Should I be afraid of taking Accutane/ Isotretinoin? What do I expect on it? | Anne Marie McNeill M.D., Ph.D

Isotretinoin is the generic name for a medication which is a vitamin A derivative.  Some still call it Accutane, although this particular brand name of the medication is no longer marketed.  Other brand names for isotretinoin that are available are Absorica, Amnesteem, Claravis, and Sotret.  These are all very, very similar to each other (I have no personal preference generic vs. brand name).
In general, isotretinoin is indicated for:

  • cystic, scarring acne, or
  • acne that has failed standard treatments (such as oral antibiotics or inability to tolerate standard treatments), or
  • or acne that has persisted into adulthood

It is also sometimes prescribed in much higher doses for some genetic skin diseases.
Isotretinoin is popular because it is very effective and usually permanently improves acne. Some studies show that after one course of the medication, there is an ~85% cure rate for acne. Therefore, in most people, acne will not recur (or recurs very minimally) after one course.  However, ~15% of people do require more than one course of isotretinoin to cure acne.
One course is usually 6-8 months, depending on what dosage of the medication you are on and how quickly you respond to the medication.
In general, we check blood tests before you start, after the first month, and again 3or 4 months later.
Commonly, during the first month on isotretinoin, your skin will be dry and your acne not much better.
Usually by the end of the third month, most patients have noticeably less acne, and by the end of the 6-8 months, most patients have little to no acne.
Isotretinoin does not improve acne scars, but 6 months after your course of the medication is completed you could consider treatment of scars if you are interested.
We offer a number of treatments (microneedling, fillers, non-ablative and ablative lasers) for acne scars.
Isotretinoin is a tightly regulated medication, because it is a teratogen.  This means if a female taking isotretinoin gets pregnant, the baby would likely have birth defects.  The medication impairs development of the limbs of a fetus.  It is very important to use 2 forms of contraception if you are a sexually active female taking isotretinoin.
Importantly, isotretinoin has no effect on future fertility, libido, future pregnancies, or the male reproductive system.
Since 2006, the dispensing of isotretinoin in the United States has been controlled by an FDA-mandated system called iPLEDGE, designed to reduce female pregnancies of patients on isotretinoin.  Dermatologists are required to register their patients before prescribing and pharmacists are required to check the website before dispensing the drug. The prescription may not be dispensed until both parties have complied. A physician may not prescribe more than a 30-day supply. A new prescription may not be written for at least 30 days. Pharmacies are also under similar restriction. There is also a seven-day window between the time the prescription is written and the time the medication must be picked up at the pharmacy. If the original prescription is lost, or pick-up window is missed, the patient must requalify to have another prescription written. Doctors and pharmacists must also verify written prescriptions in an online system before patients may fill the prescription. Due to its teratogenic effects, women with the potential to bear children must “PLEDGE” to the use of two forms of contraception simultaneously for the duration of isotretinoin therapy, as well as for the month immediately preceding and the month immediately following therapy.
While you are on isotretinoin, remember:
-Do not wax as a method of hair removal, your skin is more fragile and the skin will peel off along with the wax
-Do not donate blood (as it could go to a pregnant woman)
-Do not share your medication
There is a lot of good data which shows that isotretinoin does not cause depression, suicide, or inflammatory bowel disease.  Generally my patients are much happier after they have taken a course of isotretinoin.
In short, I do not think isotretinoin is scary.  I think it is generally very safe as long as you don’t get pregnant while you are on the medication.  I have taken it myself and am very happy that I did because I had developed some scars from acne, and it prevented further scarring.
It is important to review all of the potential side effects of a medication and your history with your provider.

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