Isotretinoin, the so called “miracle cure” is a potent drug used in the treatment of severe or recalcitrant mild/moderate acne that has not responded to any of the traditional treatments. In simple terms Accutane is a synthetic derivative form of Vitamin A that is administered in a high dose, this is the reason why there are so many side effects and why this medication should be strictly monitored by a qualified physician. Usually four to five months of isotretinoin treatment is enough to clear acne for one year or more after the medicine is stopped. Statistically Isotretinoin is a cure for 67% of those who try it, meaning there is a total acne remission for this group.
Mechanism of Action:
Because Accutane is a derivative form of Vitamin A, many of the actions of Accutane are very similar to those seen with administration of high doses of Vitamin A. While the exact mechanism of how Accutane works is still unknown, the mechanism of how it can help with acne is clear. First of all, Accutane reduces sebum production, by reducing the size of the sebaceous glands (pores will shrink). Less sebum production means less acne. Lack of sebum provokes bacteria populations to drop down, clearing up acne. However this sebum reduction effect is generally not permanent and will depend on the dose of Accutane and the length of treatment.
Accutane is also being said to prevent the abnormal shedding and sticking of cells inside the sebaceous follicle. This means that Accutane clears out the pathway for sebum to travel to the outer skin. It’s said that when sebum production returns after treatment is completed, the sebum can travel to the surface normally without getting trapped in the follicle.
Lastly Accutane is now being proven to have a positive effect clearing up acne because it has anti-inflamatory effects.
The mechanism of action of Accutane can not be speed up with any other medicines or supplements. Usually what happens is the acne gets worse during the first month of treatment before it starts to clear. Some of the side effects like dry lips appear before its acne clearing powers start to kick in. However if you have any initial breakouts it is recomended to let your doctor know about it.
Isotretinoin has significant side effects, this is the reason why this medication should be taken under strict monitoring by qualified physicians.
Statistically side effects are show to be:
80- 90% Chapped/cracked dry lips
Dryness of nose
40-20% Eye irritation
Joint and muscle pains
Temporary thinning of hair
5% -1% Intestinal problems
Decreased night vision
Depression, suicide ideation
Accutane causes common side effects in almost all patients. Most of the time these side effects are generally not serious in nature. It is very important that if you are experiencing any side effects to tell your doctor as soon as possible. If you feel your doctor guidelines are not appropiate, it would be wise to stop the medication. Somehow some doctors are not faced with cases that could make them aware of all potential risks. Your doctor may change your dosages during treatment also, for managing the side effects.
The most common side effect is dryness. Almost all patients experience dry chapped lips, a condition known as “cheilitis”. While this is common, if the drying turns into blisters, swelling or fungus like in appearance, Accutane should be inmediatly stopped and consult with your physician. Other dryness-related side effects include dry skin, dry and irritated eyes and mild nosebleeds. For people who wear contact lenses this usually presents a problem.
Other common complaints is the temporary thinning of the hair. This usually occurs when patients are close to end of a course of therapy and reverses within a few months. My hair personally thinned out and came back to normal in few weeks after finishing treatment. However in some cases, patients have had hair loss that has persisted after treatment.
Rare Side Effects:
Because Accutane is a potent drug there are some rare serious side effects that can do harm if they are not treated on time. This is very important to have in mind as side effects can not be ignored during treatment. Make sure if you experience any of these side effects to stop the medication and inmediatly consult your physician.
1) Pseudotumor cerebri (internal brain pressure)- Symptoms of this condition include severe headache, nausea, vomiting and blurred vision.
2)Corneal opacities- condition where areas on the cornea lose their transparency.
3) IBD (inflammatory bowel disease) – While still there is no proof that Accutane can cause IBD it has been reported cases of this so any diarrhea, rectal bleeding or abdominal pain you may experience should be told your derm as soon as possible.
4) Hyperostosis (bone changes) – . How significant this minimal bone changes is still unkown. What is being said is that it can happen with very high Accutane dosages or for too long accutane course.
5) Decreased night vision – be careful when driving at night!! This is a rare occurence but it can happen so its recomended not driving at night during treatment.
5) Impotence/loss of libido – Accutane does have a potential to cause erectile dysfunction problems and loss of libido which might be temporary or persistant upon discontinuation of treatment.
During Accutane therapy, blood is usually drawn periodically to check certain laboratory changes. Specifically, doctors generally monitor trigylcerides, cholesterol and liver function. If changes are noted, the drug may be temporarily stopped or the dose reduced, depending on the nature of the change.
Accutane may increase the level of blood fats (triglycerides and cholesterol), sometimes to dangerous levels. Also liver function can be affected. For this reason regular blood tests are done during treatment to prevent potential risk this may have if left untreated. These tests must be done when you have fasted for 12 hours (no breakfast), for reliable test results.
Administration of Isotretinoin:
As Accutane is a form of vitamin A, which is fat soluble, Accutane should be taken with food for better absorption of the medicine. Accutane is usually dosed according to a patient’s weight. The recommended dose of isotretinoin is 0.5 to 2 mg per kg of body weight.
Isotretinoin is proven to be harmful to the human fetus because of its teratogenic effect. Avoiding pregancy should be be taken seriously under this medication. Restrictions increase more each time because no matter the propaganda its being given there is still cases of women taken the drug that become preagnant increasing the rate of abortions. As a general rule not followed in all countries two negative test results are required before therapy is started, and a pregnancy test is done during each month of therapy. Birth control which can also be mandatory or not according location is very important and at least two effective methods of contraception should be taken if sexually active during therapy and at least one month after finishing therapy. Accutane does nothing to the ovaries birth defects are inminent and it takes as little as 20mg to provoke it.
Tips to play safe during Accutane:
1) Drink lots of water!
2) Eat healthy food low in fat
3) Take good rest
4) Do not take or use drugs that migh interfer with your mood such as alcohol
5) Use sunscreen all the time!!
6) Be observant to side effects closely and tell your doctor about any you experience. Remember any severe side effect is reason to stop accutane inmediatly
7) Read the insert, completetly!