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Skin Care

Accutane - Isotretinoin
By Dr. Jere Mammino and Dr. Robert Rosen
American Osteopathic College of Dermatology
Feb 18, 2004, 21:36

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Isotretinoin (trade name: Accutane) is a powerful drug used in the treatment of acne.  Four to five months of Accutane treatment usually leads to clearing of acne. It is a potent medication that is very effective for nearly all types of breakouts. Accutane is needed for moderate to severe acne that has failed other treatments. It should be used for a severe, scarring acne. Is also used for acne present for many years that has not respond completely to antibiotic pills and creams. While it has many side effects, in some ways it is safer than long-term antibiotic usage. Most other acne-controlling medicines are antibacterial agents, which are effective only if used daily. Over two million people have taken this drug, so a lot is known about its safety and effectiveness

Accutane is a naturally occurring derivative of vitamin A and is detectable in the bloodstream of all people. Vitamin A in large doses has the same effects as Accutane, both good and bad, but quickly becomes harmful since it builds up in the tissue. (Important: Don't take any vitamin A while on Accutane). Accutane is formed naturally in the body from the Vitamin A present in the bloodstream. This is why large amounts of Vitamin A taken during pregnancy cause the same birth defects that Accutane does. Fortunately, because it is a naturally occurring product, the body is able to quickly remove Accutane from the bloodstream. It is gone from the blood within nine days and has no lasting effect on future pregnancies.

Accutane "cures" about half of those people who take it so that they never need to do anything else for acne. In the first few weeks of treatment, about one in five patients gets a little worse, and one in 500 patients gets much worse. The rest either get much better, or better for a while. There is nothing else in the world that comes close to being this effective for severe acne. The usual patient takes it for 4 to 6 months, but some need more and must be "retreated" for an additional 4 to 6 months.

Taking Accutane with food increases the absorption of the medicine. The more Accutane one takes, the greater the chance of cure. Unfortunately, side effects depend on the dose as well. At the lowest doses, there are almost no side effects at all. At the highest, everyone get rather nasty side effects, which are related on the drying effects on the oil glands. The dose needs to be adjusted to strike a balance between effectiveness and side effects.

Side effects that are common are listed here. Chapped lips (90%), countered by a using Vaseline or Aquaphor as a lip moisturizer, Dry skin and itching (80%) helped by frequent moisturizer creams, Dryness of nose, mild nosebleed (80%), helped by "AYR nasal gel", Irritation of the eyelids and eyes (40%), Joint and muscle pains (15%), Temporary hair thinning (10%), Rash (7%), Intestinal symptoms (5%), Urinary symptoms (5%), Headache (5%), Increased sensitivity to sun (5%), Decreased night vision (<1%), Depression, thoughts of suicide (<1%).

Accutane may increase the level of blood fats, sometimes to risky levels. This reverts back to normal when the drug is stopped. Occasionally it may affect the liver. That's why regular blood tests are necessary during Accutane treatment. There is little risk of any damage if these precautions are followed.

The most damaging side effect of Accutane is serious birth defects if taken during pregnancy. It is critically important for women not to take Accutane while pregnant, and not to become pregnant while taking it. Women who are, or might be, sexually active while taking Accutane must use an effective method of birth control, of which the birth control pill is the most effective. Birth control pills do rarely fail, so an additional method of birth control such as a condom for the male partner or a spermicidal foam or sponge is also needed. Because the birth defects caused by Accutane are so serious, it's important not to share the pills with others.

Some people develop headaches while on Accutane. These respond to Advil or Tylenol. If a persistent headache develops while on Accutane, the medication should be stopped and the physician notified. Accutane has been reported to cause depression and thoughts of suicide, though a recent study has not shown any correlation. Extremely vigorous exercise should be avoided, as muscle aches can develop.

This article is taken from American Osteopathic College of Dermatology, used with permission.




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The medical information provided in this site is for educational purposes only.  Any topic discussed in this article is not intended as medical advice. It is not intended nor implied to be a substitute for professional medical advice and shall not create a physician - patient relationship. Consult a dermatologist, if you have a specific question or concern about a skin lesion or disease.
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