Isotretionoin

Isotretionoin (Accutane, Sotret, Amnesteem, Claravis) is the “atom bomb” for acne. It is the most potent anti-acne medicine available. The absolute majority of patients treated with isotretinoin are completely clear at the end of the course. Up to three quarters of patients treated with this drug never have acne again.

Isotretinoin is a derivative of vitamin A. It reduces oil (sebum) production by reducing sebaceous gland size, reducing the plugging of hair follicles, and reducing P. acne on the skin.

Multiple side effects limit the use of isotretinoin. Almost all patients experience dry lips and dry skin. Less common side effects include hair thinning, blurry vision, skin infection, abdominal pain, bone and joint pain, headache, bone spurs, mood swings, and depression. The list of side effects is very long. Yet, most of the serious side effects are very rare. Patients treated with isotretinion should be on the lookout for anything unusual (headaches lasting for many days, depressed mood, abdominal pain, etc). If something out of the ordinary happens, the treatment should be stopped. Most side effects are temporary and reversible.

Isotretinoin may cause severe birth defects in babies born to women who were on the drug during pregnancy. This is the reason (and the only reason) why isotretinoin is controlled by the government to a much higher degree than other medicines. The distribution of isotretinoin is governed by Ipledge program. This program requires the doctor, pharmacist, and patient to take several required steps to prevent pregnancies. If any of the steps are not fulfilled, the patient cannot receive isotretinoin. All women of child-bearing age are required to either be abstinent during isotretinoin treatment, or use two forms of contraception (for example, birth control pills and a condom). The requirements for men and women who cannot become pregnant are minimal. They include the prohibition to share the drug with anyone, or to donate blood while on the medicine.

The fact that a special program for isotretinoin distribution has been put in place does not in any way mean that the drug is toxic. The drug does not damage the liver, kidneys, or other internal organs. Isotretinoin is not a dangerous medicine. It has been on the market for several decades. Its side effects are well known and manageable.

The course of isotretinoin usually lasts five months. Blood work is required during treatment. Monthly pregnancy tests for women are also required. The most clinically important test on a blood panel during isotretinoin treatment is the level of triglycerides (blood fats). Occasionally triglycerides increase to very high levels which may be dangerous.

Because of multiple side effects, isotretinoin use is reserved for severe cystic acne, or lesser degrees of acne that are treatment-resistant. Acne with scarring, or acne causing psychological distress may also be treated with isotretinoin.

References:
Strauss JS. Krowchuk DP. Leyden JJ. Lucky AW. Shalita AR. Siegfried EC. Thiboutot DM. Van Voorhees AS. Beutner KA. Sieck CK. Bhushan R. American Academy of Dermatology/American Academy of Dermatology Association. Guidelines of care for acne vulgaris management. Journal of the American Academy of Dermatology. 56(4):651-63, 2007 Apr

Acne links:
www.skincarephysicians.com/acnenet
www.dermatology.cdlib.org/93/commentary/acne/hanna.html
www.ipledgeprogram.com

Alexander Doctoroff, D.O., F.A.O.C.D.
Assistant Chief of Dermatology,
Veterans Administration Medical Center
East Orange, New Jersey

Assistant Clinical Professor of Medicine,
University of Medicine and Dentistry of New Jersey

www.metropolitanderm.com