Acne…It’s Not Just Skin Deep

Shawna Beechinor, PA-C

For some people, acne is a very serious disease which causes physical AND psychological scarring. Acne and acne scarring are known to cause depression, decrease a person’s self-esteem, and even impact vocational upward mobility and lifetime earning potential. 

As a result, isotretinoin – most commonly known as Accutane® – is one of my favorite medications. There is nothing so gratifying as seeing a person’s skin improve dramatically over the course of several months, and along with it, renewed self-confidence. 

While the medication is still commonly referred to as Accutane, the brand name medication Accutane is no longer on the market but is available in its generic form, isotretinoin. There are other forms of FDA-approved isotretinoin available in brands such as Absorica LD™, Amnesteem™, Claravis™, Myorisan™, and Sotret®.

What is isotretinoin? 

Isotretinoin is an oral medication (capsule) that is typically taken twice daily for a time frame of five to seven months. The medication is typically prescribed based on a person’s weight, and the “cumulative” dose taken by the patient is an important factor when considering long-term results and/or risk of acne recurrence. It’s important for patients to ensure they are prescribed the medication by an experienced Provider.

Who is a good candidate for isotretinoin? 

I always include isotretinoin as a treatment option whenever I see a patient with moderate to severe acne, a patient who has tried and failed multiple acne treatments, a patient who has been battling acne for years without improvement, or a patient who has acne scarring. Acne scarring, even if it is mild, can be very difficult and expensive to reverse. And unlike acne, it is considered “cosmetic”, so treatment of acne scarring is generally not covered by insurance.

How does isotretinoin work to treat acne? 

Isotretinoin is the only medication to address all four of the causes of acne. 

  1. Decreases sebum production. Isotretinoin’s greatest strength is reducing sebum production – the oil produced by sebaceous glands which is a primary instigator of acne. 
  2. Decreases the level of bacteria Cutibacterium Acnes. C. Acnes is the type of bacteria which is known to cause acne; it uses sebum as a source of energy. Less oil on the surface of the skin results in a reduction of C. acnes. 
  3. Increases skin cell renewal and the shedding of dead skin cells. Dead skin cells should be shed, otherwise clogged pores develop which contribute to the formation of pimples (aka “whiteheads” or “blackheads”). 
  4. Has anti-inflammatory properties. Isotretinoin’s anti-inflammatory properties result in less redness and swelling.

How long does it take to see results? 

During the first month of treatment, you may see your acne worsen which is expected, but we understand it can be frustrating. Through the second and third months, you will see improvement, and by the fourth or fifth months, most patients are clear or almost clear. It may feel like a long time, but it is worth the wait and often patients haven’t seen their skin so clear in years.

What are the expected side effects? 

Since isotretinoin is so great at decreasing oil production, the main side effect a patient can expect to experience is very dry skin. The better a person is about caring for their skin with moisturizing products, the more comfortable they will feel throughout treatment. Other side effects of isotretinoin include:

  • Chapped lips 
  • Dry eyes
  • Nosebleeds
  • Joint and muscle pain
  • Mild headaches
  • Decreased night vision
  • Increased sun sensitivity
  • Hair thinning

For dry skin, apply a hypoallergenic moisturizing cream (not a lotion) daily, such as CeraVe®, Cetaphil®, or Eucerin®. Try Dr. Dan’s Cortibalm for dry/chapped lips; it was developed by a Dermatologist for people on Accutane. Artificial tears will help with dry eyes. Use a cotton swab to apply Vaseline® or Aquaphor® to the nasal cavity to help with a dry nose or if you experience nosebleeds. 

These are side effects that resolve after completing isotretinoin therapy. Acetaminophen or ibuprofen can be taken for joint/muscle pain and if you are experiencing headaches. If you are a teenager and do not have much driving experience, you may want to avoid driving at night. This medication can make your skin incredibly sun sensitive, so always wear sunscreen if you are going to be outside. Avoid sun exposure and wear a wide-brimmed hat and sun-protective clothing as well. In cases where hair thinning occurs, it is temporary. 

There are side effects that remain controversial but are taken seriously and are discussed thoroughly at every visit.  Those include inflammatory bowel disease (specifically ulcerative colitis or Crohn’s disease), depression, or suicidal thoughts.

Do I have to have blood drawn every month? 

No, the new guidelines indicate having labs done twice is acceptable. Because isotretinoin is metabolized by the liver, it may cause an elevation in liver enzymes. Limiting alcohol intake is recommended while taking the medication. There’s a chance it may also increase cholesterol levels, especially triglycerides. So, you can expect to have labs done twice – once before you start the medication to ensure those levels look good prior to taking the medication and once after completing two months of the medication.

Isotretinoin and pregnancy

Isotretinoin is a teratogen, which means if a patient taking the medication were to become pregnant, the developing embryo or fetus would likely have severe birth defects. For that reason, a patient with child-bearing potential is required to use two forms of birth control for one month prior to starting the medication, while taking the medication, and for one month after completing the medication. These patients must also have a urine pregnancy test every month during treatment and 30 days after completing the medication.

What is iPledge? 

iPledge is a program created by the FDA which controls the dispensation of the medication. iPledge also is an important source of information for patients interested in or who are taking isotretinoin. A patient must see a Provider who is registered with iPledge, every patient must be registered with iPledge, and prescriptions must be picked up from a pharmacy registered with iPledge. 

Patients must be registered with iPledge prior to being prescribed the medication. Basically, patients who sign paperwork stating they will be compliant with the program pledge to:

  • Not share their medication with anyone.
  • Not donate blood while on the medication for one month after completing the medication.
  • Be seen by their Provider every month in clinic while on the medication.

A single course of treatment has been shown to give complete and prolonged acne remission in many patients. If you think it’s time to discuss your acne, give our clinic a call at 208.367.4265 to schedule an appointment to see if isotretinoin or Accutane is right for you.