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It's hard to believe that summer will be over in only a few more weeks. One of the ways I can always tell summer is nearing an end is the rush of teenagers coming to our office to get their acne under control before the start of school. Acne affects around 85% of teenagers so if your teen doesn't have it yet, they will probably get it soon.
At each visit for patients with acne, I review all the options to try and customize the treatment to the patient. Factors include severity of the acne, how much distress their acne is causing, and a patient's desire to take a pill versus using topical medications. After reviewing all the options, patients or parents often ask "What medication is best?" If by that they mean what medication works the best, there is no debate. Accutane (also known as isotretinoin) is by far and away the most effective treatment for acne and it isn't even close. Accutane is kind of like Boise State Football playing Colorado State; it never loses.
When I tell patients this, the next question is often "But isn't Accutane really dangerous?" Once they ask this question, I go into my typical speech about the truths and myths of Accutane. I will discuss these common myths, misconceptions, and truths of Accutane below.
Accutane Myths
Myth #1: Accutane Causes Depression and Suicide
This is probably the most common concern parents have and rightfully so. Depression and suicide are major issues with teenagers and the problem only seems to be getting worse. I have seen teenage suicide affect my own family, so it is something I take very seriously. To sort this issue out, there have been several studies examining the risk. In summary, all the major studies actually point to LOWER rates of depression in patients taking Accutane (click here to see the article). This is likely because acne can be a CAUSE of depression, and therefor treating it can lead to improvement of not only acne, but also depression. So rather than strictly avoiding Accutane in patients at risk for depression, I think it can be considered as part of the treatment for depression in some patients. This, of course, should be done with proper supervision by a dermatologist and a patient's mental health professional.
Myth #2: Accutane Causes Inflammatory Bowel Disease
Inflammatory Bowel Disease (IBD) encompasses the diseases of Crohn's Disease and Ulcerative Colitis. These are truly awful diseases that severely affect quality of life, so any medication that actually causes them should only be used with great caution. There was a time when Accutane was thought to potentially cause these disorders in some patients which gave dermatologists some reservations about continuing prescriptions. Luckily, many studies have been done since that time and the studies point to no increased risk of IBD in patients taking Accutane (click here to see the article).
Myth #3: Accutane Will Damage My Liver
While there can be some risk of liver damage in patients taking Accutane, it is very rare. In the hundreds of patients I have treated with Accutane, I have never seen any significant liver issues. In fact, current recommendations are to limit blood tests as abnormalities are rarely seen. That being said, if a patient has other risk factors for liver disease, they should be thoroughly counseled and monitored prior to and during therapy.
Myth #4: Accutane is Only for Severe or Cystic Acne
While Accutane is primarily intended for severe cases of acne, it can be used in patients of all severities. I commonly use it in patients with milder acne who have not responded well to other therapies. Patients with mild acne should generally stick to medications other than Accutane, but they could still consider taking it under the right circumstances.
Accutane Truths
Truth #1: Accutane Will Dry Out My Skin
This unfortunately is very true. Part of how Accutane works is by destroying some of the unnecessary oil glands that cause acne. If your body produces less oil, it is going to be drier. Dryness is typically most severe on the lips, face, and eyes. Use of frequent moisturizers and taking a fish oil supplement can help counteract these side effects. Patients can also take lower doses of Accutane to limit side effects. Low-dose Accutane is still highly effective, although treatment courses are typically longer.
On a personal note. I took low-dose Accutane in 2019, and while my lips were a little dry, my hands and other parts of my body were actually LESS dry. I actually loved what it did for the rest of my skin. So while I wouldn't count on your skin getting less dry, dryness alone should not be a compelling reason to avoid Accutane in most instances.
Truth #2: Accutane Causes Birth Defects
This is definitely true with a big caveat. It will only cause birth defects if a women gets pregnant WHILE taking Accutane. Females can get pregnant 1 month after stopping the medication with no increased risk of birth defects. Men taking Accutane do not need to worry about contributing to birth defects.
Truth #3: Accutane Can Cause Abnormalities in My Blood Work
This is mostly true. There are some patients who have significant increases in their levels of triglycerides (a measure of fat in the blood). High levels of triglycerides are not a good thing, but in a young patient who is otherwise healthy, a short term elevation in triglycerides is very unlikely to cause any significant issues. In almost all cases, levels return to their pre-treatment state after finishing a course of Accutane. Other than increased triglycerides, Accutane rarely causes any other blood abnormalities. It is still common practice to monitor for liver abnormalities while taking Accutane, but current guidelines are to minimize checking bloodwork as abnormalities are so rare.
Truth #4: Accutane Can Cure Acne
This is the most important truth in my opinion. In about three-quarters of patients who complete a full course of Accutane, (a typical course is about 6 months), these patients are completely cured of acne. This is because, unlike other acne medications, Accutane actually changes the structure of your skin making it less prone to acne. What I tell my patients is that all other treatments are used to control your acne long enough for you to outgrow it, which eventually happens in most patients. But in patients wanting an actual cure for acne, there is only one choice: Accutane.
Other Truths
There are many other truths we could discuss, but I will only briefly touch upon them. Accutane can cause sun sensitivity, joint pains, headaches, hair loss, and difficulty seeing at night. All of these are fairly rare, minor, and tend to resolve after completion of treatment. In a patient who needs or wants to take Accutane, I do not think any of these should be reasons to avoid Accutane in most instances.
You Don't Have to Settle for Having Bad Acne
I hope you found this blog post helpful and enjoyable. As one who experienced moderate to severe acne as a teenager, and should probably have taken Accutane as a teenager, I have great sympathy for those suffering from it. Reading this post might give you the impression that I try to put all my patients on Accutane, but nothing could be further from the truth. I make great efforts to personalize treatments and help patients decide for themselves what treatment will be best.
If you or your teenager is suffering from acne, please contact us and schedule an appointment. I promise you will be glad you did.
For more information on acne, see the following page on our website: Acne