Accutane: it's an effective acne treatment but should you be worried?

Dr Zara Kassam PhD

Do you have acne? Have you been prescribed Accutane but are worried about taking it? The experts explain its pro’s and con’s.

 

Accutane is renowned for its acne-curing powers; odds are if you suffer from severe acne, you know all about it. Accutane – medically dubbed Isotretinoin, is what dermatologists label ‘the nearest thing to a cure for acne,’ but it’s not without its critics.

The drug has been associated with mood swings, depression and even linked with suicides. So, should you be worried if you’re on it or thinking about taking it for your acne?

Accoridng to Dr Rachael Morris-Jones, dermatology consultant Kings College Hospital, London Bridge Hospital and 55 Harley Street, the answer is no. She says “some patients are put off taking Accutane (Isotretinoin) by what they read on the internet about the potential side effects, but the reality is most patients just suffer from dry lips whilst on the treatment”.

“I find that most of my patients that take Isotretinoin are so pleased with the results and find it is well tolerated that they wish that they had taken it years ago.”

Dr Adam Friedmann, consultant dermatologist and clinical lead at The Harley Street Dermatology Clinic agrees it can deliver life changing results and it is most commonly prescribed when all other acne treatments fail.

 

What is it and what does it do?

Accutane is an anti-inflammatory drug, it is one of the very few FDA approved oral treatments for acne. Dr Friedmann tells us that it belongs to a group of drugs referred to as retinoids, which are derivatives of vitamin A which work by decreasing the production of sebum.

He explains that acne occurs as a result of excessive production of sebum; which blocks the sebaceous glands, and causes a build-up of sebum under the skin.

The bacteria linked with acne flourish in these conditions and feed on the sebum. The waste products produced by these bacteria aggravate the sebaceous glands, causing inflammation and spots.

Accutane, Dr Friedmann explains,  decreases the size of the sebaceous glands thereby decreasing the amount of sebum produced. As a result the glands are no longer blocked meaning bacteria are less likely to thrive and spots less likely to appear.

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Who is an ideal candidate for Accutane? 

Dr Friedmann prescribes Accutane for patients who either have moderate to severe acne or those who haven’t had results with other treatment combinations.

He tells Harley Street Emporium; “Initially, when taking Accutane you may notice you skin get worse, however this tends to improve within 7-10 days. A 4-6 month treatment course of between 20 mg and 80 mg of isotretinoin each day, is usually prescribed, with many patients remaining acne free long after the treatment is complete.”

Dr Friedman says “Accutane has an approximately 80% success rate when given for 4-6 months.”

It’s an impressive result, but does it come at a cost?

 

The controversies

There are many controversies about the effects of Accutane on mood and a possible link with suicide, however many studies have looked at this and have been unsuccessful in finding a relationship between Accutane and depression.

An analysis of studies and reported adverse events done by the UK’s Medicines and Regulatory Authority (MRHA) found that there wasn’t enough information to establish a cause and effect between isotretinoin and psychiatric disorders, but said “an association could also not be ruled out.”

The US FDA has stated that: “All patients treated with isotretinoin should be observed closely for symptoms of depression or suicidal thoughts, such as sad mood, irritability, acting on dangerous impulses, anger, loss of pleasure or interest in social or sports activities, sleeping too much or too little, changes in weight or appetite, school or work performance going down, or trouble concentrating, or for mood disturbance, psychosis, or aggression.”

Dr Friedmann agrees saying patients must be closely monitored throughout their treatment but he reminds us that studies have shown that there is a link between the severity of someone’s acne and anxiety and depression.[4],[5]

And he adds that in some cases, people on “Accutane can show significant improvement in mental disorders”, with studies have showing patients on the drug were no longer suffering with psychosocial tribulations such as low self esteem, anxiety and depression which all stemmed from the acne. [6],[7]

But that doesn’t rule out the need for close monitoring and for patients themselves to be self-aware whilst taking the medication.

“If you feel as if your mood is changing, talk to your parents, friends or even here at the clinic, together we will help you through any troubles and treat your acne, too.”

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Other side effects?

Apart from the association with mood disorders, Accutane can have some physical side effects as well – especially at the start of the treatment.

Most patients who visit Dr Friedmann experience severe skin dryness, especially around the lips and eyes. “It is vital to stay hydrated, keep moisturising, reapplying throughout the day and use a lip balm.”

And Dr Friedmann tells us that some patients will experience joint pain, which dissipates as the treatment ends.

Some of the most commonly reported side effects are:

  • Cheilitis (inflammation of the lips)
  • Dry skin (peeling)
  • Dry nose
  • Rashes
  • Pruritus (Itchy skin)
  • Nose bleeds
  • Dry eyes
  • Thirst
  • Eczema
  • Muscle pain
  • Increased cholesterol
  • Increased UV sensitivity
  • Drowsiness
  • Headaches
  • Insomnia

 

Who can’t take it?

It is very important that women who are considering using Accutane are not pregnant and are not considering becoming pregnant in the near future, as the drug is associated with birth defects.[8]  Your doctor may order a pregnancy test to ensure you are not pregnant before prescribing the drug.

Those who suffer from ‘fructose intolerance’ or are allergic to soya are not advised to take Accutane as well.[9]

 

Do I really need a doctor for this?

Yes, you do need a doctor. Accutane is a very powerful drug and should never be used without seeing a dermatologist or health care professional.  Please take note that websites that sell Accutane without a prescription are doing so illegally and it may be unsafe for human consumption. The FDA stresses the importance of never buying drugs such as Accutane on the Internet.

Properly prescribed Accutane is a highly effective medication for treating acne. The good news is that after completing the course of Accutane, most patients respond better to conventional acne medications and do not need to restart Accutane.

As Dr Morris-Jones says, “Acne has a huge impact on people’s lives which shouldn’t be underestimated. … Taking isotretinoin and clearing up acne literally transforms patients’ lives”

 

Have you used Accutane? Why not share your experience with us?

 

If you are interested in discussing acne treatments further you can book with Dr Friedmann by clicking here.

 

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