutane?
What Happens After Finishing Treatment?
If you're considering taking isotretinoin aka Accutane to treat severe acne, there are some important things you should know beforehand. Accutane, or isotretinoin, can be an extremely effective treatment for even the worst acne cases. However, it also can cause some potential side effects and risks that require monitoring from a dermatologist. This article will attempt to cover everything you need to know before starting an Accutane treatment plan.
What Exactly is Accutane and How Does it Work?
Accutane is a powerful oral medication derived from vitamin A that treats acne by targeting the oil glands. It works by reducing the size of the oil and sebaceous glands and cutting down the amount of oil they produce. This stops acne lesions from forming and allows existing pimples to heal while preventing new breakouts.
Accutane also reduces inflammation and can help prevent acne scars from getting worse or new scars from forming. It's one of the few acne medications capable of clearing up acne for prolonged periods, even after you finish taking it. Many patients find their acne doesn't return at all or only comes back mildly after Accutane treatment. Experts often quote that 4 of 5 patients have lasting clearance.
Who is a Good Candidate for Taking Accutane?
Accutane is prescribed for people struggling with nodulocystic acne, acne that is causing scarring, or recalcitrant inflammatory acne that hasn't responded to other oral or topical acne medications.
You may be prescribed Accutane if:
You've tried oral (antibiotics, spironolactone, oral contraceptives) or topical treatments without success
Your acne produces skin discoloration and scarring
Acne keeps coming back and is interfering with your quality of life
Accutane is often not used for those with:
Mild acne
Acne that responds to other oral/topical medications
Less severe forms of acne like blackheads or whiteheads
Your dermatologist should consider the type and severity of your acne along with your medical history before deciding if isotretinoin/Accutane is appropriate.
What are Possible Side Effects of Isotretinoin?
While Accutane provides excellent clearance of acne for most, the medication does carry some safety concerns:
Common Side Effects
· Dry lips, and some may also have dry eyes or nosebleeds
· Temporary flaring of acne while starting isotretinoin (purging)
· Increased sun sensitivity
· Joint or muscle aches
Serious Side Effects
Birth defects - high risk of severe abnormalities if taken during pregnancy
Mood changes or suicidal thoughts
While at a population level isotretinoin appears to be associated with reduced risks of depression and suicidality, there are case reports of isotretinoin causing negative mental health effects.
Increased lipids and liver enzymes
Decreased night vision
Acne fulminans - a rare severe reaction to starting Accutane that leads to a severe presentation of painful and ulcerating acne
Most side effects resolve after finishing each treatment course.
Recommended Products to Manage Accutane Side Effects
For Sun Protection
For Overall Dry Skin
What Tests, Procedures are Needed?
Everyone must be registered in the iPLEDGE program and follow its rules.
Anyone who can become pregnant must attest to abstinence or two forms of birth control during treatment. They also must have monthly pregnancy tests.
Some blood tests may be required such as checking liver function, triglyceride, and cholesterol levels.
What Results Can I Expect from My Accutane Course?
Accutane works well for 80%-90% of all patients, often providing complete acne clearance for long time periods. Most see great improvements by the end of their first course.
Here’s a general timeline of when you may see results:
1-2 months in – Less oiliness, fewer new breakouts. Can sometimes have a purging effect in the first few months.
3-5 months in – Marked decline in acne lesions
End of course – Hopefully complete clearing or close to it
Relapses can occur in up to 20% of patients down the road. A second course of Accutane, if needed, also has good success rates. Every acne case is different. Response times can vary based on acne severity, dosing and other factors. Stick closely to your dermatologist’s treatment plan.
How Long is an Average Course of Accutane?
Most patients take a 5 to 8 month course, with a cumulative dose between 120 mg/kg and 150 mg/kg over the full treatment period. Severe cases may call for higher doses, while milder cases can be shorter. Your dermatologist determines exact dosing and treatment length based on your body weight, type of acne, sensitivity to side effects and overall health status.
What Happens After Finishing Treatment?
Your dermatologist may have you return for checkups a few months after taking your last Accutane pill. They will examine your skin and ask about any symptoms to ensure your acne is fully clear and no lingering side effects remain.
Anyone who can become pregnant should continue to use an effective birth control method for one month after your final dose, followed by a second pregnancy test showing negative results before stopping contraception.
Key Details to Know About Starting Accutane
Accutane is an oral retinoid that can clear even severe cystic acne
Anyone who can become pregnant must attest to abstinence or two forms of contraception during and for one month after stopping treatment. They must also have monthly pregnancy tests.
Monthly bloodwork is not always required
Expect very dry skin, lips and rarely joint pain while taking it
Most see significant improvements in 3-5 months
Follow up with your dermatologist after finishing your course
A second Accutane course can still work well if acne ends up returning later on
Discuss your specific case, concerns, and all treatment considerations thoroughly with your prescribing dermatologist. Following their guidance closely gives you the best chance of success with this potentially transformative acne medication.
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What precautions should one take while taking isotretinoin?
If you are prescribed isotretinoin, it's crucial to use two forms of contraception to prevent pregnancy. Additionally, two consecutive monthly negative pregnancy tests are required prior to taking the medication. These are required as Accutane can cause severe birth defects if pregnant while on it.
When should you see a dermatology expert for consideration of isotretinoin?
If you have severe acne that has not responded to other treatments, a dermatologist may consider isotretinoin treatment after evaluating your condition and medical history. They will discuss whether isotretinoin is the right acne treatment for you and address any concerns you may have about the side effects of Accutane.
Who would be a good candidate for Accutane?
Patients considering Accutane should discuss their candidacy for the medication with a dermatologist. It is important to understand the side effects of Accutane and commit to the entire course of treatment as prescribed for it to be an effective acne treatment for cystic and nodular acne and moderate to severe acne.
What are the treatment options for acne?
The treatment for acne can vary from topical creams and oral medications to more advanced therapies like Accutane (isotretinoin). Consulting with a dermatologist is crucial to explore the most effective acne treatment based on individual needs.
Are there any precautions when taking isotretinoin?
Ensure that you are using an adequate amount of moisturizer for dry skin and sunscreen to prevent photosensitivity. Reduce the amount of alcohol you intake while on Accutane, and check with your physician to ensure there are no medication interactions.
Is Accutane the right acne treatment for me?
If you have acne vulgaris that has not responded well to other treatments, then Accutane may be a good option for you, but please see a dermatologist.
How does Accutane work?
Accutane works by reducing the amount of oil released by oil glands in your skin, which helps the skin renew itself more quickly. It can also reduce inflammation and keep skin cells from clogging pores.
What are the side effects of Accutane?
Accutane can cause a variety of side effects, including dry skin, chapped lips, and temporary increase in acne formation. Other less common side effects are reviewed above.
Can I get rid of acne scars with Accutane?
While Accutane can help to prevent new acne scars, it is not typically effective at treating existing acne scars.
How long does it take to see results with Accutane?
Many patients need to complete a couple months of treatment before they start to see improvement in their acne.
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