Does Accutane Work?
Dr. Angel Rivera
Anyone who has had a breakout knows how frustrating it can be. Unfortunately, there is no single overnight cure for acne, but you can feel better knowing that you are not alone in the search for how to clear up pimples. Although many people consider acne as something that affects only teenagers, the truth is that it is not limited to any age group. The onset of acne is common during puberty, but people of any age can have acne. Since everyone has different skin, it is also difficult to pinpoint a single treatment method that will work for all kinds of skin and acne. Treatment for acne can be either topical or oral, depending on the severity of the acne.
Acne is caused by excess oil produced by the glands in the skin that mixes with dirt and bacteria, like Propionibacterium acnes, which clogs pores leading to eruption of pustules and nodules. Many acne treatment methods are temporary, meaning that although you treat a breakout, it does not actually prevent another breakout from occurring. This can be extremely frustrating for people who experience frequent breakouts and want a permanent solution to the problem. Permanent scarring is also a problem that people who get acne worry about, and this can lead to other adverse health consequences like depression or anxiety.
There is no single acne medication that works for 100 percent of people who take it, but there is one very close to it. This medication is called Accutane. What is Accutane? Accutane is a drug used to treat severe cystic or nodular acne. It is somewhat controversial due to the adverse risks that it can cause when taken. However, its efficacy in treating acne is unparalleled, and many patients decide that the risk is worth it since its effect is prolonged and can even be permanent.
Accutane is isotretinoin, a derivative of vitamin-A that is taken in high doses. The drug was developed by Hoffman La-Roche and FDA approved for the treatment of acne in 1982. Roche discontinued making the drug in 2009 once generic versions became available, so the Accutane that can be purchased today is known by other names like Absorica, Claravis, Sotret and Amnesteem. These generic versions have the same active ingredient as the original Accutane and work just like it.
Accutane is usually prescribed for acne only after other treatment approaches have been attempted and found to be ineffective. Accutane belongs to the class of retinoids, and it is normal to try a topical retinoid treatment (such as Retin-A) before taking an oral retinoid. Most people have to take only one course of Accutane to permanently cure their acne. But some patients will need another course of Accutane, or another form of follow-up acne treatment to resolve their acne.
How well does Accutane work?
Accutane is remarkably effective in treating acne because it is the only medication that targets the four causes of acne, as reported by the American Academy of Dermatology. These are:
- Excess oil production under the skin
- Presence of too much Propionibacterium acnes bacteria on the skin
- Clogged pores
Accutane works by shrinking the oil producing glands of the skin that are called sebaceous glands. The typical duration of treatment of Accutane is between 16-20 weeks. Within this time, Accutane is reported to dramatically reduce the oil production of the skin. Studies have shown that a dose of 0.5-1 mg/kg per day reduces the production of sebum by up to 90 percent in just six weeks. The way it does this is by altering certain cellular processes that involve the cell cycle, cell differentiation, cell survival, and a type of cell death known as apoptosis. The combination of these functions collectively results in reduced sebum production by the oil glands under the skin, prevents the growth of P. acnes bacteria, eliminates the formation of blocked pores, and reduces inflammation. Accutane does not directly kill the acne-causing bacteria in the skin, but it makes the skin unfit for the bacteria to survive.
No other acne medication can target all the factors that cause acne. This makes Accutane stand out for its ability to provide a long-lasting solution for getting rid of acne. However, taking Accutane comes with certain risks. Many patients who have taken Accutane and cured their severe or cystic acne find that taking the medication is worth it. But, some people are not able to tolerate the side effects. If you are considering taking Accutane, it is important to be aware of the possible risks and side effects that the medication can cause.
Risks of Accutane
Accutane is notorious for the types of side effects and risks that taking it involves. Let’s take a look at what the reported risks are and what research says about it.
Mental health issues
You may have heard that Accutane can cause depression or even suicidal thoughts in people who take it. Between when Accutane first hit the market in 1982 and 2000, a study in the New England Journal of Medicine reported that the FDA received 431 reports of depression, suicidal thoughts or attempts, or suicide in people who took Accutane. However, a systematic review of 31 previous studies reporting declining mental health in patients who took Accutane from 2017 concludes that Accutane does not increase the risk of depression and in fact, it actually makes depression better by changing the self-image of a person after their acne clears up due to the drug. Overall, research has had mixed results on whether taking Accutane causes mental health issues, but to be safe, your doctor will monitor symptoms of depression or suicidal thoughts while you are on the drug.
The most severe adverse effect of taking Accutane is the potential birth defects it can cause in a fetus if taken while pregnant. Taking Accutane during pregnancy can cause serious cardiovascular, neurological, and developmental defects in the fetus such as missing eyes, hearing loss, congenital heart defects and microcephaly (underdeveloped brain), so it is classified as a ‘teratogen’. It also increases the rate of miscarriage and premature births. These risks have to be taken extremely seriously, so the FDA has put a system in place to help prevent women who take Accutane from becoming pregnant. This program is called the iPledge program and any woman of childbearing age who takes the medication must comply with its guidelines before receiving their medication.
What is the iPledge program?
The iPledge program monitors the pregnancy status of women who take Accutane by ensuring that they use two forms of contraception, take monthly pregnancy tests that must be negative and submit blood tests every month. This is reviewed by both a doctor and a pharmacist before being able to purchase the medication, and the prescription must be filled within a certain number of days after the negative pregnancy test. Women must not get pregnant for one month after stopping Accutane to make sure that the medication is completely cleared from the body.
Other side effects
Accutane can also cause other concerning side effects like dry and red skin, chapped lips, sensitivity to the sun, muscle aches, headaches, and temporary hair loss. Any unwanted symptoms should be reported to your doctor while taking the medication. These symptoms are usually not permanent and will resolve once you stop taking the medication.
How can I save on Accutane?
How much does Accutane cost? Accutane is expensive. The overall cost of taking Accutane involves purchasing the medication, getting monthly blood tests and regular doctor’s office visits. The medication alone can cost over $700 without health insurance. Even with health insurance, the co-pay amount can be pretty high. You can find other ways to save on Accutane through a free prescription drug discount card, like the one available from USA Rx. Just take the card in with you when filling your prescription to apply savings.
Is Accutane worth the risk?
Overall, whether taking Accutane is right for you will depend on how severe your acne is and whether other forms of treatment have worked for you. Every medication comes with certain risks, and while it is important to be aware of them, for many people the benefits of taking a drug can outweigh the risks.
For people who are searching for a magic cure for their acne, Accutane is the closest thing possible to this.
In general, the retinoids are known for being effective at treating acne. In some patients, breakouts can get worse when beginning the treatment before it starts to get better. The important thing is to continue the treatment as directed by your doctor to be able to get the most benefit from taking the medication. Consulting a dermatologist will help you find out whether trying Accutane is right for you and if it is worth the risks that come with taking it. Once acne is under control, many people find that other symptoms of depression and anxiety due to acne also disappear. The bottom line is that taking Accutane is a personal decision that you and your doctor can make together.