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Fact Checked

Common Alternatives for Accutane

Acne is generally viewed as a skin problem faced only by teenagers and adolescents. However, acne can affect people of all ages and although it usually begins in puberty, it can continue well into adulthood. Today, it is the most common skin problem in the United States that brings people to the dermatologist’s office. 

Acne is caused by inflammation of the skin glands and hair follicles in the skin. Development of acne is not limited to just the face, with many people commonly getting acne on their back, shoulders, arms, chest and neck. Acne is rarely a serious medical condition, but the formation of these pustules and lesions on visible areas of the body can cause more than just physical discomfort. According to the American Academy of Dermatology, having acne can have adverse consequences on an individual’s mental and emotional health. Research has found that people with acne increasingly face problems like depression, anxiety and low self-esteem. So, getting treatment for acne is important. 

Early treatment of acne can be crucial in both treating the condition and preventing other forms of stress that accompany having acne. Treatment methods that are tailored for the individual can prevent permanent scarring where acne is present and relieve emotional distress and anxiety that can accompany having the condition. 

Medications used to treat acne must be approved by the FDA to ensure that they are safe. If you consult a dermatologist to treat acne, you will likely be prescribed a combination of FDA-approved medications to clear up your acne. 

What are the best treatment methods for acne? Accutane is, by far, one of the most effective acne medications on the market.  

Accutane

What is Accutane? Accutane, also known as isotretinoin, is a vitamin-A derivative that is prescribed to treat severe acne. Accutane is not the first line medication used for acne, and is usually prescribed when other modes of treatment are not effective. Does Accutane work? What makes Accutane unique is that it is effective for treatment of all kinds of breakouts and it is sometimes prescribed for other skin problems as well. The medication is taken for four to five months as an oral pill, within which breakouts completely clear up. Many patients are completely cured from their acne with a one-time treatment, but some patients have to undergo another treatment with Accutane to prevent it from coming back. 

There are several risks associated with using Accutane. Although this medication seems like a magic remedy to treating acne, it is not right for everyone. Vitamin A can build up in the tissues of the body and become severely toxic. The most serious risk of taking Accutane is that it can cause serious birth defects in the developing fetus if taken while pregnant. Therefore, Accutane should not be taken by pregnant women or women who may get pregnant for up to 30 days after the last dose. 

Another serious issue with taking Accutane is that it can cause serious mental health problems like depression and suicidal thoughts in people who take it. These serious risks are in addition to the normal side effects that include dry eyes and mouth, chapped lips, nosebleeds, sensitivity to the sun, muscle aches, thinning skin, and headaches. These side effects usually resolve after the medication is completed, but they can cause significant discomfort in patients that take Accutane.

Is Accutane worth the risk? How much does Accutane cost? Are there other safer options to treat acne that are just as effective? Your doctor will help decide whether Accutane is right for you, but fortunately, there are plenty of other acne medications with less toxic consequences available as alternatives to Accutane that can be effective in clearing up acne.

Here is a list of common alternatives for Accutane to treat acne. 

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Topical retinoids 

Isotretinoin (Accutane) is a type of retinoid that is taken orally. The related retinoids are topical creams or gels that are alternatives to isotretinoin. The most commonly prescribed topical retinoids require a prescription. These include:

  • Retin-A (tretinoin)
  • Differin (adapalene)
  • Tazorac (tazarotene) 

Like Accutane, these medications are also vitamin-A derivatives that work by unclogging pores and reducing oil production by glands. Topical retinoids have less serious risks associated with taking them. The most common side effects experienced with using them are dry and flaky skin, and temporary skin redness. Pregnant women should not take topical retinoids either as it can be damaging to the developing fetus.  

Many people with acne find that topical retinoids work extremely well in clearing up breakouts, so this class of acne medication is worth a try before resorting to taking Accutane. Something to consider is that topical retinoids can be on the expensive side to purchase. Some insurance plans cover their purchase, but not all do. 

Antibiotics 

According to the American Association for Dermatology, the first line treatment of acne vulgaris using oral medication is with oral antibiotics. Antibiotics have been effective in treating acne for a long time. In fact, dermatologists are one of the largest prescribers of antibiotics annually. 

Several classes of antibiotics are prescribed for treating acne. These include the tetracycline antibiotics like clindamycin, minocycline and doxycycline. Macrolide antibiotics that include azithromycin and erythromycin are other popular choices for treating acne. When either of these two classes of antibiotics do not work, or if they produce undesirable side effects, trimethoprim-sulfamethoxazole (Bactrim) is sometimes prescribed. 

Recently, there has been increasing concern about long-term antibiotic use. This can lead to antibiotic resistance in patients, which cause more problems down the line. Additionally, long-term use of antibiotics can cause irritable bowel syndrome. So, while antibiotics can be helpful in short term treatment of acne, there are some risks associated with their long-term use.

Benzoyl peroxide

If you suffer from mild or moderate acne, topical benzoyl peroxide can be a good option for treatment. The benefit of using benzoyl peroxide is that many formulations are available over-the-counter and can be purchased without a prescription. Many cleansers, creams and gels for spot treatment are available for purchase from drugstores. This makes benzoyl peroxide extremely accessible as a mode of treatment for acne that is not cystic or very severe.  

While benzoyl peroxide kills bacteria that cause acne, it is not as effective for the treatment of more severe acne that can become pus-filled. In these cases, benzoyl peroxide is combined with other acne medications like topical retinoids or oral antibiotics.  

Spironolactone

Spironolactone is a diuretic drug or ‘water pill’ that removes excess fluid from the body. It was originally used to treat high blood pressure, heart failure and edema in patients, but it is now used as ‘off-label’ treatment for acne in women. This medication has proven to be very effective in treating acne that has hormonal causes. Spironolactone reduces androgen production in the body, which in turn decreases testosterone levels. For this reason, it should not be taken by men because it causes unwanted side effects. However, women can safely take it. 

A low dosage of the medication taken long term is recommended for effective treatment of acne.  Some side effects that can occur with taking this medication are irregular periods, frequent urination, breast tenderness, fatigue and headaches. Antibiotics are still prescribed more often than spironolactone, but many women have found this medication to be extremely effective in clearing their acne. Since spironolactone is an older drug, generic versions are available making the medication relatively inexpensive to purchase. 

Birth control 

Oral contraceptive pills are another option for women to treat acne. Androgens are male sex hormones that are also found in women, which can cause glands in the skin to produce too much oil. Excess oil can combine with dirt and clog pores leading to acne. Birth control pills can reduce the production of androgens leading to less oil production. There are four FDA-approved birth control pills for acne. These include:

  • Yaz 
  • Beyaz
  • Estrostep FE
  • Beyaz

Birth control pills are often combined with another acne medication like spironolactone. They should not be taken with certain pre-existing conditions, so be sure to discuss your medical history with your doctor before taking them. 

How to choose the right acne medication

What works best to clear up acne in one person will not necessarily work for someone else. Everyone’s skin is different, and the causes for acne can also vary from person to person. Which medication you decide to use should depend on several factors. Things to consider are the severity of your acne, your medical history including other medications that you take, whether you are pregnant or are planning to get pregnant, and what fits best with your lifestyle. Importantly, prescriptions are required to purchase most of these medications that treat acne. A dermatologist can evaluate your problem to recommend the best treatment method for you.

Without doubt, Accutane is considered to be the most effective medication available for treating severe acne. While taking any medication, you should also consider the side effects and risks associated with taking it, as well as how long the medication will need to be taken. The benefits of taking a medication, whether it is oral or topical, should outweigh the risks associated with taking it. So, before purchasing Accutane, it is worth discussing alternative options with your doctor to find the acne medication that is right for you.

Published September 2nd, 2020 by Chris Riley
Fact Checked by Chris Riley

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