Isotretinoin (Accutane)
A synthetic oral form of vitamin A, isotretinoin has been used since the late 1970s to mitigate severe cystic ACNE that has not responded to other treatment. Isotretinoin is the only known cure for acne. It works by decreasing formation of oily plugs of sebum, reducing the formation of keratin (the tough outer layer of skin) and shrinking the oil-producing sebaceous glands. It works so well that it can cause unpleasant side effects, such as skin dryness and nosebleeds.
Isotretinoin cures or greatly reduces severe disfiguring acne in up to 80 percent of cases. However, because it can cause severe birth defects, pregnancy must be avoided during treatment and for at least two months after treatment has ended.
Currently, initial treatment with isotretinoin is given for four to six months. After treatment has stopped, the skin condition may continue to improve for at least two more months and sometimes for as long as a year, although the sebum production gradually returns to its original levels. More than 60 percent of patients with severe acne never again require treatment. If a second course is needed, it should be given only after a six month hiatus. This second course may require higher doses.
Adverse Effects
Isotretinoin is an extremely effective anti-acne preparation, but in a small number of patients (less than 1 percent) it may be associated with symptoms of a major depressive episode. In these cases, symptoms resolve rapidly (within two to seven days) after stopping the medicine. After a period off medication, treatment can begin again at a lower dose.
In a “Dear Doctor” letter to 210,000 dermatologists, family doctors, and psychiatrists, the maker of the drug (Roche) wrote that the strengthened depression warning on its boxes was tied to uncommon adverse reactions. But the “potential consequences” led to label changes, warning physicians that isotretinoin may cause “depression, psychosis, and rarely, suicidal ideation, suicide attempts, and suicide.” Stopping the drug may not be enough to ease the depression, the label warns.
Although the link between depression and isotretinoin has not been scientifically proven (the manufacturer insists there is no link), several people who have taken it claim they experienced depression, mood swings, and even suicidal thoughts. Both the FDA and the drug company said depression is common among acne patients, whether or not they take isotretinoin. It appears that patients who are prone to depression may be at higher risk for developing depression while taking isotretinoin.
Other side effects may include thinning hair, itching, dry and flaky skin, occasional aching muscles, and, rarely, liver damage.
