Dr. Michele Green is an internationally known specialist in acne scars and prevention in NYC. Accutane is an important medication in dermatology and an essential medication in acne treatment and acne scar prevention. Accutane has been considered the “last resort” when all other medications or treatments have been ineffective for nodular acne or cystic acne. Its primary indication has always been for treating severe acne. However, Accutane has now been embraced by the American Academy of Dermatology to expand its recommendations to more than just nodulocystic acne, to chronic or recalcitrant acne papules and pustules. Many patients benefit from this medication, as it is able to prevent acne scarring in the majority of individuals. Accutane is the brand name for an oral medication called Isotretinoin, also known as 13-cis-retinoic acid. Since Accutane is a retinoid, it means that it is related to Vitamin A. It is an amazing treatment for acne patients, when no other topical or oral medications, photodynamic therapy, lasers, or chemicals peels have been effective in permanently curing acne. The new expanded guidelines by the AAD will encourage more dermatologists and other healthcare provider to prescribe Accutane sooner, and prevent needless physical and emotional acne scarring. While there has been controversy over Accutane over the past two decades, it still remains the only treatment to “cure” severe, cystic acne, and prevent acne scarring.
23 year old woman treated for acne with Accutane – 3 months
What is Isotretinoin’s mechanism of action?
The exact mechanism of Isotretinoin is not entirely known but is is believed that its mechanism of action induces apoptosis, or programmed cell death in certain cells of the body, such as in the sebaceous glands. By inducing cell death of sebaceous glands, and reducing oil gland production, the inflammation and bacteria that live in the follicle are reduced. This process allows the skin to heal and blocks the formation of new acne lesions.
In addition to apoptosis, Isotretinoin reduces sebum production and has an antimicrobial effect on certain bacteria that live in acne lesions. Accutane also reduces the size of the sebaceous glands themselves. These various mechanisms of actions work in unison to create a more permanent “cure” for cystic acne.
What is the treatment process for Accutane?
The complete course of Accutane is typically five months and patients must sign up for the Ipledge program in order to receive their medication from the pharmacy. Patients with cystic or recalcitrant acne first need to consult with Dr. Green to see if Accutane is the best course of treatment for their acne. Dr. Green will conduct a thorough review of your medical and surgical history, medication history, and past acne treatment to see if you are a good candidate for Accutane. Dr. Green will send your blood to the laboratory to have it analyzed to ensure that there are no liver abnormalities or anemia. Women are required to have two negative pregnancy tests before they are allowed to begin treatment. In addition, women are asked to use birth control during this five month period of time. Since Accutane causes permanent birth defects in pregnant women, female patients are asked to use two different forms of birth control while taking Accutane.
The dosage of Accutane is based on the weight of the patient. The dosage is generally between one to two kg per day, based on weight, and may be taken once or twice a day with food. Many patients notice immediate improvement within the very first month while taking Accutane. A very small subset of patients notice an increase in acne breakouts during this first month. Gradually, over the five months, the dosage is increased to ensure that there are no new acne breakouts. The maximum dosage given for Accutane is 2 mg/kg of body weight per day. Over 95% of patents respond to Accutane and suffer no further acne breakouts after completing their five month course of medication. All generic versions of isotretinoin use the same dosing calculations.
Male treated for acne with Accutane – 6 months
Of the 5% of patients who do not clear after 5 months, 50% of these patients completely clear after a second course of Accutane. There are a small percentage of patients who require a small maintenance dosage of Accutane to keep their skin clear of acne breakouts. 95% of patients clear completely from their course of Accutane and only have occasional pimples afterwards.
While on Accutane, monthly blood tests are required to monitor liver enzymes, white blood cell count (WBC) and red blood cells (RBC) counts. Women are required to have monthly negative pregnancy tests. Accutane is controlled through the government run IPLEDGE program. All blood tests and birth control methods must be documented and updated monthly in the system in order to prescribe Accutane for each patient.
What is the cost of Accutane?
The cost of Accutane depends on several factors. The cost of the prescription medication varies depending on which pharmacy you use to obtain the medication. In addition, monthly blood tests and examinations may be covered by your health insurance but it is important to consult your individual policy to determine benefits and eligibility.
What are the most common side effects of Accutane?
- Dry skin, peeling skin
- Dry lips (chelitis)
- Dry Eyes
- Skin peeling
- Sun sensitivity (sunscreen use is important while on Accutane)
- Joint pain
- Gastrointenstinal (GI) side effects
- Mood changes
- Night vision changes
- Hair thinning
- Allergic reactions
- Potential acne flare-up
17 year old treated for acne with Accutane
How to treat or prevent some of the common side effects of Accutane?
The most common side effect of Accutane is dry skin and Dr. Green will encourage you to use moisturizers or cortisone creams if the dryness is severe. Lip dryness, which has been associated with isotretinoin use, can also be treated with emollients. Some patients suffer from dry eyes and it daily use of saline eye drops helps correct this problem. Your skin will be very sensitive to the sun so strict sun avoidance and that of tanning machines as well is imperative. Daily sunscreen use, of SPF 30 or higher, and proper sun protection are essential while taking isotretinoin and being outdoors.
What are the potential blood abnormalities from Accutane?
- Increased sedimentation rate (ESR)
What are the potential nervous system side effects of Accutane?
- Benign intracranial hypertension
- Blurred Vision
What are the Gastrointestinal (GI) side effects of Accutane?
- Inflammatory bowel disease
- Inflammation of the pancreas or Pancreatitis
- Stomach pain
- Increased cholesterol and triglyceride levels
- Elevated liver function
- Yellowing of your eyes or skin from jaundice
- Severe diarrhea or rectal bleeding
Mental Health Side Effects of Accutane
- Can cause depression
- Increased anxiety
- Suicidal thoughts
Musculoskeletal Side effects of Isotretinoin
- Myalgia (muscular pain)
- Arthalgia (joint pain)
- Premature epiphyseal closure of the growth plate
- Hyperostotis changes (excessive bone growth)
Teratogencity and Accutane
Accutane is a teratogen which causes serious side effects, specifically severe birth defects, if the medication is taken during pregnancy or for a short time before conception. Isotretinoin is classified by the FDA as a Category X medication and is strictly contraindicated during pregnancy. Taking Isotretinoin while pregnant cause birth defects include hearing and visual impairment, missing or malformed earlobes, abnormalities in brain function, and facial dysmorphism. It is also advised not to breastfeed while taking Accutane. Since Accutane may pass during breastfeeding, you should discontinue doing so while on this medication.
Drug interactions with Isotretinoin
It is advised to discontinue Tetracycline antibiotics or Minocycline while taking Isotretinoin (Accutane) as this an contribute to the development of benign intracranial hypertension. Symptoms of this syndrome are a headache behind the eyes, ringing in the ears, and vision disturbances.
It is also important to discontinue phenytoin (Dilantin) while taking Isotretinoin as this can cause bone loss and weakening of bones. It is very important to completely read your medication guide while taking Accutane.
Is it safe to drink alcohol on Accutane?
Since Accutane is absorbed and metabolized in the liver, it is not advisable to drink alcohol during your entire course of treatment. Drinking alcohol can elevate your liver enzymes and this interaction could potentially damage your liver. Drinking alcohol while taking Accutane can cause possible side effects of permanent liver damage. It is liver metabolism which makes taking certain medications, which get absorbed by the liver, not advisable during the course of Accutane.
Female, Acne treatment with Accutane, 3 months
What procedures should you avoid on Accutane?
Accutane is a photosensitizing medication so it is best to use a high SPF daily and avoid the sun while on Accutane. Since Accutane delays would healing, you should avoid cosmetic procedures such as dermabrasion, exfoliation, plastic surgery, lasers, laser tattoo removal, laser hair removal, or waxing. Since the effects of Accutane can stay in your system after the course of medication is complete, you should avoid ablative laser treatments, such as Fraxel, for at least one year from the date of completion of the medication.
Is it safe to take Accutane?
Although there are many potential side effects for Accutane is an entirely safe medication. Isotrentinoin needs strict monitoring under a doctor’s supervision for potential side effects. A controlled dosage needs to be followed by prescribers, as a dosage which is too high can result in toxicity, resembling vitamin A toxicity.
There have been several FDA warnings about the risk of buying Accutane over the internet. Since Accutane is a complex medication, with numerous side effects, you should never initiate treatment on your own, without the medical advice and guidance of a board certified physician, like Dr. Michele Green in NYC. It is extremely important that an experienced dermatologist monitor you for possible adverse effects and administer the appropriate dosage to avoid serious health problems.
What is the iPLEDGE Program for Accutane?
The iPLEDGE Program was originally initiated in 2005 and encompasses all FDA-approved Isotretinoin. iPLEDGE is regulted by the gov U.S. food and drug administration.The goal of the program is to prevent birth defects and ensure proper monitoring and prescribing of Isotretinoin. There is a centralized system for physician, pharmacists, and patients to manage the medication and minimize any potential risks.
Women of childbearing potential who participate in the iPLEDGE program to take Isotretinoin therapy, for recalcitrant cystic acne, must have two documented negative pregnancy tests before the medication can be prescribed. They must also sign an agreement to use two forms of contraception or maintain abstinence during the period of time they are taking Isotretinoin. Birth control pills, are considered an excellent method of pregnancy prevention while on Accutane. The combination birth control pill is recommended since it contains both estrogen and progesterone, not the minipill. Monthly negative pregnancy blood tests are required for all women to continue with Isotretinoin for the entire period of time they are on the medication.
Monitoring of liver enzymes and a complete blood count are necessary both before the start of Isotretinoin treatment, and at monthly intervals. It is important to complete this monthly liver function blood tests, blood chemistry, including triglycerides, to ensure that you are to having any unwanted side effects from Accutane.
Why was Accutane discontinued?
In 2002, the original makers of Accutane, Roche Pharmaceuticals, discontinued the manufacture of Accutane when the patent expired. They discontinued manufacturing Isotretinoin for business reasons. Due to the influx of numerous cheaper generic medications now available, and the cost of defending personal-injury lawsuits brought by some people who took the medication. Isotretinoin is now available in the United States only through generic versions of the drug.
What brands of Isotretinion are currently available?
As of 2017, the following brand names are available for Isotretinoin in the United States:
These newer generic medications should be taken with food, specially with a high-fat meal. It is important to take the drug with a high-fat meal to insure its absorption, to make certain that you are receiving the correct dosing of Isotretinoin. The brand Absorica uses technology that incorporates fats in the actual capsule, to make certain that the correct dosage medication is delivered to the patient. Twice daily dosage may be better than once a day dosage to help with continued absorption of Isotretinoin.
Accutane is the only “cure’” that currently exists for recalcitrant acne. While it is a “miracle” drug for many patients, it has many possible side effects. It is critical that a board certified dermatologist be monitoring you during the course of this treatment. Dr. Michele Green has been prescribing Accutane for over two decades with wonderful treatment results and the prevention of acne scarring.
If you are suffering with acne and acne scarring, and want a permanent cure, call Dr. Michele Green to make a consultation to discuss acne treatments that can work for you. Contact us online today or call 212-535-3088.