When to consider Accutane/isotretinoin for acne!

Dear Dr. Irwin I am 24-year-old female. I have suffered from acne since I was 17. During this time I had my worst (cystic acne) and my best with almost clear skin but of course oily. I was on several antibiotics with different dosages: doxycycline, and minocycline. I really want to get rid of the acne and enjoy my life. Now I am living in Germany and went to see a dermatologist. He advised me to use accutane. I’m afraid of the side effects and also worried that even if it works the acne will come back. Previously I was on different medication, and it worked but the acne always came back.

You bring up a good point. Accutane in the U.S. is controlled and used very differently than in the rest of the world. The generic name for Accutane is isotretinoin. Other names include: Myorisan, Amneststeem, Claravis, Zenatane. This molecule is very close in structure to the vitamin A molecule and is considered a “retinoid.” Here are some things to consider…

Accutane/isotretinoin pointers:

  • This is a very safe medication when used responsibly by an educated patient and doctor.
  • This medication WILL cause birth defects if pregnancy occurs while on it. Two methods of birth control are needed when on it.  For example, oral contraceptive plus condoms, or an implant (arm) plus any other barrier method, etc.
  • Everyone experiences some dryness while on it, your doctor should help you plan for that.
  • It is a water soluble medication. It is NOT stored in the fat. This is important because that means that when you stop it, it goes out of your system quickly. Most doctors advise no pregnancy until a full month after it is discontinued.

Accutane/isotretinoin in the United States:

This medication generally is reserved for severe, cystic acne, for any type of acne including pustular which is causing permanent scars, and sometimes for acne that just does not clear up after years of trying other medications.

  • This medication is controlled very strictly by the FDA
  • There is a federal registry (IPledge) with a protocol that needs to be followed to be on it. Make sure your doctor uses IPledge. If he/she doesn’t, go to a dermatologists’ office who does.
  • In the U.S., this medication is usually dosed at 1-2 mg/kg a day, for a course of six months. This translates to a daily dose for most of about 40-80 mg depending on your size. This can vary a little.
  • A monthly office visit (usually short), is required to check side effects and progress.
  • Monthly labs are required by IPledge and include a pregnancy test among other labs.

Accutane/isotretinoin in other parts of the world:

This medication is much less strictly controlled and is used in a wider variety of settings and dosings. Where you are in Germany, it’s much more a dermatologists’ choice how to use it.

  • Birth defects can occur at any dosing, so don’t get pregnant on this medication. See suggestions above.
  • The higher dosing above is meant to be as curative as possible and a time limited dose.
  • There is a lower dosing, for example 20-30 mg/day which is meant for control of more moderate forms of acne. Discuss the risks and benefits for you with your doctor.
  • Mild to moderate acne generally does NOT need this medication. There are many other good acne treatments.

Hope this helps,  Dr. I

Dr. Brandith Irwin, MD

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Hi, I’m Dr. Irwin. I believe that consumers deserve a medically trained and unbiased skin care advocate.

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