What is Isotretinoin?
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What is Isotretinoin?
(aka Accutane)
What are the side effects of Isotretinoin?
Before starting isotretinoin, patients must register with the iPledge system; females will have a 30 day waiting period after registering while males can start immediately after registration. The reason for the 30 day waiting period in females is to have two negative pregnancy tests documented and it gives those in need of contraception the chance to get started on it so that it's effective by the time they start isotretinoin. Only women who are incapable of having children (e.g., hysterectomy or menopause) do not have to wait 30 days.
Isotretinoin is considered the most effective and powerful acne treatment available. It helps eliminate acne and also significantly improves the texture of the skin and improves acne scarring. The drug is classified as a retinoid (a Vitamin A derivative), that is capable of regulating epithelial cell growth.
Isotretinoin is more commonly known as “Accutane”. Unlike other acne treatments, isotretinoin is an oral medication that is taken daily for a span of 4 to 6 months (dosage varies based on weight and acne severity). The goal of taking isotretinoin is to clear one’s acne and to produce permanent acne relief. See below for before and after treatment.
How does Isotretinoin work?
Isotretinoin works by decreasing the size of the sebaceous glands, which secrete oil (sebum). Decreasing the size and production of these glands also reduces the number of bacteria in the follicles. In most cases, isotretinoin provides prolonged clearance and sometimes effectively cures one of their acne. In a subset of patients, particularly those with extensive acne, the acne can return over time and may require a second round of treatment.
The most common side effect of isotretinoin is dry, chapped lips. This is easily treated with frequent application of Vaseline or Aquaphor ointment. Some patients also experience dry skin and dry eyes, which can be improved with moisturizing cream and artificial tears. Some people may feel more sensitive in the sun and sunscreen should be used when outdoors.
A subset of patients may experience nose bleeds due to the dryness of the skin in the nasal mucosa. For those individuals, we recommend the use of saline nasal sprays. In eczema-prone patients, the dry skin may precipitate an eczema-like reaction, which is easily controlled with prescription cortisone creams and moisturizing creams. Most patients show improvement in their acne in the first month, but a subset of patients may get a little worse before they get better. All other potential side effects are much less common.
IMPORTANT FOR WOMEN
Isotretinoin must be taken with caution in females, because if taken while pregnant, it can cause significant fetal abnormalities. In order to prevent birth defects from occurring, isotretinoin is monitored through a system called “iPledge”, which is a personal agreement to not get pregnant while on the medication. Due to the fetal risk, people on isotretinoin should not donate blood during the course of treatment and for 30 days after the last dose.
Once the medication is started, patients must follow up every 4 weeks in order to receive a refill. The 4 week follow-up is to check how patients are handling the medication and to address any possible side effects. For females, the follow-up also includes the verification of a negative pregnancy test.
Women of reproductive age who are sexually active are required to be on two forms of birth control, for example, the contraceptive pill and condoms. It is important to note that isotretinoin does not affect a woman's ability to have healthy babies in the future, nor does it affect her fertility.
Is drug monitoring required?
Monthly lab assessments used to be a routine part of isotretinoin treatment; however, there is evidence that this intensive blood monitoring is not necessary. Many experts recommend a baseline blood test and again after two months of treatment. Laboratory abnormalities if present are often short-lived and normalize following discontinuance of isotretinoin.
Is Isotretinoin linked to depression?
Most well controlled studies have concluded that there is no definitive causal link between isotretinoin and depression. Two recent studies published in February and March of 2021, concluded that patients on isotretinoin were actually less likely to engage in suicidal behavior and experience less psychological distress and depressive symptoms compared to controls. Another study conducted in 2019 links the use of isotretinoin to an improvement in psychological well-being, even in patients suffering from an underlying mental illness. Nevertheless, anyone experiencing any symptoms of a declined psychological state or depression while on isotretinoin should speak to their dermatologist immediately.
Is Isotretinoin linked to Crohn’s disease?
Most studies show that exposure to isotretinoin is not associated with an increased risk of developing both Ulcerative colitis and Crohn’s disease, and may even be associated with a decreased risk.
See Additional Literature:
(Click on blue links for article)
Isotretinion and Depression