What to Expect with Accutane for Acne

• Isotretinoin (Accutane) for acne can be given as a standard dose or low dose regimen
• Learn the Do’s and Dont’s of Accutane and typical side effects

Editor’s note: This article is especially relevant for the Hemiboreal, Oceanic, Riverine, Rainforest, Humid Subtropical skin types.

Even If Nothing Else Works for Acne, Accutane (Isotretinoin) Probably Will

No matter how common acne may be, it is often a very difficult skin condition to deal with from many aspects. From the psychological burden of feeling insecure about your skin to the multiple time-consuming and costly treatments people often use to try to clear their skin, the list of negative side effects from having acne can go on and on.

So what happens when you’ve tried every topical treatment in the store and even recommended by your dermatologist and nothing works?

Maybe you’ve tried organic, natural, and non-toxic products and you still can seem to get rid of your pimples. Maybe you’ve experimented with different types of diets and probiotic supplements, but your acne still persists. Maybe you have even used oral antibiotics and hormone regulating oral medications and still continue to break out.

So what could possibly be next after trying everything? Accutane.

People usually turn to Accutane when nothing else works. It is a powerful and effective acne treatment, especially for severe acne, but people often try to avoid this drug due to the fear of side effects and stories they’ve heard. Well, you should not be so quick to throw out the option of trying Accutane for acne, because you may be surprised to find out that it is not as dangerous as it seems. Accutane results are remarkable, and there is no doubt that this is the best “cure” we have for acne treatments to date.

Understanding Accutane: Everything You Should Know

Isotretinoin and how it works

Accutane, also known as isotretinoin, is a type of retinoid that is a derivative of vitamin A. This is an oral medication that requires a prescription from your doctor.

Accutane for acne works by three important mechanisms^[1]:

1. Decreases sebum (oil) production
2. Reduces the size of the oil duct which reduces the number of bacteria, Acnes, on your skin and in your oil ducts known to cause acne
3. Has anti-inflammatory properties.

Who should take isotretinoin?

Accutane is officially indicated for severe recalcitrant nodular acne that is unresponsive to conventional therapies.^[2] Accutane is used off-label for moderate acne as well.

The Process of Committing to Isotretinoin

After having a thorough discussion with your healthcare provider about your treatment options for acne, if you decide to start taking Accutane you must also understand what will be required of you. Treatment with Accutane is a commitment, and there will be additional steps you must follow in order to fill your prescription each month

iPledge Enrollment

iPledge is the risk evaluation and mitigation program that you will be required to sign up for when you start taking Accutane. The goal of this program is to ensure you understand the risks of taking Accutane, ensure you are practicing safe-use habits while on the medication, and to prevent fetal exposure to the medication. There is a mandatory 30 day waiting period for women.

Women who can get pregnant

Accutane can cause serious birth defects and fetal injuries, and therefore all females are required to take pregnancy tests before treatment and every month to be able to continue receiving the monthly prescriptions. Your results will be entered into your iPledge account before you are able to pick up your script each month.

You will be required to select two forms of birth control while on Accutane. Each month you will have a quiz in iPledge asking about your forms of birth control, and also about your understanding of the serious side effects that can happen if you are not practicing safe sex while on this acne treatment.

Once you have a negative pregnancy test, log on, and take your quiz, only then will you be authorized to pick up your script each month.

Men and women who cannot get pregnant

Men have an easier road to getting the medication as they simply have to answer quiz questions online and can start the medication without delay since there is little concern for pregnancy and birth defects.

Medical testing

Prior to starting Accutane, you will be required to get blood work to ensure you are medically healthy to begin treatment. Accutane can potentially affect your lipid levels, your liver function, and your white blood cell counts. Therefore, you will be required to not only have your blood work performed before you begin treatment, but also every month to ensure the drug is not causing harm to you.

Duration of treatment and dosing

There are different methods for treating acne using Accutane, and different types of acne that are being treated. Every individual is different, so there may be variations in the way you will be treated. Several factors such as age, sex, severity of acne, and duration of acne that may affect the way you respond, so your treatment will be tailored to you specifically.

Accutane for severe acne can be prescribed in one of two ways:

1) Standard dose regimen

1. Manufacturer’s labeling: 0.5 to 1 mg/kg/day divided in two doses for 15 to 20 weeks. If the amount of acne you have decreases by more than 70% before this time period, you may discontinue treatment. In severe cases, the dose can be increased to up to 2 mg/kg/day as tolerated.^[2]
2. Typical dosing: 0.5 mg/kg/day divided into two doses for one month, then increased to 1 mg/kg/day in 2 divided doses until a cumulative dose of 120 to 150 mg/kg is reached.^[3] 

2) Low dose regimen

Low dose regimens are used for moderate acne or when trying to reduce Accutane side effects

1. Low dose regimen: 20 mg/day for 6 months.^[4]
2. Low dose regimen: 0.25 to 0.4 mg/kg daily for 24 weeks.^[5]

Cumulative dose

In both the low dose and the high dose regimen, the cumulative dose is typically targeted at 120 to 150 mg/kg. However, a physician may choose to go to a higher dosing based on each individual’s situation and clinical needs.^[6,7] 

What Effects You May Experience During Treatment

Acne flare

Once you start Accutane, you may experience an initial flare of acne. This will eventually subside.^[8] However, you should let your doctor know if you feel that the flare is severe as there are rare cases of severe breakouts known as acne fulminans. 

Skin and mucous membrane problems

A well-known side effect of Accutane is dryness due to the decrease in oil production by your body’s oil glands. This side effect is based on the dose you receive, and your dose may be adjusted to make treatment tolerable if this is causing you considerable distress.

The most common problem experienced is dry lips. Other skin and mucous membrane adverse effects you may encounter are:^[1]

• Dry eyes
• Dry Skin
• Dermatitis (irritated skin)
• Skin peeling
• Facial redness
• Nosebleeds
• Sensitive skin
• Hair loss
• Itching

Some of these problems can usually be controlled using products such as moisturizers, eye drops, and sunscreen. In the event that you cannot tolerate these side effects, you should address these issues with your provider.

Other possible side effects

Mood changes, such as depression, are a side effect commonly attributed to Accutane based acne treatment, but evidence does not support this claim. Moreover, it appears that the treatment of acne actually alleviates some depressive symptoms.^[9]

Other unlikely Accutane side effects you may experience include:^[1]

• Inflammatory Bowel Disease
• Diarrhea/colitis
• Hearing loss
• Achilles tendonitis
• Night blindness
• Paronychia
• Headaches/ Benign intracranial hypertension
• Vasculitis
• Urticaria
• Stick Palms

Clear skin

The best thing to expect from Accutane acne treatment is by far the clear skin that you obviously have been wanting.

Around 85% of patients who have been treated with 0.5-1.0 mg/kg/day have clear skin after finishing 16 weeks of treatment with Accutane. Around 13% of patient take 5-6 months to be clear of acne, and around 3% may potentially require a longer course.^[1] Overall, up to 95% of patients who take Accutane will improve.^[4]

The Do’s and Don’ts of Taking Accutane

Due to the possible side effects of Accutane treatment for acne, there are some things you should be aware of and take into consideration.

Do

• Be open about your side effects with your healthcare provider. If you start to experience mood changes, intolerably dry skin, severe body aches, stomach pains, etc., you should disclose all of this information to your provider.
• Stay moisturized. The effectiveness of Accutane relates to the decrease in oil production by your body. Using moisturizers, lip balms, and eye drops can help you tolerate the dryness you may start to experience.
• Stay committed. A lot is required of you when you take this medication. You will have many requirements to perform monthly, and in order to fill your script, you must complete them all.
• Take with food. Accutane will be absorbed 1.5 to 2 times greater when consumed with a meal, particularly with high-fat conent^[10].

Don’t

• Drink alcoholic beverages. Alcohol may enhance the side effects Accutane has on your liver, so you should not drink while taking this medication.
• Have skin resurfacing procedures. Your skin will be sensitive to scarring during and after treatment with Accutane, and therefore skin resurfacing procedures should be avoided
• Donate Blood. Due to the risk of potentially passing your blood to a pregnant female, you should not donate blood during and for up to one month after you complete treatment.
• Get pregnant. Accutane causes severe birth defects.

Key Take Away Points for Using Accutane for Acne

• Accutane (known as isotretinoin) is the most effective treatment for acne and will likely clear your skin.
• Talk to your doctor about how Accutane may work for you. It is important you are aware of all your treatment options to make the most appropriate choice for you.
• Make the commitment. Taking Accutane for will require a lot from you. You have to have lab work regularly, frequently make visits to your doctor, and enroll in iPledge for pregnancy prevention
• You must be fully informed of the side effects, especially the risk to your fetus if you get pregnant.
• Common Accutane side effects include dryness of your skin and mucous membranes.

1. Layton A. The use of isotretinoin in acne. Dermatoendocrinol. 2009; 1(3):162-169; PMID: 20436884 Link to research.
2. Accutane Roche (isotretinoin) [prescribing information]. Mississauga, Ontario, Canada: Hoffmann-La Roche Limited; November 2016.; PMID:
3. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016; 74(5):945-973 e933; PMID: 26897386 Link to research.
4. Amichai B, Shemer A, Grunwald MH. Low-dose isotretinoin in the treatment of acne vulgaris. J Am Acad Dermatol. 2006; 54(4):644-646; PMID: 16546586 Link to research.
5. Lee JW, Yoo KH, Park KY, et al. Effectiveness of conventional, low-dose and intermittent oral isotretinoin in the treatment of acne: a randomized, controlled comparative study. Br J Dermatol. 2011; 164(6):1369-1375; PMID: 21114478 Link to research.
6. Blasiak RC, Stamey CR, Burkhart CN, et al. High-dose isotretinoin treatment and the rate of retrial, relapse, and adverse effects in patients with acne vulgaris. JAMA Dermatol. 2013; 149(12):1392-1398; PMID: 24173086 Link to research.
7. Cyrulnik AA, Viola KV, Gewirtzman AJ, et al. High-dose isotretinoin in acne vulgaris: improved treatment outcomes and quality of life. Int J Dermatol. 2012; 51(9):1123-1130; PMID: 22909370 Link to research.
8. Demircay Z, Kus S, Sur H. Predictive factors for acne flare during isotretinoin treatment. Eur J Dermatol. 2008; 18(4):452-456; PMID: 18573721 Link to research.
9. Huang YC, Cheng YC. Isotretinoin treatment for acne and risk of depression: A systematic review and meta-analysis. J Am Acad Dermatol. 2017; 76(6):1068-1076 e1069; PMID: 28291553 Link to research.
10. Colburn WA, Gibson DM, Wiens RE, et al. Food increases the bioavailability of isotretinoin. J Clin Pharmacol. 1983; 23(11-12):534-539; PMID: 6582073 Link to research.