What is Accutane?

Accutane, also known as Isotretinoin, is the holy grail of treatment for severe cystic acne and scarring. Cystic acne is a particularly type of acne that can form painful bumps under the skin and lead to severe scarring, which usually is the most difficult type of acne to treat with topical and oral medications. Accutane is an oral derivative of Vitamin A and works by drying out sebaceous glands. Although this by the far the most effective tool we have against acne, there is a caveat, as with most things. The side effect profile is long and arduous, therefore we save this treatment as a last resort when all else fails. However, that doesn’t mean that I as a dermatology PA, shy away from it. I prescribe it daily in my practice, because it truly does work! This is typically about a 6 month treatment that rarely needs to be repeated and can truly be life changing for patients.

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What are the side effects of Accutane?

As you can imagine, with a medication’s main goal to be reducing sebaceous gland activity (oil glands), the number one side effect is dryness. I am not just talking about dry skin, which it certainly does, but I’m also talking dry eyes, dry lips and even dry nasal passages that can on occasion cause nosebleeds. Keeping all this in mind, it is essential that all skincare with active ingredients are completely stopped as to not exacerbate this problem.

The main concern with Accutane is with women, as there is data that it can cause severe teratogenicity (fetal abnormalities) for women when they get pregnant on this medication. Therefore, a system was created by the FDA to mitigate this risk called the ipledge system. The ipledge system has strict requirements for monthly pregnancy tests for women while on the medication, two forms of contraception and monthly office visits.

Other common side effects include sun sensitivity, headaches, high triglycerides and cholesterol levels, while less common side effects include vision changes, muscle aches and pain, mood changes, joint pain, elevated liver tests and other lab abnormalities to name a few. Make sure to report any and all side effects to your healthcare provider. Additional common education points include no donation of blood while on the medication, no alcohol use, no taking Tylenol due to metabolism through the liver and always ask about starting new medications or supplements with your provider first.

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How do I prepare for my Accutane treatment?

First you need to schedule an appointment with a qualified dermatology provider and determine if you are a candidate. I encourage you to discuss any concerns or questions you have about Accutane with your provider before starting treatment. If you have both agreed to proceed with Accutane treatment, there are a lot of things you can purchase in advance to make sure this transition and treatment process as smooth as possible for you.

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Accutane shopping list must haves

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Dry Skin Remedies

As laboriously mentioned in the beginning of the article, EVERYONE will have dry skin. This is the time to stop your retinoids, retinols, salicylic acids, glycolic acids, lactic acids, etc. Now your focus will be on gentle skincare and allowing the Accutane to do it’s job.

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Face Wash

Find yourself a gentle hydrating face wash for morning and night. A few of my favorites are:

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Face Moisturizer

Find yourself a gentle moisturizer for morning and night, such as these:

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Body Moisturizer

Don’t neglect the skin on the rest of your body, as it will need moisturization as well. As always, it works best when applied within three minutes of getting out of the shower. Pro tip: keep your moisturizer in the shower so you have no excuse to not apply it after you are towel dried off.

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Sunscreens

Photosensitivity (AKA sun sensitivity) is not something to blow off while on this medication, especially here in sunny Florida. Additionally, we know sun exposure can make post-inflammatory hyperpigmentation from acne worse, as well as scarring. So just wear your sunscreen folks. You can try some of these:

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Dry & Chapped Lips

Dry lips can be annoying while on Accutane, so make sure you are regularly moisturizing them. Cheilitis or dry lips are the most common side effect we see from Accutane and can affect nearly 90% of patients taking Accutane. For extra credit, get one with SPF in it. Remember to avoid lip moisturizers with fragrances and additives in them or you could make matters worse with lip irritation.

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Dry Eyes

Dry eyes are extremely common on Accutane and can be managed very simply with lubricating eye drops such as these.

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Dry Nasal Passages

If you are noticing dry nasal passages on Accutane or happen to be starting Accutane in the winter, you may consider adding in a saline mist to help keep these passages lubricated and avoid bloody noses.

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Excessive Dryness

Ask your dermatology provider if you are a candidate to start an oral antihistamine, such as Xyzal Allergy. Some studies have suggested addition of allergy medications have helped reduced the severity of dryness of the skin, as well as improved acne and scarring outcomes while on Accutane.

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You are now ready for a successful Accutane journey

Now you are ready for a successful and smoother Accutane journey with these tools by your side. Remember, despite the long list of potential side effects and restrictions, Accutane can be a true game changer for your skin, and often self-confidence. It’s important you are compliant with your Accutane regimen, including monthly checkins with your provider and lab work. Make sure report any side effects promptly to their healthcare provider and ask them about a personalized skincare regimen for you. Wishing you clear and glowing skin in no time!

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