Today I want to talk about one of the most controversial drugs in dermatology. Isotretinoin, commonly referred to as Accutane. Accutane is the brand name, Isotretinoin is the generic name. It was first marketed by Hoffmann-La Roche as a treatment for acne, but it has since been found to be effective for many other diseases such as brain and pancreatic cancer, harlequin-type ichthyosis, keratosis pilaris, genital warts, and lamellar ichthyosis. It is related to vitamin A and is found naturally in small amounts in the body.
When I mention the word Accutane to a patient because I think we are at a point in a patients treatment where it may be necessary, I am always amused at the response. Some people will say they have heard of it and remember how one of their friends that used to have acne took it and was very dry but loved the results. Others respond by shaking their heads saying there is no way they are doing Accutane because of all the bad things they have heard about it. Accutane is like Mormonism, it is the best thing out there but there is a lot of anti-Accutane people spreading fear and misinformation about it , just google it and you will see.
In the beginning, Accutane was only used on the most severe, cystic (pizza face), nodular acne, and these people were depressed. That is where a lot of the association with depression and using Accutane came from. I go to the Society of Dermatology Physician Assistants conference every year, and we talk about all the new issues in dermatology. Every year the presenting dermatologist will mention new studies that show that most people that take Accutane actually become happier as their skin improves and their self-esteem improves. There are many contradictory studies. What I have personally seen is the literal transformation of low sef-esteem adults and teenagers with acne, to happy self-confident, clear-skinned adults and teenagers.
Most of the side effects related to Accutane use have to do with dryness as the production of oil from the sebaceous gland is decreased. The actual mechanism of action is unknown. When I see my Accutane patients each month, I ask them a long list of questions about what side effects they are having, and 90% of the time the only side effect is dry lips with an occasional nose bleed. Once in a while they will have some back and joint pain. Rarely do I see anyone with symptoms of depression, but I do keep very close tabs on my patients so that we know if anything is going on. My cell phone number is on the clinic answering machine and they can call me at any time. I just saw a patient 5 minutes ago that has been on Accutane for 1 month and is already clear, that is not typical, but he is very happy. The biggest issue with Accutane is pregnancy. Isotretinoin is pregnancy category X, meaning if a female gets pregant while on it, there is a high probability they will miscarry the baby or it will be born defromed. No pregnancy, no issue! I will continue on the next blog.