Accutane: all links so far

accutane

• Accutane alternatives—one idea

• Accutane and Depression

• Accutane—easing the side effects

• Accutane: Jennifer’s story

• Accutane—side effects

• Accutane: What is it and what does it do?

• Going on Accutane—right or wrong?

• Is Accutane good for acne?

• Requirements for taking Accutane

• Teens, Accutane, and Diet

Also see

• Medications Oral & Topical: all links so far

Is Accutane good for acne?

The answer to this question is not as straightforward as you may think. Accutane has helped hundreds and thousands of people with acne. Some people can go through one round of the drug and be cured. Others find little or no relief. There are also what I call serial Accutane users; people who continue to go back to this medication after its effects have worn off. 

In defense of Accutane (or any other treatment for problem skin), if you do not take away the cause of problem skin, then Accutane or any other treatment is compromised as to its efficacy. If you keep bumping into a door, you can treat the bruises with ointments to help them fade, but unless you determine that bumping into the door is causing the bruises in the first place, you can see how ineffective any treatment might be.

Do some investigation and try to find out the source of your problem skin. This can take time and definitely requires patience. You may not have either of these to spare. But if you decide to go on Accutane treatments, or any medication, please be well-versed in the side effects and take whatever precautions recommended by the drug company. That information will be found on the long list of contraindications and drug interactions provided with all prescription medications.


Although Accutane is supposed to be prescribed for stage IV, nodular acne—the most severe cases—I have found that many of my clients who didn’t have such severe cases were readily given a prescription. From the experiences of my clients coming in and relating their stories to me, I have also found many people have been on Accutane more than a few times, without even having major problems with their skin.

There is a lot of information about Accutane on this blog. I hope these articles provide you with sufficient information to make an informed decision on whether or not to go on this drug yourself or to have your teenager start taking Accutane. Do more research, find as many answers to your questions as you can. If you’ve read anything here, you know I am not in favor of using Accutane to “cure” problem skin. There are many who are believers, I’m just not one of them. Good luck on your search!
 
To understand how going on Accutane isn’t always a cure for your problem skin, please read:

• Accutane: Jennifer’s story

Here are a few articles you could start with to understand the relationship to food and skin issues. There are many more articles on this blog that can help you understand why you are breaking out as well as help to keep the breakout to a minimum:

• Problem skin profile: Donna—constipated with problem skin 
• Help for Breakouts
• Sugar & Skin Problems 
• YONKA Problem Skin Helpers + more

Teens, Accutane, and Diet

My teenage daughter has had problem skin for several years. She has been treated by a local dermatologist with antibiotics and has been using special cleansers, but nothing is working. Now he wants to put her on Accutane, and after reading about the side effects of this medication I’m really opposed to it.

The first question I would ask this woman is “how is your daughter’s diet?” What is bad in her diet? Other than raging hormones, chronic skin problems can surface due to poor dietary habits. My guess, especially since she is a teenager, is that she eats a lot of sweets. If you are sensitive to sugar and you continue to consume it, you will probably end up with (chronic) problems.

Diet may have little to do with her skin problems. She may be predisposed genetically to having teenage acne. This is always a possibility. But in all of my years in practice, I find that even when there’s a genetic predisposition, diet plays a key role in problem and acne skin—whether it is happening to a teenager or an adult.

I agree with this mother’s hesitation about putting her child on Accutane, especially because of all the possible side effects. Since she hasn’t responded favorably to previous attempts to clear her skin up, it indicates to me that she is probably continuing to feed the problem, which might be centered around sugar.

Accutane may indeed help this young lady’s skin to finally and totally clear up. But before subjecting your body’s health to this or any drug, wouldn’t it be worth it to try a new dietary plan and see what effects changing food has on the state of your skin? You may end up saving your skin and avoiding all the potential side effects of taking Accutane.

For information on a young person’s skin care routine, see:

• Teen Skin—what you need to know
• Starting your youngster on a skin care routine
• Oral Antibiotics: Good for clearing up your skin or not?

There are several articles about Accutane on this blog. Here are just a few:

• Accutane: What is it and what does it do?
• Accutane and Depression

Going on Accutane—right or wrong?

I’ve been on Accutane for four months now and my skin has totally cleared up. This is my second time on it for the same thing. Thankfully, I found a liberal doctor who would prescribe it for me because I don’t have a “severe” acne problem. It’s actually a rash I get all over my forehead and temples and on my chest and upper back too. Now I can use whatever shampoo, conditioner, or styling product I like without getting any reaction, but I’m afraid that will stop when I go off the drug.

My skin looks somewhat dry and dull-looking from the Accutane treatments. It also seems really sensitive to products. When I use heavy creams or even creamy cleansers to combat the dryness, they just make me break out. Is there a heavier cream I can use that won’t clog my pores? I’m really worried that when I go off the medication, the rash will come back like it did the last time I went off Accutane.

I am using this email as a doubly bad example of Accutane abuse. Not only did she go on several rounds of this medication, but apparently she doesn’t even have true acne. I’m sure most doctors prescribe this serious drug with great consideration. This email is an example of a less conservative approach (and one I disagree with).

Thankfully, I found a liberal doctor who would prescribe [Accutane] for me because I don’t have a “severe” acne problem. I wonder how many people could have written the very same thing. Prescribing Accutane is serious business. I am worried and disappointed about this “liberal” doctor. Need I explain? I’m sure it’s frustrating having to find products that won’t cause reactions, but the potential problems caused by using Accutane far outweigh this annoyance.

I’m afraid [my ability to freely use products] will stop when I go off the drug. This is why it is crucial to find out what is causing your skin problems, be it sensitivities to ingredients or foods or other factors. Until you eliminate the cause of the problem, you won’t stop creating the symptom. It really is as simple as that.

My skin looks somewhat dry and dull-looking from the Accutane treatments. When I use heavy creams or even creamy cleansers to combat it, they just make me break out. Here is a perfect example of why I want to educate you about the difference between dry and dehydrated skin. Although this truly is a special case and perhaps this young lady’s skin really isn’t producing much oil now that she has taken Accutane, using heavy creams isn’t the solution. Is her skin truly dry or just dehydrated from the use of Accutane?

Is there a heavier cream I can use that won’t clog my pores? No! Heavy creams will clog your pores if you don’t need all the oil they contain. Only true-dry, oil-deficient skin can use heavy creams with relatively no problems. If a moisturizing cream is breaking you out—especially if it is a “heavy” cream—it is not appropriate for your skin.

I’m really worried that when I go off the medication, the rash will come back like it did the last time I went off Accutane. First of all, we haven’t established that this person even has acne. It sounds like a rash, even though Accutane helped eliminate it—temporarily. But still, she clearly illustrates a concern I have about taking Accutane. Why is she having skin problems in the first place? Whatever the source of her problem, she probably has not eliminated it from her life. As long as she continues to introduce products that are irritating her skin, she will continue to have the rash and the problem skin she describes. Eliminating the root cause will help to control or eliminate the problem skin (whether it’s a rash or acne).

Are you willing to take a strong drug, but unwilling to change your lifestyle habits? If you are unwilling to change your ways, I hate to think you will rely on Accutane (which can and does have side effects) to do all the work for you. In the long run, I think your body loses.

There are many articles about Accutane on this blog. Here a few you may be interested in:

• Accutane: What is it and what does it do?
• Accutane—side effects
• Accutane and Depression 
• Using dry skin products on oily skin—STOP THE INSANITY!

Accutane: What is it and what does it do?

Requirements for taking Accutane

Unlike many drugs, before getting a prescription for Accutane, several requirements must be met. Why? Because Accutane carries with it significant risks. For male patients, the concerns are fewer. But for females, the potential for severe birth defects is probably the number one concern while on this medication. Because of this, no female patient is allowed to begin Accutane therapy if she is currently pregnant (no matter how far along) and definitely no pregnancies should occur while a woman is taking this potentially harmful medication.

There is strict monitoring for pregnancy during these treatments. Any female about to take Accutane must first take one, and in some cases two, pregnancy tests to ensure there is no possibility of a birth before going on this drug.

If a female patient is or might become sexually active during the course of treatment, she is required to:

• use two different forms of birth control at least one month prior to treatment
• throughout the entire course of treatment
• and then for at least one month following the discontinuation of Accutane treatment

Regardless of sexual activity, female patients must take birth control pills for the duration of treatment. There are even strict policies that require a negative pregnancy test before a female patient can pick up her next month’s supply of Accutane at the pharmacy.

A formal consent form must be signed before initiating treatment with this drug. It mentions the obvious and most notable potential for severe birth defects and the patient’s agreement to take birth control for the duration of treatment. It also goes into great detail about depression and the possible signs of a depressive mental state while on Accutane.

Please continue to read about Accutane use to help you understand the risks (and possible benefits) associated with taking this powerful drug. For more information, see:

• Accutane and Depression
• Going on Accutane—right or wrong? 
• Accutane—side effects

Accutane alternatives—one idea

Are there alternatives to Accutane? I was discussing Accutane with a client who was concerned about her skin. She didn’t have a lot of problems, but was experiencing ongoing breakouts. Her diet wasn’t great—she is in college and is subject to peer pressure—and most notably, almost all of her friends are taking Accutane. Convincing someone to go the opposite way of everyone around them (especially their friends) is next to impossible, especially at that malleable age.

Since a woman has to use the birth control pill in order to take Accutane, I thought perhaps she could try going on the Pill only and see if it might help her skin. Please read this: I am in NO WAY advocating going on birth control pills. But since she wasn’t currently taking it and would be required to in order to take Accutane, why not see if the Pill alone might help her skin? Perhaps it’s the lesser of two evils, even though I am certainly not a proponent of taking birth control pills in order to clear up skin problems.

For more information, see:

• Requirements for taking Accutane
• Teenage Skin—what you need to know
• Oral antibiotics: Good for clearing up your skin or not?
• Stress + the Pill can = breakouts—a client profile

Accutane and Depression

When you take anything orally, the substance enters the bloodstream and is introduced to all the cells it comes in contact with. Whether it is a medication or vitamin pill, it affects your body chemistry. And this includes brain chemistry. Depression, which occurs due to altered chemicals in the brain, is one of the side effects that can be caused by taking Accutane. If you choose to take Accutane, I caution you to pay close attention to your emotional life. If you think you may be experiencing medication-induced depression (depression brought on by the use of this oral medication), call your doctor!

The following are the symptoms listed on the Informed Consent/Patient Agreement form that must be filled out by every patient about to undergo Accutane treatments. It instructs you to immediately tell your doctor if:

• you start to feel sad or have crying spells
• lose interest in your usual activities
• have changes in your normal activities
• become more irritable
• lose your appetite
• become unusually tired
• have trouble concentrating
• withdraw socially
• start having suicidal thoughts

This is an instance where you are trying to fix a problem (acne), and you may accidentally create another, more undesirable problem (depression).

Obviously Accutane does not cause depression in every patient. But without knowing the possibility of it occurring, you may not be watching out for the signs of depression. I recommend talking with your doctor about this aspect of Accutane specifically so you can be clear about what to watch out for and what to do should you start feeling emotional changes. I realize you want clear skin, but don’t make your body (and mind) pay the price. Knowledge is power; know what all the roadblocks are and keep your eyes open. Be sure to read other articles under Accutane on this blog.

For more information, see:

• Accutane: What is it and what does it do?
• Accutane—side effects
• Accutane: Jennifer’s story

Accutane: Jennifer’s story

Jennifer came to me years ago for a facial and has been a loyal, monthly client ever since. She is a lovely, conscientious woman in her late 20s. By her own admission, Jennifer is overweight. She doesn’t drink alcohol or smoke cigarettes, but she does have a wicked sweet tooth; something she has “no control” over.

Throughout our years together, I have seen Jennifer’s skin go through many ups and downs. She has attempted to lose weight many times, unable to find a way to drop the unwanted pounds. The same holds true for her attempt at eliminating sugar from her diet. Jennifer’s skin is now and has always been broken out—sometimes severely. She truly has an acneic condition—comedones, milia, pustules, and cysts. I am not saying that sugar is the sole reason for her skin problems, but sugar is a top factor in how her skin appears and how her skin is indeed functioning, or rather dysfunctioning.

After trying all the different routes to “curing” her acne and without changing her lifestyle habits and dietary choices, Jennifer decided to take the leap into Accutane. Because her acne had become so severe, I actually was in agreement and thought this would make an interesting case study.

Jennifer’s skin improved on Accutane—temporarily. It was definitely helping with the large cysts under her skin as well as helping to stop new cysts from developing. If new problem areas did come, they were smaller and less noticeable. Both Jennifer and I were encouraged with her progress and she surely thought her skin problems were over.

Jennifer’s treatment course ended, and eventually so did her clear skin. Within a six-month period, her skin was right back where it started, and Jennifer was depressed. And no doubt her emotions were also fueling her food intake. She was gaining weight along with her skin breaking out again.

Talk and counsel her as I did, I couldn’t get Jennifer to stop eating sugar and other foods even though she knew they were huge contributors to her skin problems. It’s true that you can lead a horse to water, but you can’t make her drink. Jennifer went on to take several rounds of Accutane. All helped for a period of time, but then her problems would always return.

My point in sharing Jennifer’s story with you is to illustrate how denial and reliance on drugs and medications will not necessarily get you clear skin. Maintaining awareness and making conscious choices are always the best ways to achieve a goal. And if your goal is clear skin and you have an acneic condition, before taking medications, ask yourself what you may be doing to contribute to your circumstances. Acne is happening for a reason. It is up to you to decide how you are contributing to your problem skin.

For more information, see:

• Sugar & Skin Problems
• I’m sensitive to sugar—are you?
• Going on Accutane—right or wrong?

Accutane—easing the side effects

There can (and probably will be) many reactions from taking Accutane, or any drug really. In this case, I hope the following information will help ease any effects you may be experiencing if you are indeed taking the acne medication Accutane. Take care to treat any symptoms that you can so you will be more comfortable during the time you are on this drug. And please contact your prescribing doctor if you have any questions about the side effects you are experiencing. Don’t be shy!

If you think you have cheilitis (inflammation of the lips, usually concentrated around the corners of the mouth, common with Accutane use) or another severe lip condition, I recommend calling your dermatologist and informing him or her of this occurrence. Your doctor can prescribe a potent medication to help get rid of this uncomfortable skin problem. Keeping a non-petroleum lip balm constantly on the area will help to ease the dryness. Try not to lick your lips as this will just further the problem. For women, not wearing lipstick would help keep the lips from drying out as well.

Chapped, flaky skin is something you will probably have to contend with while on Accutane. It is the most common side effect from taking this drug. Using gentle exfoliators will help to keep the dead skin from getting out of hand. I highly recommend using body oils (vs. lotions) to keep the skin on your body from getting too flaky and dry. Generally, you want to keep your skin well lubricated to keep the dryness down to a minimum.

Dry eyes can be soothed by using eye drops. Dry skin inside your nose can be helped by either putting some cream there or better yet an oil or balm. Balms are thicker than oils or creams and have better sticking power.

If you are experiencing excessive peeling of the palms and soles, brittle nails, or inflammation of the nailbeds, I would recommend getting a manicure and/or pedicure. This might seem like an extravagance, but these services can really help relieve the symptoms you may be experiencing on your hands and feet. If you can’t afford one of these nail services, at least get a pumice stone (very inexpensive) and get rid of the dead skin that way. Using the stone on dry skin works best, although it can be used in the tub or shower as well. Just massage the area with the stone (only on palms and soles!) and enjoy smoother skin afterwards. You could put some body oil or even oil from your kitchen on your cuticles if they are dried out.

Because being on any medication can make your skin more photosensitive (unusually sensitive to the sun), you must wear sunscreen on a daily basis. This is true whether you are on Accutane or not, but be especially diligent while on this medication. 

What you may not know. You cannot get waxed anywhere on your body if you are currently on Accutane or even recently have been. The reason is your skin is so incredibly dried out and fragile that the wax will (or can) actually pick up several of the deeper layers of skin when it is pulled off. I have heard of people going in for facial waxing, neglecting to tell the aesthetician about the fact they are using Accutane. When the wax strip was ripped off, a good deal of skin came off with it!

Don’t forget, no breast feeding your child while taking Accutane. And you also cannot give blood for at least one month after ending your treatment. This is a small fact, but an important one you may not think about. If you give blood and still have Accutane in your system, guess what? You can potentially pass this medication along to another person who might be pregnant or is about to get pregnant. I recommend waiting longer than a month to allow this powerful drug to be totally eliminated from your system. Taking supplements like chlorophyll might help to clear it from your body faster than just leaving it up to nature.

As I have said in any and all of my articles on Accutane: please do your due diligence. Plan on doing research, and read up to examine in detail the facts and concerns surrounding this powerful drug—and if you think it is the right thing for you to consider taking.

For additional information, see:

• Accutane—side effects to understand what possible side effects that can occur from taking this drug
• Kiss Chapped Lips Goodbye!
• How chlorophyll can help your skin (and ease constipation)

Accutane—side effects

What are the internal and external side effects of taking Accutane? 

The following information is used with permission and comes from two different sources in an attempt to give you a well-rounded view of the effects Accutane may have on your body. Although some of the information will repeat, I think this is a good thing because the more you understand about the potential risks and side effects, the more informed your decision will be.

All of the side effects listed indicate the seriousness that must be taken when considering Accutane. Remember, a quick-fix mentality focuses on now rather than looking ahead to potential consequences. In Accutane—easing the side effects (see link below), I discuss ways you can help ease the pain and annoyance of some of these effects. Know that you will experience some and maybe all of the side effects in varying degrees depending on your body’s constitution, so be prepared and hope for the best.

The following is taken from Physiology of the Skin II by Peter T. Pugliese, M.D. If you are interested in a more technical explanation about skin and its function, you may want to read this book. It is for “professionals,” but I know many of you who aren’t in this profession like to read as much as possible about skin care.

Side effects of isotretinoin may be mild or severe. Everyone on this drug will expect to have some side effects. Major side effects are:

1. Cheilitis*, 90% of patients
2. Chapped, flaky skin, 90% of patients
3. Dry nose and eyes, 80% of patients
4. Loss of hair, 10% of patients
5. Painful joints and painful muscles, 15% of patients
6. Excessive peeling of the palms and soles, 10% of patients
7. Elevation of triglycerides in the blood, 25% of patients
8. Abnormal liver function tests, especially the transaminase enzymes, 15% of patients 

*Cheilitis is inflammation of the lips, usually concentrating around the corners of the mouth. This can produce anything from redness and irritation to severe cracking and scaliness.

The following is taken from The Pill Book published by Bantam Books:

Side effects [with Accutane use] increase with dosage.

Most common: Dry, chapped, or inflamed lips; dry mouth; dry nose; nosebleeds; eye irritation; conjunctivitis (pinkeye); dry or flaky skin; rash; itching; peeling skin on the face, palms, or soles; unusual sensitivity to the sun; temporary skin discoloration; brittle nails; inflammation of the nailbed or bone under toes or fingernails; temporary hair thinning; nausea; vomiting; abdominal pain; tiredness; lethargy; sleeplessness; headache; tingling in the hands or feet; dizziness; protein, blood, or white blood cells in the urine; urinary difficulties; blurred vision; bone and joint aches or pains; and muscle pain or stiffness. Isotretinoin causes extreme elevations of blood-triglyceride levels and milder elevations of other blood-fat levels including cholesterol. It also can raise bloodsugar or uric acid levels and can increase liver-function-test values.

Less common: Wound crusting caused by an exaggerated healing response stimulated by the drug, hair problems other than thinning, appetite loss, upset stomach or intestinal discomfort, severe bowel inflammation, stomach or intestinal bleeding, weight loss, visual disturbances, contact lens intolerance, pseudotumor cerebri*, mild bleeding or easy bruising, fluid retention, and lung or respiratory system infection. Several people taking isotretinoin have developed widespread herpes simplex infections.
*Pseudotumor cerebri is one of the more dangerous (and fairly uncommon) side effects of taking Accutane. The symptoms are severe headaches followed by nausea and vomiting along with visual disturbances, which indicates an increased and intense pressure on the brain.

As you can see, the side effects are many. This is a very powerful drug—make no mistake about it! Please read up on this serious drug before you consider taking it.

There are many articles about Accutane on this blog. Here are just a few:

• Accutane and Depression (another possible effect that needs to be addressed)
• Accutane: Jennifer’s story 
• Accutane: What is it and what does it do? 
• Accutane—easing the side effects

Accutane: What is it and what does it do?

Since this section is about a prescription drug, I want to reiterate that I am not a doctor. If you have a medical condition that requires a doctor’s attention, seek his or her professional advice! I am not licensed to prescribe medications nor am I recommending bypassing getting a dermatologist’s opinion for your acne problems or any other medical condition you may have.

What I do recommend without exception is that you fully arm yourself with knowledge on the pros and cons of your particular problem areas and their solutions. I prefer taking a more wholistic approach to treating skin problems, but whether you do or not is fully your decision and responsibility. All views in this entire blog and in my books are mine alone. It is up to you to decide the course of action to take in any given situation.

Throughout my career, numerous people have asked me about Accutane. It is a somewhat mysterious medication with a reputation for “curing” cystic acne. But is this true? I encourage you to read through other sections in this blog to get a broader view on how you can treat and possibly stop problem skin from happening. The more you understand, the better equipped you will be to fight the good fight.

My goal is to give you some background about Accutane, a few of my clients’ personal experiences, and my own thoughts concerning the use and misuse of this potentially harmful drug. I know Accutane has helped many people rid themselves of stubborn cases of acne, but I also feel too many people too much of the time reach for the quickfix solution and neglect going deeper to the root of the problem. Like any medication, Accutane has its place in the world. I just want you to fully understand the ramifications of taking a drug to “cure” your acne problems. I will be posting more information on Accutane in the future, so keep checking in!

What is Accutane? Accutane, or isotretinoin, is a derivative of vitamin A and is used for the most stubborn cases of acne. It is made and registered trade marked by Roche Laboratories. Unlike Retin-A® (retinoic acid), which is a topical product you apply to the skin, Accutane is taken internally (orally) in pill form. It comes in 10mg, 20mg, and 40mg capsules.

What does Accutane do? Accutane causes your sebaceous or oil glands to shrink. This naturally causes a reduction in the amount of oil the glands are able to produce. Smaller oil glands, less oil production. Problem solved, right?

Hardly. This brings me onto my soapbox—well, one of my soapboxes, anyway. Shrinking the oil glands, resulting in less oil production, sounds good on the surface. And the ‘surface’ is exactly as far as this treatment really goes. Like other so-called cures for acne, Accutane treats the symptom, not the actual cause of the problem. Symptom: too much sebaceous activity. Solution: stop sebaceous activity through drug interaction. And in the meantime, you cause a host of events to occur. Yes, the drug causes a physiological action in your body (shrinking glands), but it does nothing to address why the glands are overactive in the first place.

I believe without a shadow of doubt that you are what you eat. Therefore, the following, contained in a handout from the drug company that produces Accutane, leaves me shaking my head. It says, “Acne is not caused by a poor diet.” How can it possibly be true that if you eat a diet filled with fast-food hamburgers, French fries and sugar-laden sodas, all of which I consider to be part of a poor diet, you won’t run the risk of your entire elimination system (which includes your skin) being affected? Diet is not always the sole cause of problems, and certainly not with acne in particular, but to suggest that how you are nourishing your body doesn’t affect your body, inside and out, is absurd to me.

For some people, oil production can, will, and does increase after a given time following Accutane treatments. The oil glands probably don’t produce the same amount of oil after treatment, but some people still have skin problems after using this drug. It is not necessarily a once-and-for-all treatment. This is especially true if your lifestyle habits (namely diet) have not been altered since taking Accutane. Granted, other factors may be present, like a hormone imbalance or genetics, but diet cannot be ruled out as a major contributor to your breakouts.

It’s interesting to me that in all the literature I have read about Accutane, the consequences to the liver are barely touched on. I think more attention should be paid to the liver and the potential damage Accutane can cause. Only about 15% of patients develop liver problems, and those problems are usually curable and temporary. But do patients really understand what their liver will go through while taking this drug?

I will leave you with this question: Why do you have acne? After reading information here and in my skin care books, I hope you will have more answers to this pivotal question.

For more articles on Accutane, see:

• Accutane: Jennifer’s story
• Requirements for taking Accutane
• Going on Accutane—right or wrong?