You may have heard of Accutane both from gushing celebrity advocates and media naysayers. And now, you’re probably wondering if you should give it a try after a string of failed acne regimens.
Does Accutane really work, or is it just another overhyped showbiz fad? And is this medication safe for you?
Learn about the benefits and risks of Accutane treatment and what you can expect during therapy. But before you can judge whether or not the drug works, you need to understand a few things about acne.
How Does Acne Develop?
Acne is the inflammation of the pilosebaceous unit—the part of your skin made up of the hair follicle and oil (sebaceous) gland. Its most common triggers include stress, hormonal changes, medications, poor hygiene, bad food choices and many others. When any of them is present, the following chain of events may occur:
Factors that can cause cellular overgrowth inside the hair follicle include:
- Hyperactivity of androgens or testosterone-like hormones
- Reduced body levels of linoleic acid, a fatty acid that you can get only from the diet
- Immunologic changes
The excess cells do not only grow fast, but they are also unusually sticky. The hair follicle has limited room, so cellular overgrowth can easily clog your pores and make them swell from debris and oil buildup.
Excess Sebum Production
Sebum is the skin’s oily secretion. It minimizes moisture loss from your skin and protects it from microbes and oxidative stress. Excess sebum production is often due to hormonally induced sebaceous gland dysfunction.
Increased Bacterial Activity
The sebum contains a type of fat called “triglycerides.” They are food for Propionibacterium acnes, a normally harmless skin inhabitant. P. acnes bacteria multiply fast when it’s raining triglycerides. The microbes and their waste products irritate the skin.
All of the above changes lead to pressure buildup inside the hair follicle and subsequent inflammation. The lesion can grow and rupture, causing acne.
Hormonal changes make teenagers acne-prone, but the condition can afflict people of any age, including babies.
How Do BHSkin Dermatology Specialists Get Rid of Acne?
BHSkin Dermatology physicians have a vast anti-acne arsenal, which includes the following:
Cleansing the skin twice daily minimizes impurities and oil buildup. Antibacterial cleansers inhibit bacterial growth. Cleansing is the gentlest approach to acne.
Topical medications like benzoyl peroxide, erythromycin and clindamycin have antimicrobial action. Some, like azelaic acid, can clear up your pores while getting rid of bacteria.
Your dermatologist may put you on oral antibiotics if you don’t respond to topical treatments. Minocycline and clindamycin—two of the most commonly prescribed acne-busting antibiotics—also prevent oil accumulation in the skin.
Some individuals are prone to hormonal acne or breakouts caused by androgen fluctuations. These patients may benefit from anti-androgenic medications.
Chocolate, milk, sweets, and fatty meals have all been implicated in breakouts, although the link between acne and food is not entirely clear. Still, adequate hydration and a healthy diet never hurt the skin, so we encourage our patients to make better food choices consistently.
This procedure removes blackheads and whiteheads to prevent severe acne.
Steroids injected into the skin curb inflammation in big, nodular acne.
Phototherapy and Lasers
Systemic and Topical Retinoid Formulations
Retinoids are vitamin-A-like molecules that can work wonders on the skin. Accutane is a kind of retinoid.
These treatments work in different ways, so their efficacy and safety also vary. Your dermatologist may recommend the mildest therapies first but will consider aggressive ones if you fail to respond.
How Does Accutane Work?
Accutane is a brand name of oral isotretinoin. It works at the genetic level to:
- Normalize cell growth and function in the hair follicles and oil glands.
- Prevent clogged pores.
- Modulate your skin’s immune response.
Moreover, isotretinoin has antimicrobial action against P. acnes, which is vital if the strain has become resistant to conventional antibiotics. Dermatologists recommend it for various acne types because it thwarts all the stages involved in acne formation. In contrast, other pimple treatments inhibit only one or two stages.
So when you think about it, those Hollywood Accutane users are right.
Isotretinoin is also available in topical form. Doctors may combine both oral and topical treatments to reduce your systemic dose and risk of developing unwanted side effects.
Get superior skincare from LA’s finest dermatologists
What Should You Expect When Taking Accutane?
Oral isotretinoin treatment is highly effective against acne and a myriad of other skin problems. But many find the experience uncomfortable or too restrictive. Here, we rounded up the things that you can expect when taking this medication.
Timeline of Effects
In the first two weeks, your skin’s oiliness will start to decrease. Before your first month of treatment ends, you may experience the “Accutane purge.” Skin purging looks like acne exacerbation. That is why you hear some Accutane patients saying, “It gets worse before it gets better.” But this is when the pilosebaceous units shed abnormal cells and replace them with better ones.
After 1-3 months, you should see your skin becoming clearer. From 4 months onwards, isotretinoin will continue to block acne formation. The usual duration of therapy is 4-6 months.
Isotretinoin continues to work for up to 2 months after your last intake. So your physician may stop your prescription without waiting for your skin to clear up totally. This helps you avoid unwanted side effects.
Potential Side Effects
The most frequent adverse effects of Accutane treatment are skin tightness, redness and peeling. With the purging of oil glands, you may also observe dryness of the skin, eyes and other mucosal surfaces. Photosensitivity and hair and nail changes are also common.
Systemic side effects are likewise linked to oral isotretinoin therapy, but they are either rare, preventable or manageable. They include:
- Severe birth defects because the drug crosses the placenta and also acts on the baby’s genes
- Increased vulnerability to Staphylococcal infections due to lower sebum production
- Muscle, bone or joint pain
- Pseudotumor cerebri, a benign condition where the pressure inside the skull rises. Symptoms include blurry vision, nausea and headache. It can develop if one takes Accutane with a tetracycline antibiotic like minocycline or doxycycline.
- Pancreatitis and fatty skin growths (xanthelasma) due to elevated blood triglycerides
- Exacerbation of inflammatory bowel disease, particularly ulcerative colitis
- Elevation of liver enzymes due to inflammation
- Clotting problems that can increase the risk of spontaneous bleeding
Some may think that it causes suicidal thoughts, but there is no strong evidence connecting psychiatric illness to Accutane intake. Meanwhile, acne by itself can affect people socially and psychologically, so many patients are prone to depression and other mental health issues.
Accutane Before and After: How Your Dermatologist Will Manage the Risks
After a thorough evaluation, your doctor will walk you through various aspects of the treatment. They will explain the proper intake of your isotretinoin capsules and what you need to do to optimize their benefits and minimize risks.
Besides patient education, your physician’s roles during Accutane therapy include the following:
- Patient screening—oral isotretinoin is very effective, but it’s not for everybody. Your doctor may recommend another form of acne therapy to prevent aggravating a pre-existing medical condition.
- Pregnancy testing and birth control—women will have regular pregnancy tests before, during and after the treatment. They are also required to use two forms of contraception. Birth control pills are safe to take alongside Accutane. Male patients must also use contraception during therapy because a small amount of isotretinoin ends up in the semen.
- Treating minor complications—your healthcare provider may do the following for non-life-threatening side effects:
- Give you emollients for flaky or dry skin. You may treat chapped lips with lip balm.
- Give artificial tears for eye dryness.
- Prescribe antibiotics for superficial infections.
- Adjust your dose.
- Preventing severe complications—your physician will do the following to prevent life-threatening adverse events:
- Blood testing as needed
- Avoid prescribing medications known to have unpleasant interactions with isotretinoin
- Discontinue the treatment, if necessary
- Work with other specialists, if necessary
- Assessing the cosmetic results—your dermatologist will monitor your progress to know when to stop your therapy.
Expect to see your doctor more frequently during this time.
What Should You Do to Ensure the Success of Your Accutane Treatment?
One of your priorities before starting this therapy is registering for the iPledge program. This is a web-based pregnancy risk management program for individuals on Accutane or those planning to take it.
The iPledge website has a list of requirements for both male and female patients. In a gist, they all involve strict protocols for preventing pregnancy during Accutane treatment and vice versa.
Your doctor’s Accutane prescription lasts for only a month. You need to satisfy iPledge requirements—a negative pregnancy test and declaring two birth control forms—before you are given another.
Aside from iPledge participation, you must also do the following:
- Take your Accutane pills as instructed by your physician.
- Wear sunscreen when going outdoors.
- Take the necessary blood tests.
- Schedule regular consults with your dermatologist.
- Call your doctor’s clinic for any problems.
Severe complications and unexpected pregnancy can set you back from your treatment goals, but these recommendations will help ensure better outcomes.
What Should You Not Do While on Accutane?
It’s best to avoid the following during the treatment course to prevent complications:
- Smoking—the combination of isotretinoin and cigarette consumption increases your lung cancer risk. Also, smoking releases chemicals that are bad for the skin.
- Drinking—alcohol augments the drug’s liver toxicity. The same goes for liver-damaging medications like methotrexate.
- Blood donation—isotretinoin stays mostly in your blood. You wouldn’t want it accidentally transfused to a pregnant woman.
- Phototherapy, lasers and harsh chemical treatments—isotretinoin sensitizes the skin to the effects of these therapies.
- Taking Accutane without medical supervision—as previously mentioned, your physician is there to make sure that your treatment works and remains safe. You can buy the drug online, but taking it without medical supervision can lead to dire consequences.
Do not hesitate to tell your dermatologist if you have other health concerns. There’s a long list of drugs that do not work well with Accutane, and your doctor is the best person to tell you which ones to avoid.
The Accutane treatment experience has its ups and downs. But you can reduce the hassles in yours by working closely with your dermatologist.
Will Your Acne Come Back After Accutane Treatment?
Acne disappears completely after one treatment course in about 85% of patients. The rest need a second course. The period of remission takes years for most.
Does Accutane Make You Gain Weight?
Accutane changes your body’s lipid composition, but there is no clear link between weight gain and intake of this drug.
Should You Take Isotretinoin for Mild Acne?
Some cases of mild acne may be treated right away with this medication. You may discuss it with your dermatologist. Generally, it will require a low-dose or alternate-day dosing regimen.
Does Isotretinoin Cause Cancer?
What is known today is that isotretinoin does not increase the risk of skin cancer in humans. In fact, retinoids can protect you from this condition. They stimulate the formation of skin cancer protectants and modulate the immune system. Moreover, isotretinoin has been used to boost the effects of cancer drugs against other tumor types.
To Sum It Up
An ounce of prevention is worth a pound of cure. And when it comes to preventing acne scars, nothing beats Accutane treatment. But you have to take it with caution and medical supervision.
And as always, never leave your skin’s health to chance. Partner up with no less than a board-certified professional on your Accutane journey.
Having Clear Skin Doesn’t Have to Be Convoluted Guesswork
You can have acne at any age, but you don’t have to put up with the scars. Accutane treatment can help. For head-turning, pimple-free skin, choose only LA’s most trusted dermatologists at BHSkin Dermatology. Visit us at our Encino or Glendale clinic or use our virtual portal for a remote consultation.
Book your appointment today!
Get superior skincare from LA's finest dermatologists
Book the type of an appointment that suits you best.