Everything you need to know before going on Accutane
Acne. There’s a lot of stigma surrounding the four letter word. It’s somewhat shocking, really, considering the stats: approximately 85% of people between the ages of 12 and 24 will experience some form of acne.
Despite celebrities shedding light on the topic and the societal move towards body positivity, acne is still a large insecurity for many sufferers. If you have acne, chances are you’ve probably comes across the term Accutane amongst a long list of quick fixes that include everything from DIY home remedies like using toothpaste and aspirin (don’t do either of those, btw) to multi-step treatment systems like Proactiv.
But what is Accutane? It’s neither a miracle pill nor a drug that must be avoided like the plague. In reality, Accutane (Isotretinoin) works at the level of the pilosebaceous unit to decrease sebum (oil gland) production, and for some, the results can be life-changing. That being said, it is a serious drug and one that shouldn’t be taken lightly. While there are many benefits, there are also many potential risks that must be considered.
To help shed some light, we’ve spoken with DLK on Avenue’s expert dermatologist, Dr. Lisa Kellett. Read our interview below to see what she had to say about the controversial drug and things you should consider before going on it.
What are the causes of acne?
“The pathogenesis of acne is what we call multi-factorial. So there are a number of reasons as to why you would get acne. One of them is sebum production. The other is an increase in a bacterium we call propionibacterium acne. Another cause is a disorder in the pilosebaceous unit and how it turns over itself. And then there’s always hormonal acne.”
Who’s the ideal patient?
“There’s no perfect patient. Sometimes I see women who are in their 30s and have tried everything and they’re a great candidate for it because they have what we call recalcitrant acne, which is acne that fails to respond to other things. So that would be one person, whereas another person might be young, 17 or 18, and have nodule cystic acne, [which is] acne that is starting to scar. Both of those patients are [equally] good candidates. So it really depends on the patient. There are lots of different types of people that can benefit from it.”
Do I need to speak to a dermatologist first?
“Whenever you go on a medication you should have an in-depth discussion with your dermatologist where you discuss the risks of the treatment, the benefits of the treatment and alternative options. That discussion is very important because it will allow patients to decide if they’re willing to accept the risks. The bottom line is that people who are looking for this should see a dermatologist first, get the right diagnosis, and then if patients have acne that has been resistant to previous treatments, such as topical medications and oral antibiotics, Accutane would be one of the things that they would consider.”
How long is the treatment?
“It depends on the patient and it depends on what type of acne they have. It would be anywhere from 5 to 9 months.”
What’s the dosage like?
“With Accutane you’re looking at a cumulative dose as opposed to a daily dose. So you might have a total dose over 8 months or a total dose over 5 months, but it’s the total cumulative dose, not the daily total dose [that matters]. Often the dosage is based on your weight.”
When’s the best time to start the medication?
“Accutane can make you photosensitive. So for example, if I have a patient who’s working at a golf course and is going to be outside during the summer it’s probably not a good idea to start them on Accutane—you’ll want to wait until the fall or the winter. However, if I have another patient who’s just doing office work, they might want to start during the summer. So it depends on what their lifestyle is and how much sun they’ll get.”
What are the side effects?
“Here’s the thing: any drug that you take has risks and benefits. For people who take Accutane, the most common side effect would be dry lips and dry eyes. Another common side effect would be dermatitis, or a flare of eczema, or an increase in redness of the face. Those are common side effects, but there are also significant side effects that could be very adverse. There have been associated cases of depression, but the one we worry about the most is called teratogenicity (birth defects). Another thing is there have been reported cases of irreversible night blindness while on the drug, which means you will have problems seeing at night on a permanent basis, so you won’t be able to drive at night.”
What about pregnancy risks?
“If you were to get pregnant and be on the drug, about 50% of [those] pregnancies would spontaneously abort, and of the remaining 50% of those would have significant brain, bone and heart abnormalities. [Don’t take Accutane if] you’re thinking about being pregnant or planning to get pregnant in the near future (6 months to a year).”
Can I still use other medications?
“Often we will prescribe medication, like a topical steroid or ointment, to help with the dryness or the dermatitis, [but] you have to be careful with other antibiotics while on Accutane. Be careful [when consuming] alcohol and be careful with using topical medications that might cause irritation. You’ll want to avoid things with lactic acid, salicylic acid and mandelic acid because those can be irritating. You’re already prone to having a form of dermatitis or eczema—you don’t want to use something that’s going to flare it up.”
What about blood work?
“The drug is so strong you need to do blood work monthly. Sometimes [there are] problems with the blood work so you’d have to stop taking [Accutane] for that reason.”
Can I use Accutane to treat other skin conditions?
“Accutane is used for a number of skin disorders, not only acne. Dermatologists would also use [Accutane] for inflammatory skin disorders like hidradenitis suppurativa or dissecting cellulitis of the scalp or gram-negative folliculitis.”
But does it really work?
“We tell people that there’s no cure for acne. You can control it but you can’t cure it. [That being said,] Accutane’s an effective drug and about 85% of people see a significant improvement. For the right person and under the right circumstances it can be very effective.”