Isotretinoin, sold under the brand name Accutane, is the only drug that can cure acne, but it can cause horrible birth defects when taken by pregnant women. Reports from Britain and Israel show that Accutane otherwise is much safer than we used to think.
Acne is a condition in which normally colorless, liquid skin oils are converted to solid white material. Then the skin responds to the trapped solid oil by turning red and swelling. A three- or four-month course of Accutane damages the oil glands and markedly reduces the amount of oil that your skin produces, making Accutane the most effective drug to treat acne. Having less skin oil should not cause any serious side effects as its only known function is to keep you from feeling too cold in the winter, because it slows evaporation of sweat. Dry skin is associated with lack of water, and aging of skin is associated with lack of collagen, not with lack of oil.
In the British study, ninety-three per cent of the people taking Accutane reported no long-term side effects. The British researchers reported that two percent suffered muscle aches at follow up, and 5 percent suffered from dry mouth. Fewer than one percent claimed that they had dry eyes and skin and joint pains. Higher doses were not associated with more side effects. The authors concluded that their study showed that isotretinoin is a safe drug with no serious long-term side-effects. However, it causes birth defects when taken during pregnancy.
A study from Israel also shows that Accutane is far safer than many doctors think (4). Many doctors refuse to prescribe Accutane for severe acne because they are afraid that Accutane will damage livers, raise triglyceride levels and cause heart attacks. In this study, none of the patients had liver tests that were abnormal enough to stop treatment. Only 1.5 percent of patients had serum triglyceride levels above 400 mg%, but all continued treatment. Most exciting, only 3.5 percent of patients required a second treatment.
I insist that all women who take Accutane do nothing that could cause a pregnancy while they take it. Three months after stopping Accutane, a woman has no increased risk for birth defects.
I check liver tests and triglyceride levels and if normal, prescribe 40 mg of Accutane twice a day for 14 weeks. I check liver tests every four weeks and stop the drug immediately if the liver tests become abnormal. I repeat liver tests two weeks later, and if normal, restart Accutane. Eighty-two percent of those who follow this regimen are cured of acne for life. If the acne returns months or years later, I usually prescribe 40 mg of Accutane four times a day for one month.
1)V Goulden, AM Layton, WJ Cunliffe. Long-term safety of isotretinoin as a treatment for acne vulgaris. British Journal of Dermatology 1994(Sept);131(3):360-363. Most doctors prescribe 40 mg Accutane twice a day. You can take it with food. Get liver function and triglyceride blood tests before start and once a month while on Accutane. Do not get pregnant. Apply vaseline to your lips as often as possible. Stop at 14 weeks. Accutane is the only drug that can destroy oil glands.
2) Accutane blocks formation of dihydrotestosterone and does not affect other hormones. R Palatsi, A Ruokonen, A Oikarinen. Isotretinoin, tetracycline and circulating hormones in acne. Acta Dermato – Venereologica 77: 5 (SEP 1997):394-396.
3) C Leautelabreze, C Gautier, L Labbe, A Taieb. Infantile acne treated with oral isotretinoin. Annales de Dermatologie et de Venereologie 125: 2(FEB 1998):132-134. a 22-month-old boy, since 6 months of age.
4) Analysis of laboratory data in acne patients treated with isotretinoin: is there really a need to perform routine laboratory tests? Journal of Dermatological Treatment, 2001, Vol 12, Iss 1, pp 9-12. J Alcalay, M Landau, A Zucker.
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