What You Should Know Before Starting Accutane

Accutane may have gotten a bad rap for its litany of potential side effects, but isotretinoin is still one of the top medical solutions for addressing acne. Here’s an honest breakdown of what it can do.
Patient Perspective
Written by Vivien Moon
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What You Should Know Before Starting AccutaneMichał Parzuchowski/Unsplash

Acne is forever known as the great equalizer. It does not discriminate by gender, age, or race. For some, it is hard to tackle no matter what lifestyle or skincare changes are made. While many experience an accelerated amount of pimples during their hormone-induced teenage years, others face a more aggressive form of acne that can result in physical and emotional scarring.

When pimple patches, in-office treatments, and over-the-counter creams aren’t enough, it’s time to bring in the power players (think: prescription topicals) and, if those don’t help, an oral medication – like isotretinoin (a.k.a. Accutane) – can be the saving grace. However, it comes with strict user guidelines, potential risks, and side effects, not to mention a consent form. Here’s what you need to know about Accutane from both a medical professional and a patient and why it’s not as scary as the online rhetoric may have you believe.

What Is Accutane?

Technically, Accutane is a brand name for isotretinoin, a potent form of vitamin A that was approved by the United States Food and Drug Administration (FDA) in 1982 for the treatment of severe, resistant, nodular acne that is unresponsive to conventional therapy. Off-label (read: non-FDA approved) uses of isotretinoin include moderate acne, rosacea, and folliculitis.

For those unfamiliar with the ingredient, vitamin A derivatives are a dermatologist-favorite for their ability to address a myriad of skin concerns — ranging from wrinkles to acne. Unlike its topical counterparts (including retinols and retinoids) that can be used regularly for prolonged periods of time, isotretinoin is an orally-prescribed medication that is used on a short-term basis and has stronger side effects (we’ll get into them later) than the so-called retinization process of adjusting to topicals. Then again, it is meant to be a treatment option for those who haven’t found a solution for their acne concerns through other lifestyle modifications or skincare-altering means.

How Accutane Works

So, how does Accutane work? “It treats acne by reducing the size of oil-producing glands and oil production, which, in turn, may lead to decreased acne-causing bacteria,” explains Michelle E. Park, MD, a board certified dermatologist at Washington Square Dermatology in New York City. “It also inhibits keratinization and reduces inflammation.”

Because it works from the inside out, it can address the pores, cell turnover cycle, and oil production in a way topicals alone cannot. However, due to its exfoliating nature, other forms of exfoliation will have to be stripped from the skincare routine while isotretinoin is prescribed. And that’s not the only adjustment your skincare regimen will need. Similar to topical vitamin A, Accutane may cause sensitivity to sunlight and will require adequate sun protection.

Side Effects of Accutane

“The main concern everyone has regarding Accutane are the adverse effects,” Dr. Park confirms. “Every systemic medication comes with risks, and this medication can certainly be high-risk if it is used incorrectly or without proper guidance.” If you’ve ever talked to someone on Accutane or someone who knows someone who has been on Accutane, you are likely familiar with some of the side effects. “In reality, every person on Accutane will get dryness of the skin, particularly on the lips,” she says. “Muscle aches or joint pains are also possible.” From there, Dr. Park says all of the other known side effects “are rare.”

It’s important to note that, alongside the physical side effects of dry skin, muscle aches, and upset stomach (if the instructions aren’t followed), Dr. Park acknowledges being on isotretinoin can have an impact on mental health. Some patients recount thoughts of suicide and depression while taking the medication. But, while there is a risk, Dr. Park says it is not common. “The black box warning is there as a reminder that one may experience this while on Accutane, but it is not common,” she says. “The overwhelming majority of my patients do great while on this medication.”

The Right Candidate for Accutane

“People with severe nodulocystic acne should take Accutane,” Dr. Park explains. For patients who have tried other remedies without success, isotretinoin may prove to be the solution. “Anybody who has exhausted the use of topical prescription acne medications and failed antibiotics or anybody who experiences significant scarring due to uncontrolled acne may take Accutane,” she adds.

To find out if you’re eligible for the prescription, you’ll need to visit a dermatologist and undergo a thorough check. Those who are using retinoids are advised to stop prior to beginning Accutane. Additionally, it will not be prescribed to those who are pregnant, are planning to become pregnant, or have issues with their liver.

How to Use Accutane

As you may have guessed, going on Accutane requires adjusting to a scrupulous regimen. “This medication is mandated to come with strict guidance and monitoring to be prescribed,” Dr. Park cautions. “It is administered with close monitoring by a dermatologist, with safeguards to prevent pregnancy, and clear communication of medication risks.” When these protocols are followed, she says it is “highly effective” and “relatively safe.”

Here’s what to expect from Accutane:

  1. Sign a Consent Form: Yes, really. Before a treatment plan can begin, a consent form is required. At Washington Square Dermatology, Dr. Park explains that “everyone must register on iPledge to demonstrate that they understand this medication is extremely dangerous to take while pregnant and they cannot become pregnant while taking the medication.” Alongside the consent form, women are required to take two pregnancy tests (spaced 30 days apart) before starting the medication.
  2. Skip the Drink: Since isotretinoin can impact liver function, being on the medication will require abstinence from alcohol (which may not be such a bad thing for overall skin health). “Abstain from alcohol or any other medications and ingested substances that can cause liver damage while on this medication,” Dr. Park says.
  3. Adjust Your Skincare: Because the medication works to accelerate cell renewal and to help pores decrease oil production, Dr. Park advises skipping exfoliants such as alpha hydroxy and beta hydroxy acids, scrubs, and other forms of topical vitamin A. In fact, she recommends scaling your skincare routine back to just “a gentle thick cream to help moisturize dry skin” and “a gentle daily skin cleanser.”
  4. Expect Additional Tests: One of the most consuming aspects of the medication is the need for routine testing. “The process seems tedious because there is regular follow up with the doctor and blood work monitoring to check for liver function, cholesterol, and triglyceride levels,” Dr. Park shares. “However, it’s pretty worth it if you’re looking to have acne-free, gorgeous skin.”
  5. Take Birth Control: “Females who can become pregnant must be on two forms of birth control (e.g. birth control pills and condoms),” Dr. Park says. This is due to Accutane’s potency. “The medication is highly regulated because we know that it is teratogenic, meaning it can cause birth defects in a developing fetus if a pregnant female were to ingest the medication,” she notes.

Patient Perspective

If you’ve made it this far into the article, it’s likely because you are seriously considering whether isotretinoin is right for you. Now that you know what to generally expect from treatment, it’s time to hear from a patient to better understand what it is like before, during, and after using Accutane.

Katie, 30, New York City

After a few years of dealing with constant acne breakouts in her teens, Katie, with advice from a medical professional, went through two rounds of Accutane to help clear up her complexion.

The AEDITION: Why did you decide to try Accutane to treat your acne?

Katie: Prior to Accutane, I had experienced years of trial and error. I used topical creams like salicylic acid, retinoids, oral medication such as Doxycycline, and birth control. I even made dietary changes to see if that would help. It wasn’t until I used Accutane that my skin finally began to see major improvements.

The AEDITION: What led you to go on Accutane a second time?

Katie: I took Accutane for six months when I was 19 years old. My doctor started me off with a lower dosage, so they could determine the medication’s effect on my body. After two months, my dosage was increased, and that’s when I started to see positive changes in my skin. By the end of the six-month treatment course, my skin was flawless – I was amazed! Unfortunately, a year after I stopped taking Accutane, my stubborn acne returned, so my dermatologist recommended one more six-month course. It’s been 10 years since I last took Accutane, and I get an occasional breakout due to my menstrual cycle, but, overall, my acne is gone.

The AEDITION: What was your experience taking Accutane, and how did it impact your life?

Katie: The whole Accutane process is an extreme commitment. The medication has a strong effect on the body, so each month I was required to take a blood test to ensure that my kidneys and liver were functioning normally. I also had to use two forms of birth control throughout the entire treatment and take a monthly pregnancy test to guarantee that I would not become pregnant while on the medication. Since Accutane slows oil production in the skin, I experienced extremely dry skin throughout my face, lips, body, and scalp. I was constantly applying lotion all over my body, and could only wash my hair once a week. Otherwise, I would get dandruff. Luckily, I did not experience any body aches, mood swings, or depression that other people tend to encounter.

The AEDITION: When did you start to see improvement in your skin?

Katie: I started to see improvements in my skin two months after I started taking Accutane, and it only got better from there.

The AEDITION: What would you recommend for those thinking about going on Accutane?

Katie: For those thinking of taking Accutane, I would recommend they fully understand the side effects that are associated with the drug and use it as their last resort. It’s an extremely powerful medication, but it has completely changed my skin.

The Takeaway

There are no two ways about it, isotretinoin is a heavy-duty prescription that is meant for those with severe and unchanging acne cases. What often puts people off from using the medication is the laundry list of side effects and the precautions it requires. But, for those who’ve exhausted all their options, it may offer a path to clearer skin. Consulting with a board certified dermatologist will determine whether you not you are a candidate for treatment.

If you or someone you know is struggling with suicidal thoughts, please contact the National Suicide Prevention Lifeline at 1-800-273-8255.

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VIVIEN MOONis a senior editor at AEDIT.

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