The Complete Accutane Before and After Guide: How to Get the Most Out of Your Acne Treatment

You may have heard of Accutane—an oral isotretinoin formulation prescribed for pimple treatment—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? More importantly, is this medication safe for you?

In this article, I shall explain 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 formation.

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:

Follicular Overgrowth

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 people can only obtain 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 the skin and protects it from microbes and oxidative stress. Excess sebum production is often due to hormonally induced sebaceous gland dysfunction.

Increased Bacterial Activity

Sebum contains a type of lipid called “triglycerides.” Triglycerides 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.

Inflammation

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?

At BHSkin Dermatology, we have a vast anti-acne arsenal, which includes the following:

Medicated Cleansers

Cleansing the skin twice daily minimizes impurities and oil buildup. Antibacterial cleansers inhibit bacterial growth. Cleansing is the gentlest approach to acne.

Topical Drugs

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.

Systemic Antibiotics

We may prescribe oral antibiotics if patients 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.

Hormonal Therapy

Some individuals are prone to hormonal acne or breakouts caused by androgen fluctuations. These patients may benefit from anti-androgenic medications.

Diet Modification

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.

Acne Surgery

This procedure removes blackheads and whiteheads to prevent severe acne. 

Intralesional Glucocorticoids

Steroids injected into the skin curb inflammation in big, nodular acne.

Phototherapy and Lasers

UV radiation targets P. acnes and reduces skin inflammation. Laser treatment and photodynamic therapy get rid of abnormal sebaceous glands.

Systemic and Topical Retinoid Formulations

Retinoids are vitamin-A-like molecules that can work wonders on the skin. Topical retinoids include tretinoin and adapalene. Isotretinoin can be used topically or orally. Accutane is one of several oral isotretinoin brands.

The above acne 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. We recommend this medication 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.

As previously mentioned, isotretinoin is also available in topical form. In our practice, we sometimes combine both oral and topical treatments to reduce the patients’ systemic exposure and risk of developing unwanted side effects.

What Should You Expect When Taking Accutane?

Oral isotretinoin treatment is highly effective against acne and a myriad of other skin problems. However, many find the experience uncomfortable or too restrictive. Here is a list of the things you can expect when taking this medication.

Timeline of Effects and the Chance of Accutane Purge

In the first 2 weeks, your skin will start to feel less oily. Before your first month of treatment ends, you may experience a paradoxical acne flare, termed colloquially as “Accutane purge.” Skin purging looks like acne exacerbation. That is why you hear some Accutane patients saying, “It gets worse before it gets better.” 

The cause of the Accutane purge is unknown. Patients with deep lesions or those with a size greater than 1 mm are especially susceptible. However, it may be related to skin hypersensitivity to dead bacterial debris released during the early stages of oral isotretinoin therapy. Another possible reason for its occurrence is the drug’s action itself, as it induces the pilosebaceous units to shed abnormal cells and replace them with better ones.

At our clinic, our options for treating these flare-ups include careful dose adjustment, gentle cleansing, oral steroids, antibiotics and photodynamic therapy. 

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 4-8 months.

Isotretinoin continues to work for up to 2 months after your last intake. At our clinic, we may stop the prescription without waiting for the patient’s skin to clear up totally to ensure they 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 the drug causes suicidal thoughts, but there is no strong evidence connecting psychiatric illness to Accutane intake. Meanwhile, acne itself can affect people socially and psychologically, so many patients are prone to depression and other mental health issues.

As a medical practitioner, I believe that awareness of a treatment’s potential risks protects patients. Hence, the inclusion of oral isotretinoin’s side effects in this discussion. However, that doesn’t mean you should avoid this medication if it’s what you need to treat recurrent acne. If you’re seeing a licensed medical professional for oral isotretinoin therapy, you’re also protecting yourself from the drug’s potential risks.

Accutane Before and After: How BHSkin Dermatology Providers Manage Oral Isotretinoin’s Risks

After a thorough evaluation, we walk our patients through various aspects of the treatment. We explain the proper intake of isotretinoin capsules and what they need to do to optimize their benefits and minimize risks.

Besides patient education, we also ensure the patients are rendered the following services during therapy:

• Patient screening—oral isotretinoin is very effective, but it’s not for everybody. We typically recommend another form of acne therapy to prevent aggravating a pre-existing medical condition.
• Pregnancy testing and birth control—female patients 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—we may do the following for non-life-threatening side effects:
  • Recommend emollients for flaky or dry skin, lip balm for chapped lips, and artificial tears for eye dryness
  • Prescribe antibiotics for superficial infections
  • Adjust isotretinoin’s dose
• Preventing severe complications—we 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—we monitor the patient’s progress to know when to stop therapy.

Importantly, we remind our patients to stay on top of their follow-up appointments during Accutane therapy.

What Should You Do to Ensure the Success of Your Accutane Treatment?

One thing to prioritize before starting oral isotretinoin 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.

An Accutane prescription is good for only a month. Patients need to satisfy iPledge requirements—a negative pregnancy test and declaring two birth control forms—before they are given another.

Aside from iPledge participation, patients must also do the following:

• Take Accutane pills as instructed by their physician.
• Wear sunscreen when going outdoors.
• Take the necessary blood tests.
• Schedule regular consults with their healthcare provider.
• Inform their physician of any problems.

Severe complications and unexpected pregnancy can set patients back from their treatment goals, but these recommendations 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 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 the blood, and no one would 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, we physicians 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.

When I take my patients’ medical history, I make sure to ask if they have other health concerns. There’s a long list of drugs that do not work well with Accutane, and one of my roles as a physician is to help them determine which ones to avoid.

The Accutane treatment experience has its ups and downs. However, patients can reduce these hassles by working closely with a medical specialist.

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 this option with your dermatologist. In my practice, a low daily dose or alternate-day dosing regimen works well for patients with mild acne and in whom oral isotretinoin is not contraindicated.

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.

What Do BHSkin Dermatology’s Patients Say About Our Acne Treatments?

Here are some of the things patients say about our clinic’s acne treatments:

“I can’t say enough good things about Dr. Don Mehrabi and the entire BHSkin Dermatology staff. The products they prescribed have worked some incredible wonders, and I have had a very long, severe case of acne. I highly, 100% recommend this clinic.” 〜 Jared H.

“I took my son to see Dr. Mehrabi for his acne. Dr. Mehrabi took his time and examined my son, and he is extremely knowledgeable. We have been to other dermatologists, but Dr. Mehrabi earned our confidence easily. He looks very young, but he knows what he is talking about.” 〜 Jacklin J.

“I went to Dr. Mehrabi for his laser and acne service. My face was full of little brown spots since I was born, and he removed them all without leaving any scars. Also, for years, my face was full of white heads that would not disappear. They never came back after I started using the skincare regimen he prescribed. Now, all my family goes to him for any skin problem, and I refer him to all my friends.” 〜 Parisa N.

The Case for Oral Isotretinoin Is Strong

An ounce of prevention is worth a pound of cure. And when it comes to preventing acne scars, nothing beats Accutane treatment. Just remember that you have to take it with caution and work closely with a licensed medical professional during therapy.

And as always, the best partner you can have on your Accutane journey or any skin health need is a board-certified dermatologist.

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!

Sources:

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2. Goh, C. et al. (2019). Chapter 78: Acne Vulgaris. Fitzpatrick’s Dermatology (9th ed). McGraw Hill Education. https://accessmedicine.mhmedical.com/content.aspx?bookid=2570&sectionid=210419885
3. Hunsu, V. O. et al. (2021, July 20). Retinoids as Chemo-Preventive and Molecular-Targeted Anti-Cancer Therapies. International Journal of Molecular Sciences. 22. https://doi.org/10.3390/ijms22147731
4. iPLEDGE. Safety Notice. Retrieved October 4, 2023, from https://ipledgeprogram.com/#Main
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6. Lee, J. J. et al. (2010). Mortality in the Randomized, Controlled Lung Intergroup Trial of Isotretinoin. Cancer Prevention Research. 3(6). 738-744. https://doi.org/10.1158/1940-6207.CAPR-09-0124
7. Liu, J. et al. (September 2022). Acute acne flare following isotretinoin administration successfully treated by 5-aminolevulinic acid photodynamic therapy. Photodiagnosis and Photodynamic Therapy. 39. https://doi.org/10.1016/j.pdpdt.2022.102893
8. U.S. Food and Drug Administration. (2002, June 20). Accutane. Retrieved October 4, 2023, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2002/18662s051lbl.pdf
9. U.S. Food and Drug Administration. (2021, October 12). Isotretinoin Capsule Information. Retrieved October 4, 2023, from https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/isotretinoin-capsule-information

Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA’s leading board-certified dermatologist who treats patients, builds the BHSkin clinics, and raises three kids. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from practicing in Encino-Tarzana, Glendale, and online