Treatment with Isotretinoin for Severe or Unresponsive Acne

Acne is one of the common skin conditions that usually cause pimples. It affects both men and women and is more common in teenagers because of hormonal changes. Acne appears on the body parts where oil is secreted in larger quantities and is common on the face, back, neck, eyebrows, shoulders, and chest areas. Acne is formed when the hair follicles under the skin gets blocked and mixes with oil produced from sebaceous glands. Bacteria grow in these hair follicles causing infection which leads to skin irritation, pus formation, and finally scratching of the pimple which can leave behind scars. The hair follicle wall breaks up deep in the skin causing acne nodules or cysts.

Various factors may increase the risk of developing acne and they include:

  • Oil based make-up, hair products and other cosmetics
  • Hormonal changes during puberty, menstruation and pregnancy
  • Squeezing, scratching, or picking at blemishes
  • Stress
  • Hard scrubbing of the skin (stimulates oil production)

Severe acne is the condition of acne resistant to common treatments. The acne invariably increases in size and multiplies in numbers. In many cases the acne will form pus, and bleed from picking or scratching. Acne can cause many socio-psychological problems such as embarrassment, avoiding social gatherings, and can even lead to depression.


Accutane® (Isotretinoin) is indicated for treatment of recalcitrant or severe acne and is approved by US Food and Drug Administration (FDA). This is an oral soft gelatin capsule which is generally prescribed twice daily. Accutane is dramatically effective for all types of acne, including severe scarring cystic acne. There is simply no better treatment for acne. Accutane has been used in the United States since 1982. Over the last two decades, millions of people all over the world have successfully and safely used Accutane to clear their resistant acne. Perhaps more importantly, Accutane has converted thousands of reclusive and very unhappy patients with unsightly faces, into clear-skinned and self-confident individuals. Accutane is not just a face-saver; it can also be a true "life changer".

Accutane is an oral capsule given in doses of 0.5 to 1.0 mg/kg/day divided into 2 equal doses. This drug is available in 10-, 20-, and 40- mg capsules. This drug acts upon the oil secreting glands preventing the secretion of oil. Although accutane is an effective choice for severe acne, it is contraindicated in pregnant women and individuals with mental disorders. Pregnant women should avoid using this drug as it can cause birth defects and miscarriages.

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. Accutane may cause side effects such as depression, headache, rashes, psychosis, suicidal thoughts and violent behaviors. This drug also affects the liver and intestine. You will be advised to stop using all vitamin A containing supplements during this treatment however a multivitamin is okay to take daily.

In case of swelling, redness or tenderness around fingernails, please contact Dr. Resnik's office immediately. 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. For any questions on acne and use of accutane, consult Dr. Resnik for more information.

Schedule your consultation with Dr. Resnik