Have you ever struggled with acne? At first, when it's mild, you're like, "okay, I've got this - everyone has acne once in a while, right?" But then you try something to get rid of it, 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, the anxiety sets in. You try the third treatment, and... nothing. Your panic is official, and your cheerful mood is replaced by 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 severe physical scars on the skin's surface. It comes as no surprise that people who struggle with acne are often overcome with desperation and fear and slowly fall prey to a number of inappropriate treatments and pseudo-science.
Whether it's something serious, or just a case of mild acne, people eventually become desperate and reach out for any cure they can get their hands on - including ineffective, ludicrous, and even dangerous treatments.
One of those cures is isotretinoin - brand name Accutane. Usually reserved for treating severe acne, accutane is a long-term medication that culminates with smooth, young-looking baby skin, even in cases where deep scars and large cysts were once the norm. However, can accutane be used for mild acne? Let's find out.
What is Accutane?
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 Roaccutane, Amnesteem, Claravis, ABsorica, Zenatane, Myorisan, Sotret, etc.
Isotretinoin is in a class of medicines called retinoids, structurally similar to vitamin A. The power of isotretinoin lies in its ability to alter DNA transcription in very specific ways. This affects the formation of acne.
For example, Accutane / isotretinoin rewrites the DNA of the cell to decrease the size of the sebaceous glands and reduce their output. Sebaceous glands produce skin oil, also known as sebum, which clogs pores and hair follicles. These clogged pores then become the ideal target for a bacterial infection, which results in what we know as a typical acne inflammation.
Furthermore, isotretinoin lubricates the sebaceous glands and makes them less sticky, which heavily minimizes the formation of whiteheads (comedones) and blackheads. These processes also affect the number 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, acne sufferers dream of. The effects of Accutane / isotretinoin are undoubtedly deep and systemic.
However, operating at the DNA level, this medication will have a long catalog of side effects. That is exactly why doctors and dermatologists are very careful to prescribe it. This oral medication is usually reserved for treating severe cases of acne inflammation.
Does Accutane Work for Mild Acne?
Yes. Accutane can be used to treat mild acne as well as severe and cystic acne.
However, as 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 with the goal of minimizing the number of scars. Additionally, Accutane has also been used for treating other severe skin disorders, like lupus, psoriasis, and even types of skin cancer.
When it comes to anything but severe cystic acne, Accutane 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, consult a doctor or a dermatologist for the proper treatment of your acne. They may even decide to give Accutane a shot. Due to the severe 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 strong acne medication must be approved by a certified medical professional and controlled by them for months. To decide whether to consider Accutane for your acne problem, keep reading.
How Long Does Accutane Take to Work?
Low-dose Accutane can be used to treat mild acne. 40mg twice a week is a normal dose, but you can take between 2-7 pills depending on severity.
As always, please consult your doctor.
Necessary Precautions Before Taking Accutane
If you still decide to pursue an Accutane treatment, your doctor will ask about you and your family's medical history. Here are a number of health conditions that may complicate the effects of Accutane or even prevent you from taking the therapy:
- Asthma
- Mental illness
- Liver disease
- Diabetes
- Heart disease
- Bone loss, osteoporosis, weak bones
- Anorexia Nervosa
-
If you have any allergies to foods or medicines
Especially important: Women going through pregnancy or breastfeeding must not use Accutane. 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 take certain medications for another condition, mention this to your doctor. As the saying goes - it's better to be safe than sorry.
Things to Avoid While Taking Accutane
Besides making sure you don't have any of the contraindicated preconditions for taking isotretinoin, there are also things you should avoid doing while taking the medication.
Do not have unprotected sex while taking Accutane / isotretinoin since this can lead to pregnancy- Do not have unprotected sex while taking Accutane since this can lead to pregnancy
- Do not risk getting pregnant while taking Accutane / isotretinoin since it can cause serious birth defects
- Wait for at least one month after stopping Accutane treatment before deciding to become pregnant
- Do not breastfeed while taking Accutane
- Do not donate blood while taking Accutane / isotretinoin
- Wait for at least one month after taking Accutane to resume breastfeeding
- Wait for at least one month after stopping Accutane / isotretinoin to donate blood
- Do not take other medicines or supplements while taking Accutane without asking your doctor first
- Avoid driving at night or in poor road conditions if taking Accutane has affected your vision or mental state
- Do not undergo any cosmetic procedures to modify your skin while taking Accutane
- Do not undergo waxing, laser resurfacing procedures, micro needling, microdermabrasion, and similar procedures while trying an Accutane treatment, since the medication can cause scarring
- Avoid direct sunlight and UV rays exposure while taking Accutane
- Do not use tanning beds while taking Accutane
- Do not give Accutane to anyone else without a doctor's permission, since it can cause birth defects and serious health problems
Your Doctor Approves Accutane Treatment. What Happens Next?
Taking Accutane is a complicated process. 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 even six months. During this time, Accutane 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 it 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 is no joke. However, the first couple of months can be very discouraging since it's usually during this time that the acne becomes worse. Sometimes the redness intensifies, the swelling increases, and the pain becomes more intense.
But this is normal. A worsening of the acne inflammation is proof that changes are underway and that the oral medication is working. Remain persistent and carry on with the treatment until it runs its course. During this time, have regular medical checks and report any adverse side effects to your doctor and dermatologist.
Lab Monitoring
Your doctor will schedule blood tests to ensure that everything is going fine and the medication isn't affecting your health. The goal of these 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 to always make informed decisions based on updated results.
Completing Therapy
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 baby-faced and completely free of acne.
Which is pretty amazing, right?
However, the useful effects of Accutane 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 and redness, and new acne inflammation is practically nonexistent. An additional benefit to Accutane is that patients respond better to conventional beauty treatments and other acne treatments as well.
But should you take Accutane if you're not suffering from severe acne? Consider the following before taking isotretinoin for mild acne.
The Many Scary Side Effects of Accutane
Accutane has a long list of reported side effects. However, while there are a few fairly serious dangers from using the medicine, most side effects are bearable and temporary.
Since the invention of the drug, numerous studies have sought to confirm or deny many of these adverse effects, and some of them are overstated. For the sake of clarity, let's go through them one by one.
Teratogenicity, or Birth Defects
This is the most serious danger of taking Accutane. 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 also affect the child's cells and DNA.
This makes Accutane teratogenic, or in layman's terms: something that can cause birth defects. Since the child is still forming and its cells are in the early development stages, isotretinoin can cause an almost infinite list of malformations in the fetus.
For this reason, pregnant women cannot take Accutane.
Some of the most common 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 pregnant, your best bet is to delay your Accutane therapy and leave the acne problem for a later time. Your body needs time to clear all traces of Accutane, so it's only 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. You will need to take two birth control checks 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 medication is stopped immediately.
Persistent Headaches That Make You Vomit
Accutane is also known to cause nasty headaches, often accompanied by blurred vision, dizziness, nausea, and vomiting. If you are experiencing any of these symptoms, inform your doctor.
Increased Likelihood of Suicidal Depression and Psychosis
The risk of becoming severely depressed, or even suicidal, increases sharply with the intake of Accutane. Psychosis or psychotic episodes can also become a thing, while those with neurosis will suffer from increased symptoms.
These symptoms will not affect everyone. But, if you are predisposed, expect some pretty nasty but sudden and unexpected mood swings. If this happens, remember - it's the medication's doing. 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, you will feel the opposite of depression and despair.
Vision Problems and Eye Injury
Accutane has one common side effect - it can dry out the skin. But while that's one of the more bearable symptoms, it can also affect the eyes. The reduced production of tears (which our eyes use to clean and maintain themselves) can cause redness, itchiness, and even injuries, especially in people who wear contact lenses. If you're experiencing these symptoms, consult your doctor. They'll 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.
Liver Problems
Since Accutane 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 B5 and B12 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, other liver problems, and abdominal pain.
The Less Serious Side Effects of Accutane
With the scary stuff out of the way, let's look at the more common side effects of the drug. The annoying but bearable and temporary side effects of taking Accutane are:
Dry skin, which will require the frequent use of moisturizers- Dry skin, which will require the frequent use of moisturizers
- Dry, cracking, and chapped lips
- Occasional nosebleeds
- Skin can feel itchy, dry, and red
- Hair can fall off at a greater rate, becoming thinner
- Excessive peeling of the skin, especially on the palms and soles
- Muscle pains that become worse with physical activity
- Joint pain that becomes worse with physical activity - sometimes severe
- Increased sensitivity to the sun, causing dizziness, nausea, and headaches
- The increased sensitivity to the sun can also cause sunburn
- Increased sensitivity to light, which can cause eye strain and pain in the eyes
- Triglyceride levels can become elevated
All of this, and more, awaits most Accutane users. The severity of these effects varies from one person to another, but their annoyance is not to be underestimated. After all, the treatment lasts for anywhere between 4 to 6 months. Imagine having any of the symptoms above every day for six months. Frustration can easily set in.
But as always, it's important to endure and push through it. Try not to think about the side effects too much - they're temporary and will disappear once the treatment ends.
So, besides being disciplined with the physical routine of taking the medication and performing your skincare routine, maintaining your mental discipline is also very important. Educate yourself on the potential side effects beforehand.
But are the Side Effects Really So Bad?
Since Accutane was approved by the FDA in 1982, people have had some serious complaints. Between then and 2000, the FDA received 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 of causing 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 to the root of the problem, conducting study after study. What they found was much less scary than what public outrage would have everyone believe.
For example, a recent evaluation of evidence discovered no increased risk of inflammatory bowel disease in people taking Accutane / isotretinoin. But what about mental health? Well, according to the American Academy of Dermatology, scientists are still unable to prove direct causation between isotretinoin and the aforementioned mental health problems.
Another study conducted in 2016 reviewed several 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.
Always follow your doctor's advice and take it from there.
The Positive Effects of Accutane
Besides being most effective for acne treatment, Accutane has one additional, positive, surprising effect. 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," he added.
Pretty hopeful, right?
Conclusion
The many side effects of Accutane / isotretinoin can be intimidating when considering possible treatment. Naturally, this prevents many people from taking it.
If your doctor decides against it, you could always try other, more conventional treatments, home remedies, or DIY solutions for acne. Be sure to read up on the importance of L-Lysine in maintaining skin health or the use of vitamin E oil for keeping skin healthy and moisturized. The role of vitamin C in preventing acne is vital as well.
So, should you be taking Accutane for mild acne inflammation? The medication is recommended for people suffering from severe cases of cystic acne. However, 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 hesitate 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.
References
Isotretinoin treatment for acne and risk of depression
Position Statement on Isotretinoin
I used a controversial drug to permanently cure my adult acne
Isotretinoin: controversies, facts, and recommendations
Does exposure to isotretinoin increase the risk for the development of inflammatory bowel disease?
