Benefits and Risks of Treating Acne With Accutane

Accutane (isotretinoin) is a medication used to treat severe recalcitrant nodular acne when nothing else seems to work. Teens who take isotretinoin have severe acne and typically have tried many other acne treatments, including oral antibiotics and multiple topical medications.

Although isotretinoin is effective, concern about possible side effects keeps some parents from looking at it as an option.

This pimple is such a pain
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Side Effects

The potential side effects of isotretinoin are significant, including:

  • Red, cracked, and sore lips
  • Dry skin, eyes, mouth, or nose
  • Nosebleeds
  • Peeling skin, especially on the palms and soles
  • Joint and muscle pain
  • Temporary thinning of hair

More serious side effects can include:

  • Headache, stomach pain, and/or chest pain
  • Vision problems
  • Dizziness
  • Nausea and vomiting
  • Seizures
  • Difficulty swallowing or pain when swallowing
  • Jaundice
  • Impaired wound healing
  • Muscle weakness
  • Difficulty hearing or ringing in the ears
  • Painful or constant dryness of the eyes
  • Fainting
  • Fast or pounding heartbeat

The side effect that many parents worry about the most is related to potential mental health problems. This includes rare reports of people who have developed depression or thoughts of suicide while taking isotretinoin. It's important to tell your pediatrician or dermatologist if your child has any changes in his or her thoughts or behavior while taking this medication.

The high risk of birth defects is also a big concern, which is why there is a very strict protocol to prevent pregnancy among females taking the drug.

Taking Isotretinoin

Although the brand Accutane is no longer available, there are still several generic versions that your dermatologist can prescribe. They include Amnesteem, Claravis, Sotret, Myorisan, Absorica, and Zenatane.

These medications aren't necessarily easy to get, though, as they are "marketed under a special restricted distribution program" to help reduce the risk of side effects. Prescribers, patients, and even pharmacies must be registered with the FDA-approved iPLEDGE program.

You will usually need to find a dermatologist to prescribe isotretinoin, as it's usually not prescribed by pediatricians.

It also means:

  • Needing to get a new prescription for isotretinoin each month
  • Following strict birth control requirements, including taking two forms of birth control (typically hormonal birth control pills, patches, or shots, etc., and a barrier form of birth control, like a diaphragm or male latex condom) for female patients who can get pregnant, or committing to 100% abstinence for one month prior to starting isotretinoin; committing to abstinence while on the medication; and committing to abstinence for one month after your last dose
  • Monthly pregnancy tests
  • Not being allowed to donate blood while taking isotretinoin and for 30 days after your last dose

Keep in mind that the iPLEDGE program does not recommend abstinence without appropriate contraception for patients who are or who have been sexually active. If a woman taking Accutane chooses abstinence without taking birth control, then she must "not have sex or sexual contact with any male 24 hours a day, 7 days a week."

Certain birth control pills, including the progesterone-only mini-pills, are not considered an acceptable form of birth control under the iPLEDGE program. Neither is using a female condom or the rhythm method.

Should Your Teen Take Accutane?

Accutane certainly isn't the first acne treatment your teen should try, but by the time you're thinking about Accutane, you have likely considered and tried many other acne treatments with mixed or poor results.

For the child with severe nodular acne that could leave scars, Accutane could be a good option, but your child should be well supervised as he or she takes it.

Make sure to talk to your pediatrician, especially if your child does begin having any side effects.

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Article Sources
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  1. American Osteopathic College of Dermatology. Accutane.

  2. Ludot M, Mouchabac S, Ferreri F. Inter-relationships between isotretinoin treatment and psychiatric disorders: Depression, bipolar disorder, anxiety, psychosis and suicide risks. World J Psychiatry. 2015;5(2):222-7. doi:10.5498/wjp.v5.i2.222

  3. Lee SM, Kim HM, Lee JS, et al. A case of suspected isotretinoin-induced malformation in a baby of a mother who became pregnant one month after discontinuation of the drug. Yonsei Med J. 2009;50(3):445-7. doi:10.3349/ymj.2009.50.3.445

  4. iPledge. About iPledge. 2016.

  5. iPledge. Patient introductory brochure. 2016.

  6. U.S. Food and Drug Administration. iPledge program frequently asked questions. 2006.

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