What is Accutane?
Accutane is one of the trade names for the drug Isotretinoin. Isotretinoin is a retinoid, derived from vitamin A, and is a very powerful drug for the treatment of severe acne. Accutane can control acne for months or years after the end of the treatment. Four to five months of Isotretinoin treatment at the correct dose can lead to clearing of acne for one or more years (or even permanently) after medication is stopped. Other acne-controlling medicines are only effective while they are being taken. Isotretinoin has significant side effects when taken so it is prescribed under strict guidelines.
What are the side effects of Accutane?
Side effects of Accutane can include:
- Chapped lips
- Dry skin and itching
- Dryness of nose, nosebleed
- Irritation of eyes
- Joint and muscle pains
- Hair thinning
- Rectal and vaginal dryness
- Increased sensitivity to the sun
- Delayed Wound Healing
The most damaging side effect of Accutane is serious birth defects if taken during pregnancy. Therefore, it is extremely important for women not to take Accutane while pregnant, and not to become pregnant while using it. Women who are of child bearing ability must use two effective methods of birth control (pills, IUD, etc). Before she will prescribe Accutane, Dr. Davis requires a written statement from women stating they are prepared to have an abortion if they become pregnant while taking the medication.
Accutane may also temporarily increase blood fats to risky levels. Occasionally it may temporarily raise liver enzymes. These both normalize with lowering of the dose or stopping the medication altogether. This is why a baseline blood chemistry test is established before patients start taking Accutane and is repeated after one month of medication. If results remain normal, no further blood testing is required. These blood tests must be done after you have fasted for 12 hours (no breakfast), so that the blood fat determinations are reliable.
How is Accutane prescribed?
Dr. Davis will prescribe Accutane when other acne treatments have failed, in very severe cases of acne, or when someone is “tired of having acne”. Either full dose or low dose Accutane can be prescribed. Full dose has the potential to cure acne whereas low dose will control acne but cannot cure it. Low dose Accutane can be taken for a longer period of time. Because of the serious side effects associated with Accutane, different countries have their own restrictions on the dispensing of isotretinoin. In the U.S. isotretinoin prescriptions are controlled by the iPLEDGE website. Dermatologists must register patients with this site before prescribing Accutane and pharmacists must check the site before providing Accutane. A patient cannot be prescribed more than a 30-day supply of Accutane at one time. After an Accutane prescription has been written, the patient has 7 days to pick-up the medication. If this 7 day window is missed, the patient must start the process over. With Dr. Davis, this will require another trip to the office for a pregnancy test (an office visit fee is not charge; only a pregnancy test fee). Men or women who are not of child bearing age will just need to return for a new prescription.
How does Accutane work?
Accutane decreases the amount of oil produced by the skin’s sebaceous (oil) glands. It may be as long as two months before you see improvement in your skin. In fact, sometimes acne gets worse during the first month or so of treatment. There is a medicine we can temporarily add to control this if needed.
What are the long-term results of Accutane treatment?
Your skin may stay clear for months, even years, after Accutane is stopped. If your acne returns, it may be necessary to prescribe oral antibiotics, Accutane again, or just topical acne therapy, if the acne is mild.
How does my diet need to change while I am on Accutane?
Because Isotretinoin is itself a form of Vitamin A, no multivitamins containing Vitamin A should be ingested during the course of Isotretinoin treatment or in the six months immediately following treatment. (Vitamin A is a fat-soluble vitamin that is stored in the body, so consuming high levels of the vitamin will magnify the possible side effects). Avoid foods rich in Vitamin A, especially orange or red fruits and vegetables (carrots, oranges, tomatoes, etc.) and green vegetables (broccoli, spinach, etc.). Liver (including pate) is also very rich in vitamin A and should be avoided. Pale fruits and vegetables (pears, apples, iceberg lettuce, etc.) may be eaten.