Accutane is one of the most well-known acne medications in public. Like many drugs, the brand name is more known than the drug name isotretinoin. This is not much of a concern, but there is also a lot of confusion and misinformation about the drug among the public. We ask dermatologists to separate fact from fiction and how they view the drug.
What is Accutane, and what is it used to treat?
Accutane is a Vitamin A derivative called Isotretinoin—a retinoid drug that is used to treat severe cases of acne, and has been in the U.S. market since 1982, and has been used in Canada since 1983 when Health Canada approved it. It is a powerful medication that has been instrumental in treating severe or resistant cases of cystic acne. Accutane itself is a brand name, and the drug Isotretinoin can have different names. Currently, Epuris is the latest Isotretinoin-based drug that is available on the market for treating severe acne.
What makes this drug controversial? What are some of its potential side-effects?
First, Accutane is undoubtedly a powerful drug and one with potentially serious side-effects. The most important of these is that the drug is teratogenic—it causes birth defects, and therefore, contraception is an absolute must. This is a serious but known side-effect and requires proper care on the part of the patient. Doctors prescribing this medication must evaluate their patients properly, and ongoing monitoring of lipids and blood is required to ensure the patient’s safety. The controversial aspect of Accutane involves possible links with depression and inflammatory bowel disease, both of which can have severe and potentially fatal consequences. There were several multi-million dollar lawsuits in the United States involving alleged links with these conditions.
Finally, several known side-effects are less severe but more frequent. Dry skin, especially around the eyes, is a common and sometimes frustrating side-effect for patients.
What is the general opinion among dermatologists about the drug?
As is the case with any other large body of people, there is never any consensus on an issue. Different dermatologists will have different opinions on the drug as well as how they approach the issue. What is not controversial is that Isotretinoin has revolutionized how severe acne is treated. This drug cures acne—a claim that no other acne treatment can make. It is also uncontroversial that it is a powerful drug with potentially serious side-effects.
For this reason, the drug must be prescribed by an experienced physician. Regular monitoring is also required for patient safety. Patients need to understand the possible negative side-effects as well as the benefits before starting. In particular, patients must know that they cannot get pregnant when taking this drug. Contraceptive use is mandatory when on this medication.
Many medications can potentially have dangerous side-effects. Why do you think Accutane specifically causes alarm in people?
It’s certainly true that many common medications have a minimal chance of interacting in a way that causes severe harm. The key is proportionality and the balance between risk and reward. Many people are genuinely scared of isolated incidents of terrible things happening due to or associated with a drug, almost regardless of how common or uncommon the event is.
The other factor is that acne is not a fatal disease. Depression and inflammatory bowel syndrome can be fatal. It’s very easy to think: It’s not worth it. For those that have been impacted by the negative side-effects of Isotretinoin, I can certainly understand their regret. It is important to understand that this is a powerful drug that comes with potentially serious side-effects, and the decision to take this drug should not be taken lightly.
Some who feel that this is a bad, dangerous drug underestimate the impact both in severity and scope that severe cystic acne can have on a patient, especially a teenager. Cystic acne can cause permanent scarring and be extremely painful and uncomfortable. Additionally, the worst effect may not be physical. Acne is a serious skin condition that can have a significant psychosocial impact on a patient and needs to be taken seriously. Severe acne has a strong correlation between depression and suicide, which needs to be given serious consideration.
