cystic or nodular acne

Accutane: The Acne Miracle Cure or Medicine in Vain?

 

What is Accutane?

Accutane is a former brand name for the oral isotretinoin prescription acne medicine. The Accutane brand name was discontinued, but the main ingredient, oral isotretinoin, lives on in other brand names like Absorica, Amnesteem, Claravis, Myorisan, and Zenatane. All of these brands are a form of oral isotretinoin, but the most widespread reference to it is by the former brand name, Accutane. Since it’s better known to the world as Accutane, that’s what we’ll use to reference oral isotretinoin in this article. Just keep in mind that there are other brands like Accutane out there.

Accutane is primarily used for severe forms of acne like cystic or nodular acne. Because of its extreme side effects, it’s a highly regulated prescription drug that one would have prescribed by a dermatologist. Despite the danger of its side effects, an overwhelming amount of patients can vouch for the success of this drug. It truly is a high risk, high reward remedy. As an online medical dermatology practice, we can attest that many of our patients achieve great success with Accutane. However, it is not for everyone, and despite its very high success rate, it does not guarantee a cure. In this article, we’ll tell you everything there is to know about Accutane so you can make the decision if the risk is truly worth the reward.

How it Works

Contrary to topical treatments that work on acne from the outside of the skin, Accutane works on acne from the inside-out. This is very effective because severe acne is deep inside the skin unlike mild and moderate acne. Topical treatments can’t penetrate your skin deep enough to get to the acne in the first place, but this isn’t a problem for Accutane. It also does everything the other prescription drugs do, but better and an all-in-one. There are 4 main ways Accutane gets rid of acne in just one pill: it stops sebum oil production, it kills acne-causing bacteria, it’s an anti-inflammatory that reduces swelling and redness of acne, and it increases skin cell production so no new pores get clogged up.

 Stopping Sebum Oil Production

Acne is filled with sebum oil. This oil is the feeding ground for acne-causing bacteria, it hardens to help clog pores, and it contributes to the size of an acne bump. Accutane reducing oil production is basically cutting the problem off at the source which makes this treatment so powerful. If you don’t fill a water balloon with water, you just won’t have a water balloon. This powerful effect is exclusive to oral isotretinoin.

Increasing Skin Cell Production

Most acne starts when dead skin cells are brushed over to block the pores in your skin. Sebum oil then builds up against the blockage, hardens, and suddenly you have a pore plug made of dead skin and hardened sebum oil. Increasing skin cell production makes new skin cells and causes dead ones to fall off faster. With more dead skin falling off your skin, there will be little left on the skin to start the pore plug in the first place.

Killing Acne-Causing Bacteria

These bacteria are called p. acnes. It’s a natural resident of everyone’s skin, and it usually flows out of skin pores without causing a problem. When your pores get clogged and sebum oil can’t escape, p. acnes now has a new home and feeding ground to multiply. Your immune system then rushes the surrounding skin with an inflammatory response (redness and swelling) in an attempt to kill all the bacteria. This is why your acne gets big and red. Accutane cuts off its sebum oil feeding ground so it won’t multiply, and increases cell production so p. acnes doesn’t get trapped in the first place.

Anti-Inflammatory

What gives acne its characteristic size and redness, especially in severe acne, is your body’s immune system reacting to kill acne-causing bacteria, p. acnes, that’s built up by a clogged pore. In the same way your skin gets a red bump in a bug bite, the same thing is happening because of p. acnes. What Accutane does is reduce your body’s tendency to swell and become red. Luckily, stopping your body’s natural protection against p. acnes doesn’t consequently cause harm since p. acnes doesn’t cause other illnesses.

The Journey Through Accutane

We call it a journey because along the way, there are regulatory obstacles, challenges, and valuable rewards to be earned over the course of the treatment. The intense side effects force us medical staff to use Accutane as a last resort. If a patient has tried every treatment to no avail, then you’re considered a candidate for Accutane. Unfortunately, female patients have a stricter process to go through than males due to the proven effect that Accutane has on pregnancy (see cons below).

As of October 3, 2019, most journeys go as such:

  1.       Try every treatment before becoming a candidate. There are quite a few, so the various treatments take multiple follow-ups to the dermatologist for them to confirm that they didn’t work and to switch you to a different available treatment. If there are no available treatments left to try, your dermatologist will introduce you to the iPledge program.
  2.       Read, sign, consent, and sign up to the iPledge program. This is the organization that regulates oral isotretinoin products. It teaches you about the dangers of oral isotretinoin, have blood work done before your dermatologist appointment, and makes females take 2 forms of birth control and a pregnancy test.
  3.       Your dermatologist checks your blood work to see that you’re healthy, your pregnancy test to see that you’re not pregnant, and that you’ve done the iPledge start-up process. They will then decide if you’re ready for Accutane. If ready, your dermatologist will determine the length of time and dosage you will be on with Accutane.
  4.       Your acne could flare up soon after you start, but don’t worry, this is normal and it will get better after the flare. For some patients, your acne has to get worse before it gets better.
  5.       Every month before picking up your next prescription, you will take a new iPledge quiz, some take a blood test just days before your monthly follow up with the dermatologist, and females need to have a pregnancy test done at an iPledge approved lab.
  6.       At the end of the treatment, females take one last pregnancy one-month after your last pill.

Remember that every patient will experience their own journey tailored to them upon the recommendation of your dermatologist. Each person’s skin and situation is different, so you might even be prescribed more treatments to supplement your journey.

Pros

Covered by Insurance

Maybe you didn’t know this, but acne is a skin disease, and the effect of acne doesn’t stop at physical pain. Many severe cases of acne can cause depression and other intense mental illnesses. Because of the potential consequences, medicine has deemed it a medical condition that can be covered by most insurance.

Changing your Life

It’s not an exaggeration that Accutane can change your life. Anyone who’s had severe acne knows the pain and social anxiety that comes with the clusters of red bumps. Sometimes it gets so bad, you don’t want to go outside or see anyone. Many of our Accutane patients tell stories of how they’d tried everything and lost hope that anything could help them. By the time they’ve reached the end of their treatment, you can hardly tell that our patient was the same person pre-treatment. Their skin is clear with a smile wider and brighter than the sun and a confidence that might as well be a different personality altogether. You’d think the Accutane was a cure for their anxiety as well. It’s plain to see that while it was the cure for acne, it was an indirect cause for our patients’ newfound overall happiness.

A Cure for Many

4 out of 5 patients never have a problem with acne again after reaching the end of the Accutane journey. They might get a few small pimples, but nowhere even close to the scale that they used to have. For the 1 out of 5 patients, they might have a relapse and will have to go through the journey a second time, or their acne might still present a significant issue.

Cons

There are enough possible side effects that accompany Accutane to fill a book. Even if many of them are unlikely to happen, they’re still dangerous enough for us to mention it when you sign up for Accutane. Unfortunately, we can’t talk about every possible side effect here, but we can at least explain the most common side effects and inconveniences that come with the Accutane journey.

Pregnancy Consequences

Accutane is a direct cause for complications in pregnancy. The high regulation with Accutane is especially because it can cause miscarriages, premature births, death of newborns after birth, birth defects (physical malformations of the baby), and mental retardation in the baby. These are the effects of Accutane in pregnant women. A male taking Accutane will have significantly less complications, but they may still have Accutane in their semen. The effect of Accutane in semen is not properly studied, but it goes without saying that it’s not a good idea to have a baby using such semen.

Dryness and Dehydration

The dryness and dehydration that comes with Accutane is one of the most annoying and inconvenient side effects for Accutane patients. Patients’ lips are chapped all the time and the face is like a flaky dessert. You could also get a nose bleed from the dehydration. Unfortunately, there’s nothing we can do to help you here. The dryness is the point. Accutane stops sebum oil production with is the source of all acne. The dryness is what makes Accutane so effective, so this is something patients are going to have to live with. There are ways to minimize the inconvenience like constantly moisturizing, having a lot of chapstick handy, and hydrating yourself when you can.

Sun Sensitivity

Accutane causes photosensitivity in many patients. This means one would be more prone to sunburns. The best way to counter this is to apply sunscreen as you’re applying moisturizer. Use at least SPF 15 to protect photosensitive skin.

Joint and Back Pain

Many patients get joint and back pain. It is unknown why exactly this happens, but likely it won’t cause any permanent damage to your joints or back.

Depression

Let’s be clear: there is no research evidence confirming that Accutane causes depression. In fact, many studies found that Accutane could help those with depression because of the positive emotional effects that come with clearer skin. Patients likely have little to fear about developing depression as a direct result of Accutane. But the concern that Accutane causes depression is widespread, so we’re still careful to check that our patient’s mental health doesn’t deteriorate.

Liver Strain: Alcohol and Accutane Interaction

Accutane is processed into your body through your liver. Although it doesn’t cause strain by itself, the reason it’s worth mentioning is because of our 21+ patients. A question we get a lot is if it’s okay to drink alcohol while on Accutane since they both pass through one’s liver to take effect. You take Accutane daily for 4 – 6 months, so one would naturally have this question right before having a girl’s night out or a cold one with the boys. Being honest, the combination is risky. With Accutane alone, patients have to send monthly blood work to their doctor to make sure their liver is doing okay. Adding alcohol into the mix would definitely increase the risk of liver damage. However, if you’re a healthy individual, then you can ask your dermatologist to check your blood work to see how much alcohol you could get away with consuming without any problems.

Annoying Package Tabs

This isn’t a side effect, but somehow drug manufacturers manage to make it one. The stress of pulling one of your pills out of the box it comes in is astounding. The box it comes in is resistant to nails, scissors, and pleading. The box is a fortress, but it’s worth the fight so you pry it open anyway.

Accutane via SkyMD

             To be on Accutane, patients have to try various acne treatments, countless dermatology follow ups, monthly blood work, and monthly pregnancy tests for females. So understandably, we get this question a lot: do you prescribe Accutane through SkyMD? The answer is yes! Our patients on Accutane are happy to be with us because the dermatologist visit and follow ups happen at your convenience on our online, protected platform. Most of the process is the same, except you’re not scrambling to get to the dermatologist’s office every month because it happens right on your phone. The Accutane journey is hard enough as it is, so our medical staff are very happy that we can make at least one thing about the process easier for our patients.

 

 

**The information in this article is not a substitute for professional medical advice. 

 

Bradley Ventayen

Bradley is a medical assistant at SkyMD. He graduated from the University of California, San Diego with a Physiology B.S. He is a part-time medical writer and an aspiring physician. He is blessed with the best mentors in the telemedical field to help him achieve his dreams and pursuit of knowledge.