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Accutane Treatment for Acne

Find out if Accutane is the right option for your acne treatment

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.

Inflamed and irritated acne that goes left untreated has the potential to create permanent acne scars that can be even more difficult to treat than the acne lesions themselves. In order to best manage an acne breakout and prevent the development of acne scars, it is vital to meet with a board-certified dermatologist, like Dr. Michele Green in NYC, who can accurately and effectively treat your acne. Dr. Green is an expert in the field of cosmetic dermatology, with over 25 years of experience treating some of the most discerning men and women in the world. Dr. Green takes the time to thoroughly understand the unique concerns, needs, and goals of her patients in order to deliver phenomenal, long-lasting results. During a consultation with Dr. Green, a personalized treatment plan will be established that is tailored to suit your skin type, tone, and condition. The result will be a clear, smooth, beautiful complexion, leaving you looking and feeling like the absolute best version of yourself.

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 does Accutane do?

Accutane provides patients with a clear, healthy, blemish-free complexion. Not only does Accutane help manage acne breakouts by reducing oil production and killing acne-causing bacteria, it also plays a role in preventing acne scars from forming. Accutane effectively combats all types of breakouts, whether it be cysts, nodules, pustules, pimples, whiteheads, or blackheads.

What is the treatment process for Accutane?

The first part of the treatment process entails scheduling an in person or virtual consultation with Dr. Michele Green in her private New York City office. You will discuss your current skin condition and assess if Accutane is the best course of medication for you. A thorough review of all past medical history is performed, including any hormonal changes, or family history of acne or other skin issues. While Accutane used to be relegated to simply the treatment of only severe acne cases, its usage has expanded to treat many milder, chronic, or recalcitrant cases of acne.

The complete course of Accutane is typically five months and patients must sign up for the Ipledge program in order to receive their medication directly 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 them. 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 order a complete metabolic profile and other blood tests, including hormonal tests, to the laboratory to ensure that there are no liver abnormalities, hormonal irregularities, 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, or abstain from sex, during this five month period of time. Since Accutane can cause permanent birth defects in a fetus of pregnant women, female patients are advised 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.

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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 iPLEDGE® system in order to prescribe Accutane for each patient.

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.

Is Accutane covered by insurance?

The cost of Accutane may be covered by your health insurance. Before starting Accutane, it is important to consult your health insurance provider regarding your individual policy to determine complete 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
  • Nosebleeds
  • Gastrointenstinal (GI) side effects
  • Mood changes
  • Night vision changes
  • Hair thinning
  • Allergic reactions
  • Potential acne flare-up

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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 50 or higher, and proper sun protection are essential while taking isotretinoin and being outdoors.

What are the potential blood abnormalities from Accutane?

  • Anemia
  • Thrombocytopenia
  • Neutropenia
  • Increased sedimentation rate (ESR)

What are the potential nervous system side effects of Accutane?

  • Benign intracranial hypertension
  • Drowsiness
  • Dizziness
  • Headaches
  • Blurred Vision

What are the Gastrointestinal (GI) side effects of Accutane?

  • Inflammatory bowel disease
  • Ulcerative colitis
  • Ileitis
  • Nausea
  • 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

  • Depression
  • Increased anxiety
  • Suicidal thoughts
  • Other mental health problems
  • psychosis

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, Doxycycline, 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.

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32 year old treated with Accutane – 6 months

Does Accutane make you tired?

Although it is not a common side effect, Accutane does have the potential to cause feelings of tiredness and fatigue. If you experience increased feelings of tiredness while taking Accutane, alert your provider who can make any necessary adjustments to your prescription.

Does Accutane cause hair loss?

Hair thinning and hair loss are potential side effects that can occur when taking Accutane. In part, these effects develop because Accutane can be very drying to both skin and hair. This can cause the hair to become brittle and make it more susceptible to breakage. However, this type of hair breakage can be mitigated by using deep conditioners and gentle shampoos.

Hair loss that results from taking Accutane is only temporary and should fully resolve on its own once Accutane treatment is concluded. If your hair is slow to grow back after finishing your prescription of Accutane, let Dr. Green know. Topical hair treatment serums, topical Minoxidil (Rogaine), oral supplements like Nutrafol, and in-office procedures like injections with Platelet-Rich-Plasma (PRP) may help to speed up the regrowth process. Dr. Green will be able to evaluate your hair condition and recommend the best combination of treatments for your situation.

Does Accutane cause weight gain?

No! Weight gain is not one of the potential side effects associated with taking Accutane. Additionally, Accutane does not cause weight loss. Changes in weight have not bee linked to Accutane.

Does Accutane get rid of blackheads?

Accutane used to be a treatment reserved for severe cystic and nodular forms of acne. However, its use has been expanded for treatment of all kinds of recalcitrant acne that has not been able to be effectively resolved with other oral or topical medications. Accutane combats different causes of acne including clogged pores, acne-causing bacteria, excess oil production, and skin inflammation. These qualities of Accutane make it an effective treatment for all types of acne, including blackheads and whiteheads.

Skin care while taking Accutane

Accutane causes skin to be more photosensitive and also commonly causes dryness. It’s imperative that while on Accutane, a rich, non-comedogenic moisturizer and broad-spectrum SPF are both used. These two skincare products will help to nourish the skin and replenish moisture as well as negate the negative effects of the sun’s harmful UV rays, respectively. While some well-known acne-fighting ingredients include retinoids, alpha hydroxy acids, benzoyl peroxide, and salicylic acid, these ingredients can be far too irritating for patients who are taking Accutane. While on Accutane, one should avoid using skincare products that contain these ingredients. Instead, individuals taking Accutane should stick to a skincare regimen that is gentle, yet effective in order to keep their skin looking and feeling healthy and well-moisturized without exacerbating any acne or dryness.

Non-comedogenic products containing gentle and hydrating ingredients should be included in the skincare routine of someone who is acne-prone and taking Accutane. There are many different products available for treating acne and it can be a challenge finding what works best for you. Knowing your skin type is the first and most important step in determining which products and ingredients will benefit you most. For acne-prone skin, it’s generally recommended to use a gentle cleanser, twice daily, without intense scrubbing. Scrubbing skin too aggressively can exacerbate skin irritation and worsen inflammation.  Cleansers that are meant to treat acne usually work by gently exfoliating the skin, sloughing off dead skin cells and reducing the presence of bacteria and oil that are causing acne. Dr. Green has carefully formulated the Gentle Cleanser from her MGSkinLabs, Inc. Line, to provide patients with a way to retain skin moisture while effectively cleansing the skin. This cleanser is perfect for daily use and gentle enough for those who are very dry and sensitive, as one may be while taking Accutane.

Applying a lightweight, oil-free, non-comedogenic moisturizer is essential for patients who are taking Accutane. Accutane works by reducing the amount of oil produced in the skin, which contributes to the moisturization of skin. It’s always important to keep the skin hydrated to maintain skin health, and especially so when using a drying medication such as Accutane. The Ultimately Sheer Hydrating Lotion from Dr. Green’s MGSKINLABs is designed for sensitive and acne-prone skin, making it the perfect moisturizer for patients on Accutane. The lotion is enriched with aloe and rosewater and never leaves behind a greasy feel like some hydrating lotions do.

Using a broad-spectrum SPF while treating acne with Accutane is a non-negotiable skincare step. Accutane can make the skin extra sensitive to sunlight, potentially worsening the appearance of the acne, exacerbating the breakout, and resulting in dark marks where there are acne lesions. Dr. Green recommends a physical sunscreen that incorporates ingredients such as zinc oxide or titanium dioxide, that sit atop the skin and act as a physical barrier against the sun’s rays. Dr. Green’s SPF 50 Advanced Formula Broad Spectrum Sunscreen is a great option for sun protection, especially when on Accutane. To ensure proper coverage, apply 15 minutes before sun exposure and reapply after swimming, excessive perspiration or anytime after towel drying. Also, sunscreen should be reapplied every 1.5-2 hours for best sun protection, while exposed to direct sunlight.

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, chemical peels, laser treatment for acne scars or 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 the Fraxel® laser, for at least one year from the date of completion of the medication.

When planning any acne scar treatment, after the course of Accutane is completed, it is imperative to consult an acne scar expert, like Dr. Green, to determine the best laser treatment and waiting time necessary after the course of Accutane is completed. In general, dermal injections, of Restylane®, Sculptra®, or Juvederm®, can be done while a patients is still on Accutane. Radiofrequency lasers (RF), such as Vivace and eMatrix® laser, need to wait at least six months after completing a course of Accutane therapy. Microneedling® with PRP.

When does Accutane start working?

The majority of patients notice an immediate improvement in their skin in just the first month of taking Accutane. Over the next 5 months of treatment, the dose of Accutane is gradually increased to ensure that there are no new breakouts. The maximum dosage of Accutane prescribed is 2 milligrams per kilogram of body weight per day. Over 95% of patients respond well to Accutane treatment and suffer no further acne breakouts after completing their five month course of medication. All generic versions of isotretinoin use the same dosing calculations. Of the 5% of patients who do not clear after 5 months, 50% of these patients completely clear after a second course of Accutane.

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28 year old female, acne treatment with Accutane – 1 month

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. Women must have a negative pregnancy test completed monthly while taking 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 Isotretinoin are currently available?

As of 2017, the following brand names are available for Isotretinoin in the United States:

  • Zoretanin
  • Absorica
  • Amnesteem
  • Claravis
  • Myorisan
  • Sotret
  • Claravis
  • Zenatane

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.

Does Accutane help with acne scars?

Inflammation from acne can cause damage to the skin tissue, ultimately resulting in the formation of acne scars. In general, acne that causes acne scars tends to cystic because it is infected and more inflamed than whiteheads or blackheads. Accutane works by minimizing the oil glands in the skin and directing the growth of new skin to prevent buildup of these clogged pores. These positive effects can also help to combat the development of acne scars by reducing the amount of inflammation and the severity of the acne breakouts. Accutane helps to eliminate any existing acne and prevent new acne breakouts from forming, allowing the skin to heal.

After your completion of Accutane therapy, once your acne breakouts are under control, residual acne scarring may now be visible. While one may be eager to start treating these acne scars immediately, it is important to wait the prescribed amount of time upon completing the course of Accutane. Cosmetic procedures such as dermabrasion, exfoliation, plastic surgery, lasers, laser tattoo removal, laser hair removal, and waxing should be avoided during treatment and for several months afterwards. Since the effects of Accutane can stay in your system after the course of medication is completed, you should avoid ablative laser treatments, such as Fraxel, for at least one year from the date of completion of the medication. In order to establish a plan for treating your acne and residual acne scars, schedule a consultation with an expert, like Dr. Michele Green in New York.

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How to get Accutane?

Accutane is available by prescription only. In order to get Accutane, the first step is having a consultation with a board-certified dermatologist, like Dr. Green. With Dr. Green, you will discuss your current skin condition and she will assess if Accutane is the best course of treatment for you. A thorough review of all past medical history is performed, including any hormonal changes, family history of acne, and your previous methods of acne treatment. A complete metabolic profile, among other blood tests, are then sent to the laboratory to ensure that there are no liver abnormalities, hormonal irregularities, 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, or abstain from sex, during this five month period of time. Since Accutane can cause permanent birth defects in a fetus of pregnant women, female patients are advised to use two different forms of birth control while taking Accutane.

Participation in an online program called iPledge is required to receive an Accutane prescription. All patients must be registered with iPledge to get their prescription from the pharmacy. Dr. Green will provide you with an identification number that you will use to access the iPledge program and fill your prescription. Additionally, before you start taking the medication, you must sign an informed consent sheet acknowledging that you understand the risks associated with taking isotretinoin.

A follow up visit with Dr. Green is required once a month while you are taking Accutane so that your progress may be evaluated and your condition, including any side effects you may be experiencing, may be discussed. During each monthly visit, a set of blood tests are sent to the lab, including a pregnancy test if you are a woman who can become pregnant.

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Accutane – 6 months before and after

How do I get started with Accutane for acne treatment today?

Acne breakouts and acne scars can leave you feeling self-conscious about your appearance, affecting your self esteem and quality of life. Treating acne can feel impossible when you’re attempting a DIY approach, and when over-the-counter treatment isn’t successful, acne lesions can leave behind permanent scars that are difficult to remove. If you are suffering with acne and acne scarring, and you want a permanent solution, schedule a consultation with board-certified dermatologist, Dr. Michele Green in New York. She is an internationally-renowned expert when it comes to treating acne and acne scars, helping thousands of patients from around the world achieve lasting clear, smooth, beautiful complexion. Dr. Green is here to provide you with complete skin restoration and give you blemish-free, healthy skin.

Please call us today at 212-535-3088 or email our New York City-based office today to schedule a consultation with Dr. Michele Green and discover which acne treatment is best for you.

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