Acne Effects Medication Side

Isotretinoin (Accutane) is a drug used to treat severe acne that hasn’t responded to other treatments. It may be prescribed for other uses. Some serious side effects have been reported from taking it.

Isotretinoin (Accutane) is a vitamin A derivative known as a retinoid. Your body reacts to it similar to how it reacts to vitamin A. Because vitamin A can build up in your tissues, it can quickly become a problem. You should not take vitamin A supplements while taking this drug.

Isotretinoin is available as a variety of brand names, including Absorica, Amnesteem, Claravis, Myorisan, and Sotret. The original brand, Accutane, is no longer on the market. However, the drug is sometimes still referred to by this name.

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Since isotretinoin is designed to treat severe acne, it has a visible effect on the skin. The medication can be very effective in treating severe acne because it targets:

The dose of isotretinoin a doctor prescribes may be linked with the severity of the side effects you may experience. People prescribed lower doses may not have any common side effects, while higher doses may result in more severe side effects, according to the American Osteopathic College of Dermatology.

While taking isotretinoin, your skin may be more sensitive to the sun. Be sure to use sun protection and skin moisturizers when outdoors. Avoid using any type of indoor tanning device.

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Because your skin can become fragile and may be at an increased risk of scarring, the Food and Drug Administration (FDA) recommends that cosmetic procedures, such as hair removal techniques like waxing, dermabrasion, or laser treatments, should be delayed until you’ve been off isotretinoin for at least 6 months.

Found insufficient evidence to support this recommendation. It may be best to speak with a doctor about any upcoming cosmetic procedures while taking isotretinoin.

But recent studies have not been able to establish a causal relationship between isotretinoin and these gastrointestinal diseases. Tell a doctor if you notice any concerning gastrointestinal symptoms while taking isotretinoin.

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An allergic reaction to medication can be life threatening. If you experience these symptoms after taking medication, call 911, contact your local emergency services, or have someone take you to the nearest hospital. It is possible to develop an allergy after repeated exposure to a medication.

People in their childbearing years should take a pregnancy test before starting this medication. An effective form of birth control, plus a backup method, should be used.

People should not get pregnant for 4 weeks after this medication is stopped. If you do get pregnant, stop taking the medication and talk with a doctor right away.

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Taking isotretinoin during pregnancy can cause miscarriage, death of the fetus, or premature birth. It can also lead to severe birth defects such as:

It can also cause a buildup of fluid and pressure on the brain called hydrocephalus. Babies may be born with an underdeveloped brain and small head, which is called microcephaly. This can lead to intellectual and developmental disabilities.

It’s unclear whether the drug passes to babies through breast milk. People should not breastfeed while taking isotretinoin or for at least 8 days after their last dose.

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Anyone who plans on taking isotretinoin must register with iPLEDGE. It is an FDA-approved restricted distribution program designed to tell people about the risks of birth defects and to prevent pregnancy while taking the drug.

A doctor may also need to monitor your liver function, blood sugar, and cholesterol levels while you’re taking this medication, especially for longer periods of time.

Of sexual dysfunction linked to long-term isotretinoin use have been reported, but more detailed studies are needed to better explain these results.

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Stop taking isotretinoin immediately and talk with a doctor if you experience any of the side effects or symptoms below. They may potentially lead to longer-term problems, such as organ damage, if not addressed promptly. These symptoms can include:

The potential for serious mental health problems, including depression, psychosis, and suicidal thoughts, has been reported with isotretinoin. Warning signs may include:

Most side effects from taking isotretinoin go away within a few days to a few weeks after treatment stops. But side effects may persist longer even after treatment ends. If left untreated, these side effects could result in permanent problems. In some cases, these may include conditions such as scarring or vision loss.

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Because of the danger to pregnant people, it is not recommended to donate blood while taking this medication or for a full month after you have stopped taking it.

Contact a doctor as soon as possible if your side effects continue for more than a few weeks after you stop taking isotretinoin.

Isotretinoin can do a good job of clearing up your skin, but there is the potential for side effects while taking the medication. Most side effects fade within a few weeks after you stop taking the medication. Some side effects are more serious and need immediate treatment.

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Have a detailed conversation with a doctor to explore the risks and benefits of taking isotretinoin. A healthcare team can also work with you to manage any side effects.

Has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Tomorrow when we arrive into clinic (or this afternoon if you are reading this during your lunch break), we will invariably be greeted with patients who struggle with one of the most common diseases we treat – acne.  More than likely, we will reach for topical retinoids, topical antibiotics, and the occasional systemic antibiotic.  Evidence supports the short-term use of systemic antibiotics to gain control of acne and help our topical regimens overcome the disease process. Yet, in an era when concerns of antibiotic resistance are ever-present and our knowledge of the microbiome is ever-increasing – are we doing the right thing? How can we be stewards of proper antibiotic use in light of resistance concerns while simultaneously bringing out the best skin for our patients?

During the 2020 GW Virtual Appraisal of Advances in Acne Conference, Dr. Neal Bhatia, Director of Clinical Dermatology at Therapeutics Clinical Research in San Diego, CA, helped us fine-tune our use of these effective, but sometimes misused, elements of our armamentarium against acne. In his lecture, Use of Antibiotics in Acne, Dr. Bhatia displayed his eminent ability to breakdown important research and guidelines to help us answer clinically relevant questions.

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Before we get into the full review, here are my “practice barometers” – what I took away from the lecture that may change my practice or confirm my standards:

Consider anti-inflammatory dose antibiotics, photodynamic therapy, hormonal therapies, and other adjuncts in a patient who needs longer-term control, but is not a candidate for isotretinoin

Per capita, what specialty writes the greatest number of oral antibiotic prescriptions? Answer: dermatologists.  It should be no surprise that the majority are in the tetracycline class.  These tetracyclines have multiple effector points on the pathogenesis of acne – but how? Prior to comedogenesis, there are elevated inflammatory markers in uninvolved skin of patients with acne (increased CD4+ T-cells, increased macrophages, follicular IL-1 expression, aberrant integrin expression).  So, what comes first, the comedone or the inflammation? Note, a similar discussion is occurring in hidradenitis suppurativa. Either way, tetracyclines are able to inhibit the activation or impact of matrix metalloproteinases (MMPs), kallikrein 5 (KLK5), and human cationic antimicrobial protein 18 (hcap18) which lead to inflammation in acne lesions. In that light, maybe our script pads are being used correctly!

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I am sure we have all considered, or even prescribed, other antibiotics for treatment of acne.  Each comes with advantages and disadvantages.

Guidelines and consensus statements in the JAAD support the use of systemic antibiotics in patients with moderate to severe acne – but only when used with the right patient

So, it seems we are prescribing the right medicine.  But do we use a low dose? Regular dose? Dr. Bhatia presents a study that shows slightly better results with inflammatory lesion counts when treated with doxycycline 40mg modified-release as opposed to the traditional doxycycline dosed at 100mg daily in patients with moderate to severe acne

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This information was presented by Dr. Neal Bhatia at the GW Virtual Appraisal of Advances in Acne Conference held July 30th, 2020. The above highlights from his lecture were written and compiled by Dr. James Contestable, staff dermatologist at Naval Medical Center Camp Lejeune. Images of slides courtesy by Dr. Neal Bhatia

The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government. The author is a military service member.

Next Steps in Derm is a virtual mentor for dermatology residents and young physicians seeking dermatology updates,  advice on practice management and building their careers. Get advice from experienced physicians in dermatology. Next Steps in Derm is part of the SanovaWorks network.

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In this series, we take a deep dive into the literature and guidelines to give you a quick reference on the use of new or complex therapies.  This series will become your