Is Isotretinoin the Best Acne Medication, Or Should It Be Avoided?


The drug isotretinoin is a medication that is known to stir up a range of opinions. The medication is also known by the names Absorica®, Accutane®, Amnesteem®, Claravis®, Myorisan®, Sotret®, and Zenatane™. The reason this particular medication, used for the treatment of acne, is so often contested is due to the side effects and both physical and psychological issues it can cause. Many wonder if this is a wonder-drug, or if its use should be stopped. There is certainly evidence that isotretinoin is a serious medication that can be harmful. There is also evidence that it is the single most effective treatment for severe recalcitrant nodular acne.

If your dermatologist has recommended this prescription, it is important to gain an understanding of the medication, the side-effects, and the risks involved in using it as part of a treatment plan. When isotretinoin is used responsibly and carefully, it can be the solution you’ve been seeking to relieve your painful and embarrassing severe acne.

What is isotretinoin and How Does It Work?

The drug is prescribed in pill form and should be taken daily with the careful instruction and monitoring by your dermatologist. Generally, one course of treatment will last anywhere from four to six months, but it can be longer or shorter depending on the individual. The reason this drug is so successful at permanently reducing or eliminating severe acne is because it directly affects each of the four ways that acne can develop. First, it reduces the size of a person’s oil glands and oil production. Acne is a bacteria that lives in the oil of a person’s skin. With the reduction of skin oil, there is also a significant reduction in the bacteria. Also, isotretinoin will slow the production of skin cells within the pores. These skin cells can be the reason pores become clogged. Finally, it has the properties of an anti-inflammatory which helps to reduce the number and severity of outbreaks.

What Are the Side-Effects of isotretinoin?

Aside from the possibility of an allergic reaction that causes hives, breathing difficulty, and swelling of the face or lips, there are several side-effects that can be classified as common. As with any drug, it should be used only when a doctor determines that the benefits it will provide will outweigh the possible side-effects. If the common side effects worsen, or if you experience any more serious side-effects, you should seek immediate medical attention. The most common side-effects include:

  • Dry Mouth
  • Minor Swelling of lips and eyelids
  • Nosebleeds
  • Upset Stomach
  • Thinning Hair

More Serious side effects are rare but include:

  • Depression, Increased Aggression, Violent Behavior, and Thoughts of Suicide
  • Severe Tingling of the Skin
  • Severe Sun Sensitivity
  • Signs of Infection Such as Fevers or Sore Throat
  • Skin Peeling on the Hands or Feet
  • Severe Stomach Pain
  • Nausea and Vomiting
  • Severe Headache
  • Hearing Problems or Ringing
  • Severe Diarrhea
  • Dark Urine
  • Yellowing of Eyes and Skin

Why Is It Controversial?

Many of the above symptoms are a result of a more serious issue. Other conditions can develop through the use of this drug. These conditions can include bowel diseases, liver and pancreas damage, depression leading to suicide, and birth defects if taken while pregnant. Many feel the medication is too powerful, and the possible side-effects outweigh the benefits. Also, isotretinoin was initially prescribed only in the most severe cases of acne and only after all other alternatives were tried. However, use of this medication has become more common for less serious cases. Many feel that its use is becoming too commonplace and hence, the medication is being misused. There is no doubt that isotretinoin is a medication that should be used with extreme care and caution. However, when used properly, it can be the best and only option to finding relief.

Precautions and Responsible Use

First, this drug should only be used after other treatment options have failed, and it should only be used in cases of severe acne. For the patient, they must also abide by certain standards required to take the medication. An informed consent form must be signed, and the patient must enroll in the iPLEDGE program. This is an education program ensuring the patient fully understands the possible side-effects and promises to abide by the strict guidelines developed to protect users. The following is a list of these guidelines:

Pregnancy tests must be taken before and monthly during use of isotretinoin. Birth control medication may also be recommended if the patient is sexually active. However, only certain ones are allowed in conjunction with isotretinoin. The patient must promise to avoid any sexual activity, or use two separate forms of birth control. There is a definite connection between this drug and birth defects; every effort is taken to avoid this.

Regular follow-up appointments must be made and kept for ongoing observation by the dermatologist.

The patient also must vow to immediately contact their provider if they are experiencing any side-effects, regardless of their severity.

The patient agrees to avoid blood donation for a minimum of 30 days following their last dose.

Is isotretinoin the Best Acne Medicine?

There will always be a debate on this of isotretinnoin is the best acne treatment available. If the necessary precautions are taken, the patient fully understands and accepts the risks, and promises to abide by the guidelines set by iPLEDGE, it may be the best treatment option. Also, it should only be used by those with severe acne that was unresponsive to other treatment options. In the end, the FDA allows its use and the American Academy of Dermatology supports isotretinoin as a viable treatment when done properly. However, what is of most importance is that the person taking the medication knows the risks and accepts them. It is a personal choice. No drug is the perfect remedy for anyone; there are always important considerations to be made.

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