Doctor's Responses Archive

Viewer's Question:

I'm a young woman with real bad acne. I've heard Accutane is very good for acne but is dangerous. When is Accutane used and what problems can occur from it?

Doctor's Response:

People with severe acne that does not respond to other medications are candidates for taking Accutane. Accutane is the brand name for isotretinoin, a class of drugs called retinoids.

Isotretinoin (Accutane) is taken by mouth, usually once or twice a day for 16 to 20 weeks. It appears to reduce the size of the oil glands so that much less oil is produced. It also reduces cell shedding and the stickiness of cells in the follicles. Isotretinoin (Accutane) is generally very effective in helping prevent extensive scarring in patients with severe acne. After 16 to 20 weeks of treatment, their acne is completely (or nearly completely) one in most (up to 90%) of cases. For some people, however, the acne will come back, and they will need additional treatment with isotretinoin.

All acne patients should carefully consider the several disadvantages of isotretinoin. The drug is not only expensive but it also has some significant adverse effects. Possible side effects include inflammation of the lip and mucous membrane of the eye; dry mouth, nose, or skin; itching; nosebleeds; muscle aches; photosensitivity; and, rarely, decreased night vision. Other more serious side effects include increased blood cholesterol, lipid, and triglyceride levels and abnormal liver enzymes. To make sure isotretinoin is stopped if these side effects occur, the doctor usually monitors a patient's complete blood count, blood chemistries, cholesterol, triglycerides, and liver enzymes before therapy is started and periodically during treatment. All of these side effects usually go away after the medication is stopped. If you experience side effects while using isotretinoin, you should tell your doctor. The doctor may be able to reduce the dose of the drug so that the side effects are decreased or stopped.

The most alarming adverse effect of isotretinoin (Accutane) is that it is teratogenic: it can cause birth defects in the developing fetus if a woman takes it during pregnancy. Therefore, it is crucial that women of childbearing age are NOT pregnant and do NOT get pregnant while taking isotretinoin.

If you (or any woman in the childbearing years) is to take isotretinoin (Accutane), you must use an appropriate birth control method for 1 month before therapy begins, during the entire course of therapy, and for 1 full month after therapy stops. You should talk to your doctor about when it is safe to get pregnant after the treatment with isotretinoin (Accutane) has been stopped.

In sum, isotretinoin (Accutane) is highly effective in clearing up severe acne but it is does have some side effects and it is dangerous for women during pregnancy because it can cause birth defects in their children. As with all medications, you should only take isotretinoin (Accutane) with caution.


Last Editorial Review: 4/1/2002