Isotretinoin (formerly Accutane®) for Acne

Isotretinoin, commonly known by the brand name Accutane^Ò, is an acne medication available by prescription only. This medication comes in the form of a capsule that you swallow and take in regular doses. Isotretinoin is an extremely potent medicine that should be taken under the supervision of a dermatology specialist as it has risks of side effects. At Schweiger Dermatology Group, we will determine whether isotretinoin is a good choice for you based on a variety of factors.

What is Isotretinoin?

Isotretinoin is an oral medication prescribed to treat severe, persistent acne vulgaris with cysts and nodules. It’s a vitamin A retinoid, which is known to help treat acne, but is only recommended when other acne treatments, such as topical creams and antibiotics aren’t effective in managing painful and uncomfortable breakouts.

Severe acne can be challenging to treat and often leads to scarring without intervention. Isotretinoin can permanently clear acne in some individuals, reducing the likelihood of scarring that requires dermatological treatment. While no longer available under the original brand name, Accutane^Ò, isotretinoin is currently available under various general and brand names, including Absorica, Amnesteem, Claravis, Myorisan, and Zenatane.

Tretinoin vs Isotretinoin

While tretinoin and isotretinoin are both retinoid medications, they do have distinct differences to be aware of. Tretinoin, also known as all-trans retinoic acid, is a topical retinoid available over the counter or by prescription. It helps unclog pores and promotes cell turnover, making it great for mild to moderate acne. For those with moderate acne, topical prescriptions may deliver great results.

On the other hand, isotretinoin is an oral medication reserved for severe cases of acne that haven’t responded to other treatments. It is significantly more potent than topical retinoids and can penetrate deeper into the skin, addressing the root causes of severe acne more effectively.

How Does Isotretinoin Work?

Isotretinoin tackles severe acne from multiple angles, making it a comprehensive solution for stubborn pimples. Isotretinoin limits oil production in the sebaceous glands which is the primary contributor to acne lesions. It prevents blackheads and whiteheads by improving the rate of dead skin cell shedding.

Additionally, isotretinoin has anti-inflammatory ingredients that reduce redness and swelling. Lastly, it limits the growth of Cutibacterium acnes, a bacteria that plays a role in the development of acne lesions.

What are the Benefits of Isotretinoin?

Isotretinoin works wonders for severe acne that other treatments can’t seem to get rid of. Unlike other acne treatments that may provide temporary relief, a single course of isotretinoin, lasting 6-8 months, can lead to clear skin for several years or even permanently in some cases.

Additionally, by effectively treating severe acne lesions, isotretinoin can help prevent further scarring and improve the appearance of existing acne scars. While isotretinoin may be more expensive upfront, its long-lasting nature makes it a more cost-effective solution than the continual use of other acne treatments.

Long-Term Isotretinoin Side Effects

Although many patients experience success with isotretinoin, there are potential side effects, some of which can be severe. It’s critical to weigh the risks and benefits carefully with your dermatology provider before starting treatment. Long-term side effects of isotretinoin may include:

Birth Defects: Isotretinoin can cause severe birth defects if taken during pregnancy. Therefore it should not be used by pregnant women or those planning to become pregnant
Mental Health Issues: Some patients may experience mood changes, depression, or suicidal thoughts while taking isotretinoin, although the cause of this isn’t fully understood and it is considered extremely rare.
Dry Skin: Dryness on the skin, lips, nose, and eyes is a common side effect due to the limiting of the skin’s oil production.
Photosensitivity: Isotretinoin can increase skin sensitivity to sunlight, increasing the risk of sunburn and sun damage.
Bone and Muscle Effects: Long-term use of isotretinoin has been associated with an increased risk of osteoporosis, muscle weakness, and joint pain.
Elevated Blood Lipids: Isotretinoin can raise triglyceride and cholesterol levels, requiring regular monitoring and possible diet adjustments.
Inflammatory Bowel Disease: Some studies have suggested a link between isotretinoin use and the development of inflammatory bowel diseases like Crohn’s disease and ulcerative colitis, though the evidence is inconclusive.

How to Reduce Side Effects of Isotretinoin

While side effects can be a concern for acne sufferers, there are things you can do to curb their impact. Following the prescribed dosage and duration of treatment can minimize side effects and ensure the treatment succeeds. Drinking plenty of water and using moisturizers can alleviate dryness and skin irritation.

Wearing sunscreen, protective clothing, and limiting sun exposure can prevent sunburn and further inflammation. Routine blood tests and check-ups with a dermatologist can also help detect and address any potential side effects early on. Lastly, a diet low in fatty foods and a healthy lifestyle can help manage cholesterol.

How to Get Isotretinoin

Isotretinoin is a medication that can only be prescribed through a dermatologist or other qualified healthcare provider. Due to its potential side effects, particularly the risk of birth defects, isotretinoin has strict regulations and monitoring programs.

In the United States, the iPLEDGE program is a risk management protocol designed to ensure the safe use of isotretinoin. Patients must enroll in this program, undergo mandatory pregnancy testing, and commit to using effective birth control methods throughout treatment and for one month after discontinuation.

Additionally, prescriptions for isotretinoin are limited to a 30-day supply, requiring patients to undergo regular follow-up appointments with their dermatology specialist.

Isotretinoin Alternatives

While isotretinoin is considered the gold standard medication for severe acne treatment, it may not be suitable or preferred by everyone. Luckily, there are plenty of isotretinoin alternatives that a dermatologist can prescribe to you.

Oral Contraceptives: Certain combined (estrogen and progesterone) oral contraceptives can help regulate hormonal imbalances that contribute to acne, which can help resolve hormonal acne in women.
Spironolactone: This diuretic medication can block the effects of male hormones and reduce oil production, making it a good alternative to isotretinoin and birth control for hormonal acne in women.
Chemical Peels: Professional chemical peels, such as glycolic acid or salicylic acid peels, can help unclog pores and improve the appearance of acne.
Laser and Light Therapies: Acne laser treatments like photodynamic therapy, isolaz laser, and blue light therapy can help reduce acne lesions and improve skin texture. These are often popular options for clearing severe acne.

Isotretinoin Acne Treatment at Schweiger Dermatology Group

At Schweiger Dermatology Group, we understand how hard it can be to live with severe acne. It can be painful, frustrating, and harm self-confidence. That’s why we offer a variety of acne treatments for adults, teens, and children.

If isotretinoin is determined to be right for you, our dermatology specialists will provide comprehensive care and monitoring to ensure safety and help you achieve the desired results. Call us today or find a location nearest you to book an appointment with one of our providers online.

Reviewed by Dr. Jeremy Fenton.

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