Does Accutane Deserve Its Bad Rap?

Accutane (and its side effects) are serious business. Many of us have become so wary of it that we've sworn that we'd never try the drug (or recommend it others). However, we couldn't help but wonder: Do the risks actually outweigh the potential benefits of the drug? To find out what dermatologists are saying about the drama-ridden medication in real time, we reached out to three M.D.s to get the 411 on Accutane — read on to learn the surprising truth.
What It Is, And What It Does
Dermatologist Diane Berson, M.D. was the chief resident of Dr. Alan Shalita, the founder of Accutane, back in the '80s. Since its launch, Accutane (the trade name for isotretinoin) has surprised both doctors and patients with its acne-clearing powers. "Accutane is a vitamin A derivative and an oral retinoid. It's used for patients who have acne that has been recalcitrant, meaning that it's not responsive to other drugs — and for acne where there's the risk of severe and permanent scarring," says Dr. Berson.
Accutane is unique from all other acne treatments in that it addresses all four causal factors of the skin disease, says Dr. Berson: increased keritization, or buildup of skin cells; excess sebum (that would be oil); growth of the p.acnes bacteria; and inflammation. "It can be a life-altering drug for a lot of our patients," says Dr. Berson. "Accutane has an over 80% success rate, and most patients will only need one four- to five-month cycle of the drug to be cured." Not improved people, cured.
The Risks
Of course, while Accutane might perform miracles on acne, the drug doesn't come without serious downsides. Says Dr. Jenny Kim, a dermatologist at UCLA: "Every medication can be abused, and with a strong drug like Accutane, there can be side effects if the drug is not taken properly." Because of the risks that have been reported with Accutane over the three or so decades that it's been prescribed, doctors take a close look at different aspects of a patient's health before prescribing the drug. First of all, says Dr. Berson, in female patients there is the issue of pregnancy. "If you're on Accutane, you must avoid getting pregnant by using two forms of birth control simulataneously, because the drug can cause serious birth defects. However, it's important to note that Accutane is teratogenic, not mutagenic — meaning, that the drug can affect a fetus, but it does not affect a woman's future fertility."
A second common worry? That Accutane is related to mood disorders; specifically, depression. "Isotretinoin has been shown to be associated with depression in some people. However, some studies have shown that acne itself is associated with depression," says Joshua Zeichner, M.D.. It's also possible that going on birth control pills at the same time you start Accutane could affect your mood. But, says Dr. Kim, a history of mood disorders may cause your doctor to decide to try other treatments, rather than risk potentially exacerbating the problem.
The final, and most recent side effects to be connected with Accutane, are ulcerative colitis and Crohn's disease, both of which are types of inflammatory bowel disease. While Dr. Berson states that there could be a connection between Accutane and digestive issues, she's not convinced that Accutane causes digestive inflammation. "In the general population, the occurence of ulcerative colitis is not much different from the occurence of the disease amongst those who take Accutane. However, it is possible that acne and these digestive diseases may both be related to internal inflammation."
The Bottom Line
Accutane is a very serious drug — and dermatologists, patients, and pharmacists are all required to treat it as such. "Accutane is very closely regulated by the FDA," says Dr. Kim. "When a patient is on Accutane, they have to come in for a blood test every month. Then, there's a window of one week where we analyze the blood, and then once the prescription is called in, the patient has a short window of time in which to pick up their prescription. Accutane wasn't always this regulated, but we've learned that we have to be extremely careful with this drug in order to avoid the serious side effects."
Thankfully, when Accutane is used properly, the dermatologists we spoke to all say that the results can be life-changing. "You can have a very serious illness — cancer, a thyroid problem — and you can hide it, but you can't hide a skin disease. It's one of the first things that people notice." For patients that feel that their skin might be without hope, Accutane can be the difference between feeling confident and feeling unable to go out in public. "I've been prescribing Accutane since 1995," says Dr. Kim. "If it's used properly, it can really make a huge difference."
Photographed by Nina Westervelt

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