Severe acne can be difficult to treat.

Isotretinoin, a prescription medicine, often is an effective solution for teenagers and adults with moderate to severe acne. It is a powerful and effective medication, but what are the risks involved?

For years, isotretinoin was referred to by its brand name “Accutane,” but Accutane has been discontinued in the United States. You may see isotretinoin available now in the US under the names of Absorica, Amnesteem, Claravis and Myorisan.

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Dr. Emily McLean

Dr. Emily McLean, a board-certified dermatologist at Novant Health Dermatology - SouthPark answered some questions about using isotretinoin to treat severe acne:

Is it safe to take isotretinoin for severe acne?

Isotretinoin is a very safe and effective drug to take for acne. Not every patient is a candidate for isotretinoin, and it is important to be monitored while taking the medicine, so I recommend that you see a board-certified dermatologist to be evaluated before you consider starting the medication. With appropriate monitoring and correct dosing, yes, it is safe.

What are the potential side effects?

The most common side effects are dry eyes, dry skin and dry lips. There are other possible side effects that we monitor for while you’re on therapy. These can include problems with the liver, muscle and joint aches and pains, problems with night vision, headaches and blurry vision. These are all rare and you will be monitored for all those side effects with monthly clinic appointments and with occasional blood testing.  

How long does treatment usually last?

The treatment typically lasts between 6 and 9 months, but that varies based on the patient’s clinical response and how well he or she tolerates the medication.

Should isotretinoin be the first acne treatment someone should try, or is it a last resort?

It really depends on the patient. If someone comes in with very severe scarring that is really impacting their quality of life, sometimes we use isotretinoin as first-line therapy. I always try to have a conversation with my patients about how assertive they want to be in treating their acne. Some people don’t want pills, in which case I think it’s very reasonable to begin with topical therapies, meaning creams and washes, because they can be effective. There are also other pills besides isotretinoin that can be useful for acne. It is important to work with your doctor to develop a tailored treatment plan.

Can pregnant women use isotretinoin?

No! That is the big red flag. We know that isotretinoin causes severe, dramatic birth defects. There is a medication monitoring program, called iPLEDGE, instituted by the U.S. Food and Drug Administration, to ensure that patients don’t start taking isotretinoin while pregnant, or become pregnant while taking isotretinoin.

Women who are of childbearing age must have two forms of birth control while they’re on the medication, and must take monthly pregnancy tests to make sure they don’t become pregnant while on the medication.

For men, it is important that they never share their medication with anyone, especially a pregnant woman. Men also can’t donate blood while they’re on the medication, in case a pregnant woman was to receive it.

What happens if severe acne is left untreated?

I worry about two things. One is the psychosocial impact on the patient. There have been numerous  studies showing that people who deal with severe acne have higher risk of depression, are less confident going about their day-to-day lives, and have limited professional and social opportunities because of the limitations they feel due to their appearance. Additionally, severe acne can be scarring, and scarring is permanent. Whenever possible, we like to prevent the scarring. Fortunately, there are many things we can do to improve the appearance of scarring after acne is appropriately treated.

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