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When Should You Consider Taking Accutane?

Updated on January 21, 2017
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Accutane, which is known scientifically as 13-cis retinoic acid, is a very potent drug used for the treatment of severe acne. It is one of most restricted drugs on the FDA list and for good reason. This drug was initially developed to be used as a chemotherapy medication for the treatment of brain cancer, pancreatic cancer and more. The drug is still undergoing research for use in head and neck cancer chemoprevention. In children with high-risk neuroblastoma, treatment with 13-cis-retinoic acid (Accutane) reduces the risk of cancer coming back after high-dose chemotherapy and stem cell transplant.

Acne treatment has been around since the 1930s when medical professionals used high dosages of Vitamin A (retinoic acid) to subdue the body’s production of sebum – an oily and waxy substance secreted from sebaceous glands that cause acne. Improving on this discovery of Vitamin A’s ability to treat acne, the Swiss health care company, Hoffmann-La Roche (Roche Pharmaceuticals), developed isotretinoin, a derivative of retinoic acid, in 1982. Although Accutane was initially developed as a chemotherapy drug to kill cancer cells, Dr. Gary Peck began using isotretinoin to eliminate one of the primary causes of severe acne. Since this was not the primary reason why the drug was developed, it came along with some severe side effects. In 2010, an Alabama man who filed a product liability lawsuit against Roche Holding AG was awarded over $25 million after he developed inflammatory bowel disease (IBD) and had to undergo five surgeries – one to remove his colon. In the summer of 2009, Accutane manufacturer, Roche Pharmaceuticals, stopped manufacturing the drug. Representatives for Roche said the acne treatment had hit the end of its life cycle because of the end of its patent and the addition of several generic Accutane drugs to the market.

It is very important that you weigh the potential benefits against the potential risks before taking this drug. This is because the list of side effects from this drug is quite scary. In cases where an individual has very severe acne which affects his or her quality of life and his or her ability to live a normal life in society, then there is every reason to consider Accutane. I would try to walk you through some options and things one can try before finally settling on Accutane. It is advisable for everyone to try these remedies out and find out if it works for them before they finally settle on Accutane. To appreciate the various ways of treating acne, we need to first get an in-depth understanding of how acne is formed.

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What is Acne?

Acne is a skin disease that normally affects people during their teen years. This is when most people have reached their adolescent stage and hence their bodies have started producing sex hormones. These hormones send signals to the sebaceous glands to produce more sebum. In most people, the sebaceous glands produce the right amount of sebum which does not clog any pores. However, in some cases, there is an excessive production of sebum which can result in it being trapped under the skin. This causes sebum eating bacteria to invade the pores and feed on the sebum. The immune system reacts to this by producing white blood cells to attack the bacteria in the pores which result in the inflammation of the skin and that is what we call acne.

Acne can differ in severity and this is mainly due to the amount of sebum produced and how deep it is trapped under the skin. Mild acne results from the body producing a reasonable amount of sebum which is trapped just under the surface of the skin. This normally manifests itself in the form of whiteheads and blackheads. This type of acne is usually not painful and causes very little scarring. Moderate acne occurs when the sebaceous glands produce quite a large amount of sebum which gets trapped deep under the skin. This is what leads to the formation of cysts which can be quite painful and causes very deep scarring. Here, bacteria invade sebum which is trapped deep under the skin which causes severe inflammations and getting the sebum out can be quite painful. The severe case of acne occurs when nodules are formed. Nodules are formed very deep within the skin and are large, hard and painful bumps. They cause extensive scarring and can really affect the psychological well-being of the individual it afflicts.

It is very important to avoid Accutane if you have mild to moderate acne since the benefits are not worth the risks. If you suffer from moderately severe to severe acne, you can opt for Accutane. However, the final decision whether to prescribe you Accutane or not lies with your doctor and would assess if your acne is severe enough to warrant a prescription. The following solutions should first be tried and only if they don't work can one go ahead to consider Accutane.

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Over the Counter Acne Drugs

The first step in treating acne is to try over the counter medications. These drugs are mostly topical medications where you apply them directly to the area affected by acne. The active ingredients in most over the counter medications are benzoyl peroxide, tretinoin, sulfur, salicylic acid, antibiotics and alpha hydroxy acids. These drugs serve different purposes. Firstly, they help to reduce inflammation. Secondly, they kill bacteria and make the skin less hospitable to bacteria. Over-the-counter acne products can further help decrease sebum on the surface of the skin. Last but not the least, these drugs assist in the quick renewal of the skin and help remove dead skin cells so that sebum does not have enough time to clog the pores.

It must however be noted that if you are suffering from severe cystic or nodular acne, topical acne medications would not be of much help since these drugs do not attack bacteria deep within the skin. Topical medications cannot penetrate deep into the skin where bacteria are located. They are therefore effective for moderate to mild acne which is not predominantly cysts. The disadvantage of these medications is that you have to continue using them until your acne finally goes away on its own which can be quite expensive.

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Oral Antibiotics and Birth Control Pills

Oral antibiotics include drugs like tetracycline and erythromycin. These drugs attack the bacteria deep within the skin that causes inflammation. It is effective for cysts and nodular acne and can help relieve inflammation for some time. However, antibiotics cannot be taken regularly for a long period of time since the bacteria that causes acne can become resistant and may not respond to treatment. Also, long-term use of antibiotics can make you prone to certain infections in the future.

Birth control pills can also help reduce acne in women since they help reduce androgen production which in turn reduces acne formation. However, staying on birth control pills for a long time also has its side effects. Some women have reported an increase in weight, headaches, nausea and vomiting after being on birth control pills.

Diet

There has been a strong connection between acne and diet. Certain types of food have been found to alter hormone levels which in turn exacerbate acne. Some people have reported an increase in their acne after eating foods that are rich in cholesterol such as shellfish and seafood (shrimps). Others have also reported an increase in their acne from excessive consumption of dairy and sugar. People who are intolerant to gluten and wheat have reported an increase in acne after consuming foods that contain gluten. Acne may be a way of your body telling you that it is allergic to some foods that you are consuming at the moment. You can therefore gradually eliminate certain foods from your diet and monitor the progress of your skin over time. You can also keep a journal and record the food you eat every day and monitor its effect on your skin.

Certain diets have also been found to help relieve acne. One of the simplest ways to improve your skin is to drink a lot of water. Water helps to flush out excess toxins from your skin and body which might be causing your acne. You can also introduce vitamin A and vitamin C rich food sources into your diets. Vitamin A promotes normal turnover of skin cells which helps prevent acne. Vitamin C also helps protect your body from toxins. Some people have also reported a tremendous improvement in their acne after switching to a vegan diet.

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Accutane

When you have tried all the above remedies and there is no significant improvement in your acne, then it is quite justified to go ahead and try Accutane. It is first advisable to talk with your doctor so that he or she can outline some of the potential effects of taking this drug. Women are expected to do a mandatory pregnancy test before taking this drug as Accutane has been linked to the abnormal development of fetuses in the wombs of pregnant women. Your doctor may also require you to do a series of liver tests to make sure you don't have any underlying liver conditions as Accutane has been linked to liver disorders in some patients. People on Accutane are normally obliged to take blood tests every month to make sure their liver enzymes and triglyceride levels are within normal limits.

Once the drug is prescribed, your daily dose is dependent on your weight and the severity of your acne. If you weigh 60 kg you may be required to take 60 mg a day. Also, if you weigh 80 kg you may be required to take 80 mg a day. The drug is normally taken for 6 months. However, the duration may vary. The most important thing is to reach the maximum cumulative dose which is 120mg/kg. This prevents your acne from coming back and hence avoids the need to take a second course. It is advisable to take Accutane with a high-fat meal since this ensures optimal absorption.

The most common side effect of taking the drug is chapped lips and dry skin. It is advisable to have some form of moisturizer always with you to keep your skin and lips moist. You can also experience peeling of the skin from this drug and hence a good moisturizer is always recommended. Joint pain is also a common side effect to Accutane. It is therefore advisable to limit your physical activities during your treatment. It is very important to note that Accutane can sometimes cause your acne to become severe for the first few months before finally clearing your skin. This is because it causes your skin to purge out all the acne that has been trapped under your skin. Hence, you shouldn't be discouraged when your skin is not improving for the first few months. Some people have reported mood swings whilst they were on Accutane. It is very important for the family members of Accutane users to monitor them and report any unusual behaviors so as to get appropriate help since Accutane has been linked to suicide in some individuals.

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After Accutane

Accutane can really transform the life of some individuals and give them a chance to start their life afresh. The quality of life of such individuals is greatly improved and they go ahead to live their life to the fullest. However, the emotional scars from having acne usually take a long time to heal and they will forever remember the horrible experiences they encountered as a result of being afflicted with acne. They come to view the world in a new light and learn to treat everyone with respect no matter their condition.

Accutane has a success rate of over 80% which is very good. This means that for 80% of individuals who take Accutane, they can live their life free of acne for a very long time. Of course, there would be the occasional acne here and there but it would be nowhere near what it was before they took Accutane. For the remaining 20%, they might have to take a second course of Accutane to rid their skin of acne forever.

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