Medical Therapies: Treatment with Accutane for Severe or Unresponsive Acne

Medical Therapies Index : Treatment with Accutane for Severe or Unresponsive Acne

What Is It?

Acne is caused by a number of different things happening at the same time. Our sebaceous glands become active when we hit puberty, making more skin oils. The bacteria that live in our skin (Propionibacterium acnes) normally eat this oil and overgrow. The lining of the hair follicles also get clogged up, sometimes blocking the pores and making a bad situation worse. Accutane is a brother to vitamin A and Retin-A, and helps clear acne by decreasing sebaceous (oil) gland function and making new normal layers of outer skin. It is available in 10mg (light pink) and 40mg (yellow) soft gelatin capsules for oral administration. Its scientific name is 13-cis-retinoic acid or isotretinoin. Approximately 80% of patients who take Accutane experience a "cure", where they never have acne the way they had it before treatment. Only about 20% require additional courses, usually within the first three years. You will still get pimples after treatment, but only a few, and usually never as bad as it was before. The dosage and length of treatment are determined by your body weight and the severity of your condition. It should be taken with food, all at one time with your biggest meal.

Accutane exerts its beneficial effects on acne in 4 ways:

Decreases facial oil (sebum) production
Thins the dead layers of skin (reduces keratinization)
Reduces Propionibacterium acnes bacteria in the skin
Reduces the redness and swelling (anti-inflammatory)

Accutane works on the face, chest and back equally well. Acne of the back and chest is usually harder to treat, and therefore more likely to relapse and require another course of treatment. Accutane may cause a flare of your acne in the first 2-6 weeks, although this usually only occurs with severe cases. To avoid this, we may use other medicines in combination with Accutane to treat the flare. A short course of Prednisone by mouth or injection in the arm may be used a well.

Indications and Usage:

Accutane* is indicated for the treatment of severe recalcitrant cystic acne (those unresponsive or not fully responsive to conventional therapy with systemic antibiotics, topical benzoyl peroxide, topical retinoic acid, topical antibiotics or acne surgery).

Contraindications:

We cannot use it in pregnant women, because it causes birth defects.
Women CANNOT get pregnant while taking Accutane. They must use an effective form of contraception. If pregnancy occurs during treatment, the physician and patient should discuss the desirability of continuing the pregnancy.
It is recommended that contraception be continued for two months or until 2 normal menstrual periods have occurred after Accutane is discontinued.
If you are allergic to parabens, do not take Accutane.
Women should not wax during Accutane therapy; the skin is more fragile during treatment and a burn or dermatitis may occur.

We will get blood tests before medication is started, and then just before each 4-week appointment. Women will have a serum pregnancy test with each set of labs. We cannot renew your prescription until we have checked your blood tests.

We expect certain tests to go up while you are taking Accutane. They are a normal consequence of treatment, but occur most frequently in patients with diabetes mellitus, obesity, increased alcohol intake and family history of blood lipid elevation. They usually return to normal after therapy has been stopped. We will discuss any abnormal values with you and discuss any action that may need to be taken.

The most common blood tests to go up are:

Accutane has a long list of side-effects, which are usually only annoying in nature, and return to normal after the course is over. Reducing the dose for a week or so and increasing it back to normal will usually allow us to continue therapy. There is little effect on the success of your treatment if we have to lower or stop your medicine for a short period of time. Occasionally, healing may be exaggerated by crusting and overgrowth of granulation tissue. In case of swelling, redness or tenderness around fingernails, please contact the office immediately. All Vitamin A and vitamins containing Vitamin A must be avoided during the course of treatment.

A multivitamin a day is fine, however.

The FDA requires that you be warned about an idiosyncratic reaction related to Accutane usage. Accutane may make you feel down, depressed or even have suicidal thoughts. This reaction appears to be independent of your general state of mind when not taking Accutane, and is dose-related (it will go away when the medicine is stopped). If you experience any of these feelings, stop the medicine immediately and call the office.

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