Acne Isotretinoin

Isotretinoin, commonly called Accutane, is a potent oral medication for severe and persistent acne. It is derived from vitamin A and is typically prescribed when other treatments, such as topical therapies and oral antibiotics, have not provided satisfactory results. It is especially beneficial for patients with large, painful nodules and cysts or those developing scarring from their acne.

Acne occurs when hair follicles are blocked by excess oil, dead skin cells, and bacteria. Isotretinoin targets this process by reducing oil production in the skin, preventing clogged pores, and reducing the environment in which acne-causing bacteria thrive.

The treatment works by:

• Shrinking Sebaceous Glands: Isotretinoin significantly reduces the size of the oil glands in the skin, leading to lower sebum production.
• Preventing Clogged Pores: Isotretinoin normalizes skin turnover, which, combined with less oil production, helps prevent clogged pores, a key factor in acne development
• Reducing Inflammation: The medication may also have direct anti-inflammatory effects on the skin, which helps reduce the painful and red appearance of nodulocystic acne.

Isotretinoin was initially prescribed almost exclusively for individuals with severe cystic acne or those with scarring. However, due to its effectiveness, it has, over time, become more commonly used for those with moderate acne who have been unable to manage breakouts with traditional topical and oral therapies.

While isotretinoin is highly effective, it’s not suitable for everyone. Candidates should undergo a thorough evaluation, reviewing their medical history, acne history, and potential risks before deciding if isotretinoin is right for them.

Unlike other acne medications, isotretinoin requires additional steps and precautions before starting. All patients being treated with isotretinoin must be registered through an FDA monitoring program called iPLEDGE; requirements are more stringent for females due to the potential for pregnancy-related complications. Limited bloodwork is done before starting treatment and at least once while taking the medication. To remain compliant with iPLEDGE, monthly appointments are required for regular evaluation and monitoring.

As with any medication, isotretinoin comes with potential side effects. While most patients tolerate the treatment very well, it’s important to be aware of possible reactions:

• Dry Skin and Lips: One of the most common side effects of isotretinoin is dryness, especially of the skin and lips. This can be managed using skin moisturizers, lip balms, and sometimes topical steroids.
• Increased Sun Sensitivity: Isotretinoin makes your skin more sensitive to the sun, so wearing sunscreen and avoiding direct sun exposure are essential.
• Muscle and Joint Aches: Some patients may experience mild muscle and joint discomfort during treatment.
• Mood Changes: Though rare, isotretinoin has been associated with negative mood changes in some individuals; however, the most common impact on mood is a positive one. Increased self-esteem that comes with clear skin has been demonstrated to commonly occur in multiple studies.