Accutane is also known as isotretinoin, an oral medication frequently used for severe, cystic acne. The chemical composition of Accutane is related to vitamin A and it is therefore classified as a retinoid and not an antibiotic. Other brand names for isotretinoin that are identical to Accutane include Sotret, Amnesteem and Claravis.

This oral medication is used in severe acne and often when other acne treatments have failed. Many dermatologists also support the use of Accutane for the treatment of lesser degrees of acne when the risk of physical or psychological scarring is present. As with all acne treatments, the use of Accutane is determined by considering a patient’s acne severity as well as their individual needs. At The Menkes Clinic, our board-certified dermatologists have decades of experience prescribing Accutane to acne patients and are extremely knowledgeable about its use. We have treated thousands of patients safely with Accutane.

Acne is one of the most common of all skin problems, characterized by whiteheads, blackheads, pimples and, in some people, deep painful bumps that look and feel like boils. When it's severe, acne can cause permanent scarring of the skin. There are many factors which contribute to the development of acne, including hormones and genetics. The most common reason is due to hormones. When hormones surge during puberty or pregnancy, the sebaceous glands enlarge in the areas where acne occurs. There is also a genetic component involved with acne. Individuals may inherit an increased chance of suffering from acne if their parents did.

Acne occurs when the lining of the wall of the hair follicle sheds skin cells, which then stick together with the sebum produced by the sebaceous glands. This causes a plug to form below the surface of the skin. This plug cannot be washed away. This process can take days to weeks for a visible lesion to form. Whiteheads and blackheads are the result. The sebum and cell debris together contribute to the growth of bacteria that naturally live in your pores. Your body's own immune system will naturally attempt to clear the clogged pores by sending in certain specialized cells that invade the follicle to help clean it up. However, in the process, the wall of the follicle may weaken and rupture, emptying the contents of the follicle into the surrounding tissue. When this occurs, swelling or redness can develop around the affected follicle, resulting in the larger bumps or pimples characteristic of acne. These are known as papules and pustules and can sometimes cause scarring.

There are several significant advantages to using Accutane in the treatment of acne patients with cysts and scarring, as compared to other standard acne treatments (including oral antibiotics and topical medications).

• Predictable duration of treatment, usually 5 months
• Marked improvement of existing acne scars
• Lasting remission, with little or no acne lesions for months to years after completion of a single treatment course (40% patients)

At the end of Accutane therapy (which typically lasts 5 months), patients will achieve clearance of acne lesions on the face and body and improvement in the appearance of acne scarring.

Both male and female patients are required to be enrolled in the FDA-mandated online isotretinoin registry, iPledge. This program was developed to ensure patient safety. Our staff will facilitate all necessary steps to complete this enrollment.

The iPledge program has specific requirements including routine monthly blood tests for all patients. All women of childbearing potential (i.e., menstruating) will be required to obtain a pregnancy test each month, beginning one month before therapy begins until one month following completion of Accutane therapy. Two documented forms of contraception are also required of female patients of childbearing potential (not males) throughout treatment and for one month following therapy. There has been no evidence of isotretinoin excretion through seminal fluid in males.

Nearly all patients achieve initial clearing of acne during Accutane therapy. Furthermore, about 40% observe complete and long-term remission of the disease following a single course of treatment. Another 40% eventually develop less severe recurrent acne, which is usually treatable with less invasive medications such as oral antibiotics and/or topical medication.

Accutane is the most effective medication available to improve and prevent the scarring that may result from severe, cystic acne. By repairing collagen in the deeper layers (dermis) of the skin, remarkable improvement may be seen in both shallow and pitted acne scars during and after treatment using Accutane. This effectively remodels the skin’s surface to correct both new and existing acne scars, leaving skin smoother and restored.

Both male and female patients are required to be enrolled in the FDA-mandated online isotretinoin registry, iPledge. This program was developed to ensure patient safety. Our staff will facilitate all necessary steps to complete this enrollment.

Accutane’s most serious side effect is the risk of birth defects caused by the medication when taken during pregnancy. These defects include mental retardation, hearing and vision abnormalities, facial malformations and heart defects. Isotretinoin is classified as FDA Pregnancy Category X and its use is contraindicated in pregnancy. Therefore, prevention of pregnancy is paramount during treatment. Patients receiving isotretinoin are also not permitted to donate blood during and for at least one month after discontinuation of therapy.

Most common side effects include increased sun sensitivity, and cracked, peeling lips. Other less serious side effects include the following:

• Nosebleeds
• Changes in the nails
• Slower healing of cuts or sores
• Bleeding or swollen gums
• Hair loss or unwanted hair growth
• Sweating and flushing
• Voice changes
• Tiredness
• Cold symptoms
• Dry eyes

Some side effects that may be more serious and indicate that you should call your doctor are:

• Headache
• Blurred vision
• Dizziness
• Nausea/vomiting
• Stomach pain
• Chest pain
• Diarrhea
• Muscle or joint pain

At The Menkes Clinic, our board certified dermatologists and staff are highly skilled and experienced in the management of patients taking Accutane. We are readily available for consultation and closely monitor all patients through regular monthly office visits and blood tests.

Schedule a consultation with one of our dermatologists if you are considering acne treatment with Accutan®e. You will receive a thorough evaluation and discussion of treatment options from which we will formulate a plan based on your medical needs and personal preferences. Since Accutane is an oral medication and treatment that requires monthly office consultations as well as blood tests, you will be followed closely to monitor your progress.

Following treatment with Accutane, patients can expect clearer skin and if acne recurs, smaller and fewer pimples as compared to before Accutane therapy. Approximately 80% of patients treated with Accutane at an appropriate dose will have a remission from their acne that lasts months to years. 40% of patients observe complete and long-term remission of the disease following a single course of Accutane, while another 40% eventually develop less severe recurrent acne which is treatable with less invasive medications. The remaining 20% relapse significantly enough to warrant an additional course of treatment. Each additional course, however, has a higher probability of cure.