Isotretinoin for Acne

Isotretinoin  is a powerful medication used to treat severe inflammatory acne. It is an oral medication that is taken once or twice daily. This medication is probably best known by the now-defunct brand name Accutane.

Isotretinoin (not to be confused with tretinoin) is classified as a retinoid, made from a synthetic form of vitamin A. It is taken orally, in pill form, once or twice daily.

It's considered the most effective prescription treatment available for severe acne. Isotretinoin can successfully treat, and completely clear up acne, even acne that has not improved with other treatments.

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Isotretinoin works by shrinking the oil, or sebaceous, glands in the skin. This reduces the amount of oil that is produced.

When your skin isn't producing excess oil, it isn't hanging around clogging up pores and creating pimples. By controlling the oil, acne is also controlled.

Unlike most acne medications, you don't have to continuously use isotretinoin to keep breakouts at bay. Most people only need one (16 to 20 week) course of treatment to get good results. Some people do require a second course of treatment to completely clear the skin.

After treatment is finished, pimples rarely come back. But if needed, after your course of isotretinoin you can be transitioned to a topical acne medication to maintain your newly-cleared skin.

Isotretinoin first made its mark in 1982, sold under the brand name Accutane. In June 2009, however, Roche Holding AG decided to stop making this acne medication.

The drug maker said it wasn't making enough money from the sale of the drug to justify continued distribution. Others speculated it was because the acne medication had come under scrutiny because of its side effects.

Although Accutane is no longer around, isotretinoin is still sold as Absorica, Amnesteem, Claravis, and generic isotretinoin.

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While isotretinoin is a valuable treatment for severe acne, it does come with side effects. Some of these can be severe, so you'll be carefully monitored by your doctor during the entire time you're taking this medication.

The most common side effects of isotretinoin include:

• Dry, peeling, flaking, and itchy skin
• Dry eyes, mouth, and nose
• Chapped lips
• Nosebleeds
• Photosensitivity
• Thinning hair
• Decreased night vision
• Fatigue

Not as commonly isotretinoin causes:

• Nausea and vomiting
• Headaches
• Bone and joint pain
• Diarrhea or rectal bleeding
• Severe chest or abdominal pain
• Difficult or painful swallowing
• High blood triglycerides

Also to note, isotretinoin can cause miscarriage and severe birth defects in babies whose mothers take the drug while pregnant. It's very important that you do not get pregnant while taking isotretinoin, and for at least one month after stopping treatment. You also may not breastfeed while taking this medication.

There is some speculation that isotretinoin may be linked to the development of inflammatory bowel disease. But at this point there is not enough evidence to prove or disprove this, Basically, the jury is still out on this one.

Your doctor will discuss the possible side effects with you before you start treatment. Remember, if you have any questions don't be afraid to ask.

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Probably the most widely discussed side effect of isotretinoin is depression and suicide. There have been reports of depression, psychosis, suicide attempts, and suicide, in people taking isotretinoin.

Exactly how or why this happens isn't known, but some researchers believe the drug may disrupt the way serotonin is made and used by the body.

Don't let this possible side effect scare you too much. Most people who take isotretinoin never experience any psychiatric problems. There is no conclusive link between isotretinoin use and depression, and some research has cast doubt on if there's really any link at all.

Just as a precaution, though, make sure you tell your doctor if you have a history of depression or mental illness. Know the warning signs and tell your doctor immediately if you experience any symptoms of depression, psychosis, or if you are having suicidal thoughts.

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Prepare to become very familiar with iPledge. Anyone taking isotretinoin is required to be enrolled in this program.

The primary goal of iPledge is to ensure no woman takes isotretinoin while pregnant, or becomes pregnant during treatment. Doctors who prescribe isotretinoin, and pharmacists who dispense it, must also register with the program.

Before receiving your first prescription, and for each month during treatment, you will have certain requirements that must be met. This can include monthly pregnancy tests, using two forms of birth control, and picking up your prescription within a certain window of time.

It's not just women who can become pregnant who must register with iPledge. Men, and women who can't become pregnant, also must comply with certain requirements before taking isotretinoin.

• iPledge Requirements for Women of Childbearing Potential
• iPledge Requirements for Men and Women of Non-Childbearing Potential

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Isotretinoin is meant to be taken only by those with severe acne. If you have mild to moderate acne, your doctor will have you try other acne medications first.

Of course, not everyone is a candidate for isotretinoin treatment. But if you have already tried other acne treatments without much success, if your acne is quite severe, or if you have widespread acne of the back or body, isotretinoin may be an option.

Your doctor is your best resource, so ask for her opinion. Even if isotretinoin isn't the treatment for you, your doctor will have other treatment options available so it's worth making that appointment.

A Word from Verywell

Isotretinoin has proven to be a successful acne treatment. For those who suffer from severe inflammatory or cystic acne, it may be a viable treatment option, especially if acne has not responded well to other medications. Ultimately, you and your dermatologist must decide if isotretinoin therapy is right for you.