This powerful brand name of oral medication known as isotretinoin is used to treat those who suffer from severe cases of acne. Many have been extremely grateful for the development of this treatment, that said, it doesn’t just target the acne, but actually affects the entire body; so much so that it can permanently change the body and the individual’s skin.
What Is Accutane?
Recognized by a variety of names, such as Roaccutane, it was first discovered in 1979. Patients with severe forms of acne were prescribed this medication and saw drastic results, mainly that of their acne cleared up, permanently.
On a molecular level, it is a derivative of Vitamin A (13-cis-retinoic acid) and is ingested orally at the same time that food, with high levels of fat, is consumed. This pill is taken for approximately 3-5 months depending on the severity of the acne, but it can also be taken at a lower dose for a longer period of time.
Since gaining popularity as a miracle acne treatment, those who suffer from acne on a less severe level also want in on this oral medication. There are those, however, who disagree due to the fact that Accutane is a systemic medication and has had permanent side effects to the individual who takes it and therefore must be taken with caution.
How it Works
The absorption of this medication affects the development of acne in four distinct ways.
- Oil Glands
While everyone has oil glands all over the skin, by taking this medication they become reduced, anywhere from 35% to almost 60%, and in turn, the production of oil produced is also drastically reduced by approximately 80%.
- Acne Bacteria
Bacteria live in the skin, specifically, P. Acnes, when the levels of oil are reduced, as described above, so too are the amounts of bacteria.
- Production of Skin Cells
The skin naturally produces skin cells inside the pores of the skin, but when this medication is ingested the production slows down and thus the pores are less likely to become clogged.
It reduces the production of inflammation of the skin, and thus reduces the development of acne.
Of Important Note
Those who use the Accutane treatment may notice that in the beginning, their acne will worsen, about 30% of patients noted. That said, approximately 95% of users describe clear skin after completing a complete cycle of the drug in both cases of non-inflammatory acne and inflammatory acne.
For those who take the medication for one cycle, many will go into remission, but about 30-35% will face a relapse and may need a second cycle. Typically, sufferers who take a cumulative dose of between 100-120 mg/kg will have the best results and are not likely to relapse.
Patients who take a lower dosage of the medication are more likely to relapse, and possibly more than on one occasion. The dose that is given is directly related to the weight of the patient, on average 0.5 – 2 mg for every kg of weight.
There are other factors that may influence a patient relapsing, such as the severity of their acne, whether or not they are taking the pill with the correct amount of dietary fat, their gender, and if they are female and suffer from Poly-Cystic Ovarian Syndrome (PCOS).
Lowering the Amount
As there are some severe side effects that can be the result of taking the Accutane some doctors have started to prescribe a lower dose than their usual 1 mg for every kg of weight for shorter intervals at a time. For those who do not have severe acne they have a better chance at going into remission with a lower dose over a longer period of time; therefore, the side effects, such as scarring, are drastically less.
The same is believed to be true for those who suffer greatly from the condition, so long as they achieve the full dose of 120 mg per kg. The most important factor that the cumulative amount of the isotretinoin, that which accumulates in the body, will determine the success of the treatment.
The Journal of Clinical and Aesthetic Dermatology describes the correct cumulative dose best by stating that a patient weighing 70 kg should receive 120 mg per kg or 70 kg x 120 mg which equals a cycle of 8400 mg in total.
One example would be to start a patient on a dose of 40 mg per day, which would be 0.5 mg per kg for the first month, the amount could then be increased to 60 mg daily, and thus it would take approximately five months for the patient to achieve the full dose.
In the case where side effects cause the dose to be lowered, the end dosage can still be reached by lengthening the duration of the medication.
Although taking Accutane intermittently, for example, for 7 days straight in a month, may alleviate any side effects, the result of the acne may not have the same effect. The studies that have been conducted on patients who have received an intermittent dose end up with a lower cumulative dose and thus the results are inconclusive.
In the first study, the intermittent dose was compared to that of a regular dose, the amount was the same during the entire week, but then with the intermittent group, the dosage stopped. The end result meant that the intermittent group only received 25% of the cumulative dose than the regular group received.
Overall, the acne cleared less than the regular group, and the intermittent group was more than three times likely to relapse.
In a second study, the comparison was made of an intermittent group, who received the medication for one week out of a month, to a regular group that received a continuous low-dose of the Accutane every day.
The result was that the intermittent group only received 50% of the cumulative dose as the regular group did, and while both group’s skin cleared up, the intermittent group developed relapses.
What Are the Side Effects of Accutane?
There are some serious side effects that acne sufferers considering the form of medication need to be made aware of. Some of these side effects can be short-lived, for the duration of the cycle of dosage, while others may extend beyond the treatment and can be quite severe.
What researchers do believe:
If the dosage of the isotretinoin is used for a shorter term, there is no reason to believe that the dosage will cause the patient to suffer bone density problems.
Celiac disease is a condition where the individual cannot digest gluten, and the lining of the small intestine can be damaged if glutens are consumed. There is no causal link between this disease and the intake of this medication.
Depression or Suicide
There is no direct link between depression or thoughts of suicide when taking Isotretinoin.
Inflammation of the bowel is not believed to be directly related to treatment from isotretinoin.
The ingestion of isotretinoin can result with teratogenicity, which can, in turn, result in birth defects or even spontaneous abortions.
Teratogen and Pregnancy
Teratogen is a medication that can cause the development of a fetus to be abnormal and thus cause birth defects. Accutane is in essence, teratogen. When Accutane was originally released to the public the Centers for Disease Control (CDC) received reports that many women who took the drug while pregnant suffered from spontaneous abortions or birthed babies with severe birth defects. The decision was made to not expose pregnant women to the drug.
These severe birth defects can affect a variety of systems within the fetus such as the skull, including the eyes and ears, the central nervous system, cardiovascular health, abnormalities with the thymus and the parathyroid, and even tragically, death.
The iPledge program was approved by the Food and Drug Administration (FDA) because the high risk of birth defects in pregnant women when taking Accutane was pretty much a guarantee. This pledge requires that female patients who are of a childbearing age must agree to use two forms of birth control while taking the drug.
Unfortunately, studies from the Netherlands, the UK, and Canada have shown that between 11-24 women who have been using the drug Accutane have become pregnant despite the warnings. In these countries, approximately 50 out of every 1000 women become pregnant, showing that even though the rate is lower, the results are still upsetting.
In California, a study was conducted to show the rates of pregnancy before the iPledge program was created and after, showing that the rates of pregnancy using the drug Accutane are lower, but may not be low enough.
Before the program began, 3.1 women in this state out of 1000 became pregnant using Accutane. That number decreased to 2.7 after the program was installed, what researchers believe is not low enough.
This may be due to the fact that contraceptive methods require that the females adhere to taking the birth control regularly in order to be effective and many women have difficulties with this. Birth control could be in the form of oral contraceptive, condoms, or even abstinence.