Have you ever struggled with acne? It’s like a plastic surgery gone wrong, one that you never asked for, and it makes you do things. At first, when it’s mild, you’re like, okay, I got this, everyone has acne once in a while, right? But then you try something, and it doesn’t work. Then you try another treatment, but that one doesn’t work either. Frustration is just the beginning.
Slowly, but surely, anxiety sets in. You try the third treatment and... Nothing. Your panic is now official, and your cheerful mood is quietly replaced by a pervasive sense of quiet desperation. Are you always going to be like that? You begin to hate the person in the mirror.
This damaging thought process is exactly when acne is at its most dangerous. While rashes, redness, and pimples may come and go, the psychological traumas that acne inflicts on a person can outlast any physical scars on the surface of the skin. It comes as no surprise that people who struggle with acne are often overcome with desperation and fear, and slowly but surely fall prey to a number of inappropriate treatments and pseudo-science.
No matter if it’s something serious, or just a case of mild acne, people eventually reach out for any treatment under the sky - and that includes ineffective, ludicrous and even dangerous treatments.
One of those so-called "miracle cures" that people who suffer from acne frequently reach out for is accutane, also known as isotretinoin. Usually reserved for the treatment of severe acne, accutane is a long-term medication that culminates with smooth, baby skin, even in cases where deep scars and large cysts were once the norm. However, can accutane be used for mild acne? Should it? Let us find out.
Accutane was originally the brand name of what is now known as Isotretinoin, but the name largely stuck. Since then, it has been marketed under other brand names, such as Amnesteem, Claravis, ABsorica, Zenatane, Myorisan, Sotret and so on.
Isotretinoin (colloquially accutane) is in a class of medicines called retinoids, which are structurally similar to Vitamin A. But the power of isotretinoin lies in its ability to alter DNA transcription in very specific ways which affect the formation of acne.
For example, accutane / isotretinoin rewrites the DNA of the cell in such a way that it decreases the size of the sebaceous glands and reduces their output. Sebaceous glands produce skin oil, also known as sebum, which in turn clogs pores and hair follicles. These clogged pores then become the ideal target for a bacterial infection, which, when it finally happens, results in what we know as the typical acne inflammation.
Furthermore, isotretinoin lubricates sebaceous glands and makes them less sticky, which in turn heavily minimizes the formation of whiteheads (comedones) and blackheads. These processes also affect the numbers of harmful bacteria on the skin, further reducing the likelihood of acne inflammation.
All of this makes isotretinoin / accutane the sort of miracle cure that most, if not all, people with acne dream of trying out. Undoubtedly, the effects of accutane / isotretinoin are deep and systemic. Operating at the DNA level, it goes without saying that the medication will have a long catalog of side-effects. That is exactly why doctors and dermatologists are very careful to prescribe it, and it’s usually reserved for treating severe cases of acne inflammation.
As we already mentioned, isotretinoin (accutane) is generally reserved for treating severe cases of cystic acne. Usually, these take the shape of pustular, nodular acne, resembling small, soft hills on the skin. They are sometimes hard, and sometimes soft to the touch because they are actually small subcutaneous caves of blood and pus. Ideally, doctors prescribe accutane (isotretinoin) as early as possible in the onset of acne with the goal of minimizing the number of scars. Additionally, accutane has also been used for treating other severe skin disorders, like lupus, psoriasis, even types of skin cancer.
When it comes to anything but severe, cystic acne, accutane (isotretinoin) is usually unnecessary and contraindicated. However, there are people who have used accutane for treating even mild, but awfully persistent acne, and have achieved stellar effects with accutane. However, as always, it is absolutely necessary to consult a doctor or a dermatologist for the proper treatment of your acne. They may even decide to give accutane a shot - but they have to be aware of this. Due to the severity of the side-effects of accutane, and its deep involvement in core bodily processes, accutane (isotretinoin) treatments are always monitored and controlled by doctors. Remember - isotretinoin / accutane rewrites your cells’ very DNA. If you don’t want to end up with a severe illness, or a permanent, painful systemic condition, do not take accutane on your own. Any use of the medication must be approved by a certified medical professional, and then controlled by them for months. To decide whether to consider accutane / isotretinoin for your acne problem, keep reading.
Especially important: Women who are going through pregnancy or breastfeeding must not use accutane / isotretinoin. This is a hard rule, because taking the medication can cause complications for the baby and stop, or distort its development. You should also inform your doctor if you’re taking any supplements, in the form of vitamins, minerals or otherwise. If you are already taking certain medications for another condition, again, you should mention this to your doctor. As the saying goes - better safe than sorry.
Taking accutane is a complicated process, with many milestones and controls along the way. Often, treatment begins with a lower dose, which increases over the following few weeks. Treatment can vary, but it takes anywhere from 16 to 20 weeks, or four to five - even six months. During this time accutane / isotretinoin is usually taken in the form of a pill, once every day, for the entire length of the treatment period. The treatment is long because accutane / isotretinoin works at the deep, cellular level. It takes time for the compound to reach the targeted skin cells, then more time to actually produce changes in the DNA, and then finally, even more time for the cells to regenerate, follow the new instructions and for the final effects (smooth skin) to become visible.
Taking accutane / isotretinoin is no joke. The first couple of months can be very discouraging, however, since it’s usually during this time that the acne actually becomes worse. Sometimes even radically so - the redness intensifies, the swelling increases, the pain becomes more intense. You need to constantly remind yourself that this is normal. This worsening of the acne inflammation is actually proof that changes are underway, that the treatment is working. However, one must remain persistent and carry on with the treatment until it runs its course. During this time, you will have to do regular medical checks and report any adverse side-effects to your doctor and dermatologist.
In order to ensure that everything is going fine and the medication isn’t affecting your health in adverse ways, blood checks are consistently scheduled. The goal of these lab checks is to ascertain the levels of triglycerides and assess your liver function. For women, pregnancy tests are a must too. These blood checks are repeated periodically in order to always make informed decisions based on updated results.
As we already mentioned, the standard length of therapy is anywhere from 16 to 20 weeks or 4 to 6 months. At the end of this period, around 85% of the patients are completely free of acne. However, the useful effects of accutane / isotretinoin don’t stop there - it’s just the start. For months and even years after the treatment, there is often a visible reduction in scarring, redness and new acne inflammation is practically nonexistent. An additional benefit to accutane / isotretinoin is that patients respond better to conventional acne treatments as well.
But should you be taking accutane / isotretinoin? Especially if you’re not suffering from those severe, cystic acne? Consider the following before taking accutane / isotretinoin for mild acne.
Accutane / isotretinoin has a really long list of reported side-effects. However, it’s a spectrum, and while there are a few fairly serious dangers from using the medicine, most of the side-effects are bearable and temporary. Since the original invention of the drug, however, there have been numerous studies seeking to confirm or deny many of these adverse effects, and some of them are definitely overstated. For the sake of clarity, however, let’s divide these into more serious ones and not-so-serious ones, and go through them one by one.
This is the most serious danger from taking accutane / isotretinoin. As we mentioned above, accutane works on a deep, cellular level, helping rewrite the cell’s DNA. Naturally, this makes it problematic during pregnancy, since accutane will affect the child’s cells and their DNA too. This makes accutane teratogenic, or in layman terms: something that can cause birth defects. Since the child is still forming, and its cells are in a stage of early development, accutane / isotretinoin can cause an almost infinite list of malformations to the embryo and the fetus.
For this reason, and we cannot stress this enough - accutane / isotretinoin is forbidden to pregnant women.
Some of the most common birth defects and fetal malformations include changes to the facial structure of the child, accompanied by defects in the development of the central nervous system (the brain). In short, accutane will deform your child’s face - and mess up its brain. If this hasn’t scared you enough, accutane also induces cardiac and numerous gland abnormalities. So, if you are with child, your best bet is to delay your accutane / isotretinoin therapy and leave the acne problem for a later time. These effects are temporary however. Since your body needs around a month to clear itself from all traces of accutane / isotretinoin, it’s safe to become pregnant or breastfeed one month after taking the medicine. No defects will occur if the accutane has left your system.
This is why women who take accutane are usually subject to stricter controls from their doctor. There are two birth control checks you will need to take when on the accutane therapy - one month before starting, and one month after that, to ensure that you haven’t conceived in the meantime. If pregnancy is detected, the accutane / isotretinoin medication is canceled.
Accutane / isotretinoin has also been known to cause especially nasty headaches, often accompanied by blurred vision, a sense of dizziness, nausea and vomiting. If you are experiencing any of these symptoms you should inform your doctor, but if you want to complete the therapy you will have no choice but to endure.
The risk of becoming severely depressed, even suicidal, increases sharply with the intake of accutane. Psychosis or psychotic episodes can become a thing as well, while neurotic people will become more neurotic. It should be said that these symptoms will not affect everyone - after all, not everyone is predisposed to the same things. However, if you are predisposed (and acne makes everyone predisposed!), you can expect to have some pretty nasty, but sudden and unexpected mood swings. If this happens to you, remember - it’s not real. It’s a trick. It’s the medication’s doing. It will pass, and to the best of your ability, you shouldn’t take it seriously. As the famous wise saying goes, “This too shall pass.” These symptoms are temporary and eventually disappear. And, after you finally see your smooth, clean face - believe me, you will be feeling the opposite of depression and despair.
Accutane has one very common side-effect - it can dry out the skin. But while that’s one of the more bearable symptoms, it can sometimes affect the eyes too. The reduced production of tears (which our eyes use to clean and maintain themselves) can cause redness, itchiness, and even injuries, especially to people who wear contact lenses. If you’re experiencing these symptoms, you should consult with your doctor who will probably prescribe you drops to keep your eyes lubricated. Additionally, accutane can also reduce the ability to distinguish between shades of white and black, which can be especially dangerous when driving at night.
Since accutane / isotretinoin is mainly processed by the liver, it can make it harder for the liver to deal with all the work. Usually, doctors will prescribe you Vitamin B or other supplements to make the load on your liver more bearable. But, in some cases, liver enzymes can become too elevated, which can cause hepatitis, jaundice, liver swelling, a variety of other liver problems and abdominal pain.
All of this, and more, awaits most accutane / isotretinoin users. The severity of these effects varies from one person to another, but their annoyance is not to be underestimated. After all, the accutane / isotretinoin treatment lasts for anywhere between 4 to 6 months. Imagine having any of the symptoms above, even the lightest one, every day for six months? Frustration can easily set in.
But as always, it’s important to endure and just push through it. A frequent mistake that people make when undergoing accutane therapy is to hyperbolize the symptoms they’re experiencing. Those itches become blown out of proportion, those headaches begin feeling like some ancient curse. But it’s a trap and a mistake to despair over these side-effects - they’re temporary and will go away once the treatment is over. So, besides being disciplined with the physical routine of taking the medication and performing the assorted skin care, it’s also very important to maintain your mental discipline as well. Just educate yourself on the potential side-effects beforehand, always remember their temporary nature, and persevere.
Since Accutane, now known as isotretinoin, got approved by the FDA back in 1982, people have had some serious complaints. Between then and 2000, the FDA received a total of 431 reports from people complaining of irritable bowel syndrome, suicidal thoughts, depression and so on. The reputation of the medicine became even worse after a US congressman publicly accused accutane / isotretinoin for the suicide of his 17-year-old son. Needless to say, this put the drug in the public eye, and not in a good way.
But the negative publicity paid off. Scientists scrambled to get at the root of the problem, conducting study after study. What they found was a lot less scary than what the public outrage would have everyone believe.
For example, a recent evaluation of evidence discovered there was no increased risk of inflammatory bowel disease in people taking accutane / isotretinoin. But what of mental health and all that talk of depression, psychosis, and suicide? Well, according to the American Academy of Dermatology, scientists are still not able to prove direct causation between isotretinoin and the aforementioned mental health problems. Another study conducted in 2016 reviewed a number of existing studies exploring the link between taking accutane / isotretinoin and suicidal depression but concluded that there was “weak evidence” to support such claims. A meta-analysis conducted in 2017 inspected a total of 31 studies researching the effects of accutane / isotretinoin on depression, and concluded that it doesn’t increase the risks.
So, what is one to do with all this contradictory information? Well, as always, you should follow your doctor’s advice and take it from there.
Besides being the medication that has so far been proven as the most effective for acne treatment, accutane has one additional, positive surprising effect. Namely, after the transformation is complete and the person sees themselves in the mirror for the first time, it inevitably improves the patient’s mental health.
"I personally have one specific patient who had clinical depression, was on antidepressants and [was] being followed by a psychologist," Joshua Zeichner, assistant professor of dermatology at Mount Sinai Medical Center in New York City, told INSIDER. "And after treating with isotretinoin, [his] face was totally clear, [he] had a huge boost in confidence, and [he] went off his depression meds. When I tell you it's life-changing, it's really life-changing."
The many side-effects of accutane / isotretinoin are a force to be reckoned with when considering possible treatment. Naturally, this prevents many people from taking it, which may be the wiser decision.
If your doctor decides against it, you could always try a number of other, more conventional treatments for mild acne and acne in general. Be sure to read up on the importance of L-Lysine in maintaining skin health, or perhaps the use of Vitamin E oil for keeping skin healthy and moisturized. The role of Vitamin C in preventing acne is vital as well, and free of the scary consequences of accutane / isotretinoin.
So, should you be taking accutane for mild acne inflammation? The medication is recommended for people suffering from severe cases of cystic acne, but your doctor and dermatologist can still choose to give accutane / isotretinoin a try if your acne is especially persistent and resistant to other treatments. Don’t be afraid to ask your doctor about this solution, since you never know until you try.
Despite its many scary side effects, accutane / isotretinoin still remains one of the most powerful acne treatments. If used with your doctor’s approval and under their watchful eye, it may finally be the solution you’re looking for and it can change your life for the better.