Accutane (isotretinoin) is a medicine used to treat severe lumpy acne when nothing else seems to be working. This medication is for teens who have tried many other acne treatments without success, including oral antibiotics and several topical medications.
Accutane was once a popular brand of isotretinoin that is no longer sold. However, some people still call it Accutane. In addition to the generic form, brands currently available in the United States include:
Although isotretinoin is effective against severe and difficult to treat acne, concerns about possible serious side effects, including mental health issues and severe birth defects, prevent some parents from considering it as an option.
What is Accutane?
Accutane is a powerful medicine, but isotretinoin is also a natural component of vitamin A which is found in everyone’s blood. Large doses of vitamin A have the same effects as isotretinoin-based medications, and this goes for both the dangerous side effects and the positive ones.
Despite the problems with side effects, isotretinoin is sometimes preferable to taking antibiotics over the long term, which has its own set of negative consequences, including resistance to antibiotics.
How effective is it?
Accutane is the most effective drug for severe acne that has not responded to other treatments. In about 50% of people who take it, it cleans the skin so much that they never need to treat acne again. Meanwhile:
- About 20% gets a little worse
- About 0.002% worsens
- The rest (almost 30%) improve significantly permanently or make temporary improvements
Most people take this medicine for four to six months. Some people need to take it for an additional four to six months to see improvement.
You will usually need to find a dermatologist to prescribe isotretinoin for you, as it is usually not prescribed by pediatricians.
What are the side effects?
The most common side effects of isotretinoin are important, including:
- Red, chapped and sore lips
- Dry skin, eyes, mouth or nose
- nose bleeds
- Peeling skin, especially on the palms and soles of the feet
- Joint and muscle pain
- Temporary thinning of hair
Less common but more serious side effects may include:
- Headache, stomach ache and / or chest pain
- Sight problems
- Nausea and vomiting
- Difficulty swallowing or pain when swallowing
- Impaired wound healing
- Muscular weakness
- Difficulty hearing or ringing in the ears
- Painful or constant dryness of the eyes
- Fast or pounding heartbeat
Risk of mental health problems
Research has linked Accutane to several possible mental health side effects, making its use in adolescents highly controversial. Possible effects on mental health include:
The mental state of people taking this medicine should be closely monitored by doctors, and parents / guardians should be alert for any changes in mood or behavior.
Risk of birth defects
A high risk of birth defects is also of great concern, enough that there is a very strict protocol to prevent pregnancy in anyone taking this drug. Possible effects may include:
Specific birth defects related to isotretinoin include:
- Defects of the skull, ears, eyes or face
- Cleft palate
- Central nervous system abnormalities
- Brain malformation
- Hydrocephalus (accumulation of fluid in the brain)
- Microcephaly (abnormally small head)
- Deficits of the cranial nerves
- Cardiac abnormalities
- Kidney, thymus and parathyroid gland abnormalities
If a person taking Accutane becomes pregnant, the drug should be continued immediately and the pregnancy should be evaluated by an obstetrician experienced in reproductive toxicity.
Accutane in semen
Small amounts of isotretinoin are likely to be present in the semen of men taking this medicine. It is not known if this can harm the fetus, but contraception should be avoided. If pregnancy occurs, the woman’s doctor should be informed immediately of the possibility of exposure to isotretinoin.
What are the requirements before prescribing?
These drugs are not readily available because they are “marketed under a special restricted distribution program” to help reduce the risk of side effects. Prescribers, patients, and even pharmacies must be registered with the FDA-approved iPLEDGE program.
Other requirements include:
- Need to get a new prescription for isotretinoin every month
- Not be allowed to donate blood while taking isotretinoin and for 30 days after your last dose
Anyone who may become pregnant is required to:
The iPLEDGE program recommends making appropriate contraceptive decisions rather than a commitment to abstinence for anyone who is or has been sexually active, even if they do not currently have a partner.
Some birth control pills, including minipills containing only progesterone, are not considered an acceptable form of birth control under the iPLEDGE program. The use of the female condom or the rhythm method is also not.
Frequently Asked Questions
How bad should your acne be for you to consider Accutane?
You should only consider Accutane if:
- Your acne is bad enough to leave scars
- AND has been present for several years
- AND did not fully respond to antibiotic pills or topical treatments
How long does it take for Accutane to clear acne scars?
Accutane has no effect on acne scars. However, some of the red and brown spots on your skin will go away as your acne heals. A few months after stopping isotretinoin treatment, your dermatologist can assess any remaining scars and talk to you about treatment options.
What else can I take if Accutane isn’t working?
If Accutane doesn’t eliminate your acne, you have other alternatives to try. Some evidence suggests that oral Dapsone (diaminodiphenylsulfone) may be effective when isotretinoin has failed. Other recommendations may include:
- Topical retinoids
- Oral contraceptives plus spironalactone (women only)
- Techniques for removing cysts or nodules
- Low dose prednisone
- Chemical peels
- Laser therapy and light therapy
Some doctors may also recommend one or more of these treatments in addition to isotretinoin. Keep in mind that it may take several weeks for isotretinoin to start showing results.
A word from Verywell
Accutane is definitely not the first acne treatment your teenager should try, but by the time you think about this drug you have probably considered and tried many other acne treatments with mixed or poor results.
For the child with severe lumpy acne that could leave scarring, Accutane might be a good option, but your child should be well supervised while taking it. Be sure to stay in contact with your pediatrician while this medication is prescribed, especially if your child starts to have side effects.