By Eirish Sison
If you've ever experienced breakouts of acne — red, inflamed, sometimes pus-filled bumps — on your face and body, you're definitely not alone. According to the American Academy of Dermatology, acne affects 40 to 50 million Americans, making it the most common skin disorder in the United States.
Most people get acne during puberty, when hormonal changes likely cause increased oil production in the skin. But for many, acne persists into their 20s, 30s, 40s and beyond; this called adult acne. In most cases proper skin care and topical ointments containing salicylic acid or benzoyl peroxide, or oral antibiotics are enough to manage acne symptoms, but some people have severe acne that does not respond to these milder forms of treatment. If it seems like you've tried every wash, scrub, mask, cream and pill out there but your acne still hasn't gone away, your dermatologist may prescribe oral isotretinoin.
Acne is a skin condition that causes whiteheads, blackheads, and inflamed red growths (papules, pustules, and cysts) to form. These growths are commonly called pimples or "zits." They occur when tiny holes on the surface of the skin, called pores, become clogged.
Scarring may occur if severe acne is not treated. Some people, especially teenagers, can become very depressed if acne persists.
Acne is very common during adolescence. And, for reasons unknown, acne is on the rise in adult women, with more that 37 percent of women ages 20 to 49 experiencing adult acne, according to a survey published in the Journal of the American Academy of Dermatology.
Oral isotretinoin is a medication commonly used to treat severe cystic acne that has proven unresponsive to other treatments like antibiotics. It is commonly referred to as Accutane, but it is is no longer manufactured under this brand name. Instead it is available with a prescription as Amnesteem®, Claravis®, Sortret®, or as a generic (isotrentinoin).
According to "Guidelines for care for acne vulgaris management" published in the Journal of the American Academy of Dermatology, many dermatologists also prescribe isotretinoin for less severe acne that also resists treatment, and may cause "physical or psychological scarring."
Isotretinoin works by counteracting all causes of acne, according to an article by James J. Leyden, MD, published in the Journal of the American Academy of Dermatology: preventing excessive oil production, comedogenesis (appearance of blackheads and whiteheads), growth of the acne-causing bacteria P. acnes, and inflammation caused by the bacteria.
A study conducted by researchers from the department of dermatology at the United Leeds Teaching Hospitals Trust, General Infirmary at Leeds in the U.K observed that 61 percent of patients treated with isotretinoin remained clear of acne 10 years after treatment. Of the patients who relapsed, 16 percent needed further treatment with antibiotics while 23 percent needed another course of isotretinoin therapy.
Patients may experience an increase in the severity of their acne when they first start isotretinoin treatment, which is why the medication is introduced slowly — increasing the dosage over time.
According to Jeffrey Benabio, MD, dermatologist with Kaiser Permanente in San Diego, isotretinoin treatment usually lasts about five months, but this varies depending on the acne severity, the patient's weight and the dose of isotretinoin the person can tolerate (the side effects of isotrentinoin can be quite severe in some patients).
Some people will require multiple courses of isotretinoin to experience satisfactory clearing of acne.
A long list of possible side effects is associated with isotretinoin use, like dry lips, mouth, skin and eyes; sensitive and easily injured skin; increased sun sensitivity; nosebleeds; increased cholesterol levels; and upset stomach. More serious but less likely side effects include mood changes (including increased depression, and in rare cases, suicidal thoughts), severe headache with vision changes, hearing loss, yellowing of the skin and eyes, chest pain, muscle fatigue, joint pain, severe diarrhea and rectal bleeding. Read the medication guide that comes with your medicine carefully. Talk to your doctor immediately if you experience any side effects of the medicine.
Isotretinoin is a severe tetratogen, meaning its use during pregnancy or less than a month before a pregnancy can cause serious birth defects.
Should patients be concerned about the possible side effects? "Not concerned, but [they should be] well educated about the risks and benefits of isotretinoin in order to make an informed decision about what is best for them," says Dr. Benabio.
He also advises avoiding excess sun exposure, eating a healthy, low-fat diet (as isotretinoin may increase cholesterol levels), and using a moisturizer daily during isotretinoin treatment (as it can cause extreme drying of the skin).
A pregnant woman should never take isotretinoin, and women should not become pregnant one month before, during, and one month after isotretinoin treatment, as the medication can cause serious birth defects. Isotretinoin can only be obtained in the United States through a program called iPledge, which has a system of requirements that helps ensure that women using isotretinoin do not get pregnant (however men also have to register with the program to get isotretinoin). Women who can get pregnant are required to have two negative pregnancy tests before treatment, and commit to using two different effective birth control methods, or completely abstain from sex with men, during the whole course of treatment and for one month after. The prescription for isotrentinoin needs to be renewed each month during treatment. In order to get a their new prescription filled, women are required to have a negative pregnancy test and show they understand effective birth control methods and the risks of birth defects the medication causes by answering questions through the iPledge program.
Those who need to donate blood should not do so during and one month after isotretinoin treatment; those with severe depression or family history of depression should also avoid taking oral isotretinoin.
Eirish Sison is a health writer based in the San Francisco Bay Area.
Published August 30, 2011