Accutane (Isotretinoin): Dangerous drug or misunderstood medicine? Here’s the truth.

Idaho Dermatology Clinic’s Tyler McKinnon, PA-C talks to us about acne and how to treat it.

Acne: the universal nuisance that can undermine confidence and attract focus away from your otherwise beautiful face. For most people, acne is an occasional zit or pimple in just the right (or wrong) spot, at just the right (or, actually, wrong) time to distract from an important presentation at school, or a Zoom meeting for work or even that special date with a certain someone. In most cases, occasional acne can be controlled with topical medications, or even a short course of antibiotics or hormonal treatments. For a minority of patients, acne can be constant, widespread, painful, and debilitating to self-esteem. I know, because in my teens I was one of those patients. When acne is severe, potentially scarring, or constant and not sufficiently responsive to topical or lower-level oral medications, isotretinoin (aka Accutane) really stands out as the only medication that offers consistent, potentially permanent relief.

This improvement does come with a price – six months of dry, dry skin. Every patient that undergoes a standard six-month course of oral isotretinoin treatment experiences severe dry skin, most commonly affecting the lips, and to a lesser degree the face and arms. This dryness can be mitigated significantly with frequent application of a good lip balm (I recommend purchasing Dr. Dan’s CortiBalm®, sold in our clinic for around $4) or a thick ointment such as Aquaphor® or Vaseline® (we’re talking about twenty times a day, no joke), facial moisturizer such as CeraVe® or Cetaphil® (or, if you are a little more dedicated to the absolute best experience possible while on isotretinoin (Accutane), speak with our Licensed Aesthetician, Ashley Grayson, about Image’s Vital C Repair Crème, it leaves your skin feeling fantastic, even while on isotretinoin (Accutane)) and copious amounts of moisturizing cream to the arms. The dryness can occasionally be accompanied with temporary joint and muscle aches, as well as nose bleeds and headaches. These bothersome secondary effects are just that: temporary, even though they can rarely be severe.  Over the counter pain medications (ibuprofen, acetaminophen, etc.) can be used if necessary.

Dry skin is the only side effect of isotretinoin therapy that is common, and indeed, is an issue for every patient. I’ve seen my patients experience complete (99% of the time), and permanent (75% of the time) improvement of acne. Most agree the temporary discomfort was well worth it for them.

Additional possible side effects seen in some patients include: 

  • Temporary vision decreases (night vision in particular)
  • Temporary hair thinning
  • Sun sensitivity (you wear your sunscreen everyday anyway, right? …RIGHT?) (I love EltaMD® UV Clear for application to the face, it’s an affordable but elegant and effective option you can pick up conveniently at our clinic’s front desk.  EltaMD® Active is my favorite option for elsewhere on the body.)
  • Liver stress/pancreatitis (VERY rare, used to require a monthly blood draw, has been reduced to a one-time blood draw currently, and some authorities are starting to recommend reserving testing for only high-risk individuals.  I’ve never had a patient experience liver damage over hundreds of cases)
  • Aggravation of pre-existing inflammatory bowel disease (Crohn’s or Ulcerative Colitis). This is a real concern for patients with a previous diagnosis of IBD (NOT irritable bowel syndrome or IBS, this is different). IBD is characterized by painful, bloody stools and abdominal pain. IBS is a tendency toward loose stools and/or constipation and is not a concern for isotretinoin therapy.
  • Aggravation of pre-existing depression. In my experience, and according to the more recent medical literature, this potential has been potentially overblown. If you are actively being treated for depression with a history of suicidal thoughts, please consult your counselor and/or psychiatrist and do not start isotretinoin therapy until approved by these Medical Providers. Otherwise, depression shows very little tendency to worsen while being treated with isotretinoin, if any at all.
  • Birth defects if taken while pregnant. This requires a monthly in-office pregnancy test.  Isotretinoin SHOULD NEVER be taken by a woman who has the potential to become pregnant, which would include any woman with a viable reproductive system and who is not on two effective forms of birth control. Isotretinoin has no effect on future pregnancies or reproductive potential, and men can father a child while on isotretinoin with no increase in potential for birth defects. However, men must avoid donation of blood or plasma while taking isotretinoin.

There are some other uncommon special cases in which isotretinoin may not be the best option, so it is important to consult a Medical Provider who has experience with the medication. If a patient is experiencing severe, constant acne that may not be responding well to other treatments, especially if there is the potential for permanent scarring of the skin, I do not hesitate to discuss isotretinoin as the most effective, and potentially long-lasting option available. In my experience, there are essentially never (alright, you should never say never) any serious or long-lasting side effects, just clear, smooth skin, and the confidence a patient seeks to be comfortable in any situation.

Tyler McKinnon has practiced medicine at the Dermatology Clinic of Idaho since 2016. He received his Bachelor of Science Cum Laude degree in Biochemistry from Utah State University and later attended Pacific University in Hillsboro, Oregon where he completed his training as a Physician Assistant. In pursuit of ongoing medical education, Tyler has obtained Diplomate status from the Society of Dermatology Physician Assistants. In addition to having a minor in Spanish, Tyler lived in Argentina for two years, which allowed him to gain the fluency required to better serve his Spanish speaking patients.

Get to know Tyler by Following us on social media where he is often featured in our #MeetIdahoDerm series and to book a consultation with him just click on Medical Appointment here on our website or call, 208.376.4264.