Poole Dermatology

Acne

Isotretinoin for Acne

Health Tips from Poole Dermatology

Why Isotretinoin?

by Jeffrey C. Poole, MD
Isotretinoin is the active ingredient of several oral acne medication brands, including Accutane (now withdrawn from the market), Amnesteem, and Sotret.

Although there have been concerns raised about a range of possible side effects, isotretinoin continues to be prescribed for acne because of its unique benefits. Isotretinoin is by far our most effective therapy for acne, and has the potential to cure someone’s acne. It is a very safe medicine when properly prescribed, and virtually every patient I have treated with isotretinoin is thrilled with the results and lack of significant side effects.

Generally, isotretinoin has been thought of as a “last resort” treatment or for severe-nodular cystic acne. However, I prescribe isotretinoin in a wide variety of cases:
- for the persistent or resistant acne that is not responding well to standard treatments
- for the patient that is beginning to develop or at risk of developing acne scars
- for the patient with moderate but extensive acne at a young age with a family history of severe or scarring acne
- and often for the adult patient who has persistent moderate acne and is tired of all the creams and pills and wants a “cure”.

These are some of the most common reasons I use for starting isotretinoin, but I address each person individually regarding their acne and situation, and often present isotretinoin as one, excellent option.

Isotretinoin is an oral medication used to treat severe acne when other acne treatments have failed to bring acne under control. It is available by prescription only.

Despite concerns about side effects, isotretinoin remains an important treatment option for those with severe acne. It can clear up acne that resists all other forms of treatment, including oral antibiotics.

Isotretinoin is commonly known by the former brand name Accutane®, but Accutane® is no longer available. Other brand names of isotretinoin include Amnesteem®, Claravis® and Sotret®.

How is Isotretinoin Used?

A course of isotretinoin treatment typically lasts 15-20 weeks, though it may be prescribed for longer periods if lower doses are used.

Most people require only one course of isotretinoin treatment, though an additional course of treatment may be recommended in some cases. A person's acne may continue to improve for several weeks or months after stopping isotretinoin.

Precautions When Using Isotretinoin

Isotretinoin is prescribed in a very controlled manner to reduce the risk of developing side effects.

Isotretinoin must not be used by female patients who are or may become pregnant. There is an extremely high risk that severe birth defects will result if pregnancy occurs while taking this medication in any amount, even for short periods of time.

People using isotretinoin must agree to the strict terms of the iPLEDGE program before starting isotretinoin. Those participating in the iPledge program commit to the following:

  • Seeing the dermatologist every 30 days while taking isotretinoin
  • Taking necessary tests, such as blood tests or pregnancy tests

Isotretinoin is dispensed in quantities to last only 30 days. A prescription refill is required for the next 30 days. A doctor must have assurances that ALL patients are following the iPledge program before approving the refill. This includes the requirement that all women have two (2) negative pregnancy tests before the approving the refill.

Learn more about iPledge at the iPledge Website or calling the toll-free number, 1-866-495-0654.

Taking Isotretinoin

Take Isotretinoin exactly as directed by your doctor. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the capsules whole with a full glass of liquid. Do not chew or suck on the capsules.

Your doctor will probably start you on an average dose of isotretinoin and increase or decrease your dose depending on how well you respond to the medication and the side effects you experience.

Side Effects of Isotretinoin

Isotretinoin may cause side effects. Call your doctor if you have any unusual problems while taking this medication.

  • Dry Eyes. Isotretinoin may cause your eyes to feel dry and make wearing contact lenses uncomfortable during and after your treatment.
  • Sun Senstivity. Avoid unnecessary or prolonged exposure to sunlight and wear protective clothing, sunglasses, and sunscreen during daylight hours. Do not use indoor tanning booths or tanning lights.
  • Increased Risk of Scars. Isotretinoin increases the risk that you will develop scars from procedures that traumatize the skin. Do not plan skin care procedures, such as waxing, laser hair removal, or dermabrasion, while you are taking isotretinoin and for 6 months after stopping treatment. Ask your doctor when you can safely undergo these treatments.

Other more serious reported side effects include depression and inflammatory bowel disease (IBD).

There is not enough evidence to determine whether isotretinoin can cause depression and other mental health conditions. Studies have shown that severe acne is itself associated with depression and can impact a person's self esteem. Nonetheless it is important to remain cautious. If a person taking isotretinoin has any symptoms of depression or another mental health condition, the person must contact their doctor and stop taking isotretinoin right away.

Similarly,  if a person taking isotretinoin develops any of the following signs or symptoms of inflammatory bowel disease (IBD), the person must stop taking isotretinoin and contact their doctor.

  • Severe abdominal pain
  • Diarrhea
  • Bleeding from the rectum
  • Jaundice. Yellowing of the skin or eyes
  • Dark urine

Take isotretinoin exactly as directed by your doctor. Do not take more or less of it or take it more often than prescribed.

Read the medication guide that you receive with the medication for a complete list of possible side effects.