Accutane?

[AltaGuy]

Like many people in this thread, I'm a little torn:

- I did a course of accutane (two or three months, I forget) in high school and it cleared up my acne permanently and immediately. I noticed no side-effects, not even dry lips. For myself, I am really glad I did it.

- I could never really recommend anyone else take it. The side-effects are potentially so severe in some people that it's scary to think what could have happened, and I would never want to feel responsible for that.

The only over the counter medication that ever worked slightly for me was the active ingredient in ProActiv, benzoyl peroxide. It worked for me a little bit, and could be found at the time in Oxy-5 or something like that. I tried a course of antibiotics, but they did nothing for me, and are probably almost as poor a solution as accutane given the high likelihood the acne will come back after treatment is finished.

[Street Pharmacist]

A lot of good info on here and some suspect info.

Accutane its essentially a very high dose vitamin A and has some serious side effects that you should be made aware of:

-highly teratogenic. That is to say it causes birth defects. Women must sign an agreement that they will take their birth control as prescribed and that they understand this side effect
-can cause liver injury, especially if given with other substances that can cause liver injury (higher dose Tylenol, alcohol and others). Regular blood tests to monitor how many liver enzymes are found in the blood stream can give the doctor a good idea if the liver is healthy. Typically, those enzymes only make it into the blood stream as liver cells die.
-Inflammatory Bowel Disease. This link is only somewhat more newly discovered. The largest study done to date that I'm familiar with showed an incidence of 1.1% in the general public compared 1.2% who have taken Accutane. However, if we look at Ulcerative Colitis specifically the rate its about 2-3 times the normal average (approximately 0.1%).
-Irritable Bowel Syndrome. This link is very weak, and no real data to support it.
-Worsening depression, suicidal ideation, suicide. This link its not well supported by data either, but s conversation should be had with your doctor regarding your risk

Less serious side effects include dry skin, eyes and mouth, stomach upset and diarrhea/constipation.

A very important note when looking at anecdotal evidence with this drug: Some of the issues talked about here start in the same time frame as Accutane its typically prescribed. For example, most incidences of IBS are in the late teens to mid twenties, which coincides with the age where Accutane its prescribed. Many of these prior would have experienced these side effects regardless of Accutane use.

Also, Accutane is and should remain the last resort for moderate/severe inflammatory acne. If it is to be prescribed, as with every single therapy, it should always come down to benefits vs. risk. Is the potential for these issues greater than the risk of not treating? For many people it is, but we need to remember that acne can be psychologically devastating for some Accutane isn't just for anyone with acne, and all topical and oral options should be tried first.


Off topic, but you cannot become resistant to antibiotics. By their very design they do not kill your cells, they are designed to kill bacteria. Most of the bacteria that cause disease are transient, that is to say they don't typically live on you except when causing disease. That means that it its new bacteria causing these illnesses each time. Previous antibiotic use certainly can contribute to resistance in a population that shares these organisms, but that does not preclude you individually from using them again. Ie. You are not resistant to the antibiotics

[AltaGuy]

Sort of on a side-note, but I'm curious as to whether anyone has ever even heard of antibiotics working for acne in anyone? I've heard of them working on a temporary basis, but almost every person I know who has had severe acne has eventually gone on to use accutane after a course of antibiotics, as I did.

Why do the antibiotics at all?

[Street Pharmacist]

Originally Posted by AltaGuy

Sort of on a side-note, but I'm curious as to whether anyone has ever even heard of antibiotics working for acne in anyone? I've heard of them working on a temporary basis, but almost every person I know who has had severe acne has eventually gone on to use accutane after a course of antibiotics, as I did.

Why do the antibiotics at all?

They do work for some if not most, and they are much safer option to try first.

[Komskies]

Use a clean pillowcase every single night. Moisturize with a noncomedogenic moisturizer.

[Bill Bumface]

Accutane is the devil. I was on it for a few months, experienced extreme joint pain, dry skin everywhere, painful lips, brutal nosebleeds in the middle of class, so I came off.

My friend's brother was brutally depressed on it and basically didn't leave the house for a year. When he came off it, he was a different person, and realized it wasn't just a teenage "phase".

Not worth it.

I'll take the occassional bout of pizza face.

[OldDutch]

Originally Posted by TorqueDog

I would do as much research as you can. Ask your dermatologist for as much detail as possible about the sort of side effects he/she has seen with it, incidences of side effects, etc.

Isn't this sort of like saying "I saw a UFO, therefore it was aliens"?

Wow you are so smart and hilarious as always TorqueDog. Thanks for that.

I have a brother who has Chron's, it developed after taking Acutane. Same with my friend who is allergic to Wheat right after going off it. Another friend who has had to move from Calgary to a more humid city because of dry eye that occurred after the treatment.

All doctors have said they can't pinpoint 100% to the drug, but it likely was the drug, hence they could not positively identify or explain why these illnesses suddenly happened.

Looking at other posts their are many people with the similar issues not unlike mine. They can't say 100% for sure either, as it is hard for doctors to make that call.

But by all means try and make me look like a crack head and pick a fight for whatever reason you want. I'm just going to give my advice and examples and throw you on ignore.

[Byrns]

I was on it 20y ago, and I haven't seen the same side effects as some of you. (just dry lips and eyes, but I blame Calgary weather for that)

Unless someone is being nice, and not telling me.

(not saying that those suffering aren't legit, the booklet of side effects included with the drug is proof of that)

[Peanut]

I haven't read the rest of the thread yet but my advice would be DON'T DO IT.

Especially if your acne is "only" moderate. I have acne. I know how much it sucks, I do. But seriously, your overall health is SO MUCH more important.

I went on accutane when I was about 23 because, like you, I had been struggling with acne for about 10 years, tried every possible treatment available, and was verging on depression about the state of my face (it's really hard on the self esteem).

I was on accutane for 6 months and it was awful. Nosebleeds, dry eyes, dry lips, my skin was literally flaking off in chunks. Oh, and your acne also gets WORSE at first so you're dealing with more acne in addition to skin flaking off in chunks, lips cracking and bleeding, etc.

I gained a bunch of weight while I was on the drug, was likely depressed, and generally just felt like ####. However, it did clear up my skin and I enjoyed lovely clear skin for two years. BUT THEN, my acne came back. And it's back in a major way but I refuse to ever go on accutane ever again.

Oh, and I also have since struggled with liver, gallbladder and digestive problems that reared their head in my first pregnancy at age 27 - I ended up having to deliver my daughter early because my liver wasn't functioning properly (cholestasis was the medical term), and I've since suffered from severe gallbladder attacks (the most painful thing I've ever experienced, and yes I'm including labour in that list).

None of these liver and gallbladder problems are anywhere in my family history, and I'm pretty young to be experiencing them. So I do attribute them to the accutane. So now my liver is compromised, my gallbladder sucks and I bet I will likely have surgery to remove it eventually, AND I still have acne. It was NOT worth it for 2 years of clear skin.

[troutman]

Originally Posted by AltaGuy

Sort of on a side-note, but I'm curious as to whether anyone has ever even heard of antibiotics working for acne in anyone? I've heard of them working on a temporary basis, but almost every person I know who has had severe acne has eventually gone on to use accutane after a course of antibiotics, as I did.

Why do the antibiotics at all?

I have been given tetracycline types of treatments for minor acne (rosacea), but that would not work with the more serious types of cystic acne I had as a youth. Some acne is much worse than "pizza face". Imagine going through high school with lesions and scars all over your body.

https://en.wikipedia.org/wiki/Acne_vulgaris

I had far worse than pimples on my face. I had lesions all over my back and chest. Other things were tried, but only Accutane helped with the cystic acne.

[RogerWilco]

Originally Posted by Frankster

I did a course of Accutane a couple of years ago. I had to sign papers stating that I wouldn't get pregnant, but I don't suppose you have to worry about that OP.

I still get acne, but nowhere near as bad as it was before, and most of it centers around things you don't have to worry about either

It is a very powerful drug with some really nasty side effects. There is a lot of info about this drug because it has been so widely prescribed. Just go in eyes wide open.

Also, if you can't or don't want to commit to the monthly blood tests, stay away from it.

You can't get anyone pregnant while on it or 6 months after either.

[Mango]

If you're looking for an alternative to Accutane, I highly recommend Kavi: http://www.kaviskin.com/

I did a lot of research about their acid peels and all of the reviews were positive (http://www.acne.org/kavi-salicylic-a...707/page1.html). After trying it myself, I echo all of them. It's a pricey product, but well worth the money. The results are fantastic.

http://www.kaviskin.com/skincare/salicylic-acid-peels/

[Kipper is King]

So, I had a very good talk with my dermatologist today. He actually said he does not think I need Accutane for the time being.

He wants to see how I do with some other topical stuff, but my skin has settled down of late, for sure.

[manwiches]

I had a friend who took it back in high school. My recommendation would be no. He became borderline suicidal and was severely depressed for the time he on it. He's better now, but he can attribute those feelings from the accutane.

[Street Pharmacist]

Originally Posted by Peanut

I haven't read the rest of the thread yet but my advice would be DON'T DO IT.

Especially if your acne is "only" moderate. I have acne. I know how much it sucks, I do. But seriously, your overall health is SO MUCH more important.

I went on accutane when I was about 23 because, like you, I had been struggling with acne for about 10 years, tried every possible treatment available, and was verging on depression about the state of my face (it's really hard on the self esteem).

I was on accutane for 6 months and it was awful. Nosebleeds, dry eyes, dry lips, my skin was literally flaking off in chunks. Oh, and your acne also gets WORSE at first so you're dealing with more acne in addition to skin flaking off in chunks, lips cracking and bleeding, etc.

I gained a bunch of weight while I was on the drug, was likely depressed, and generally just felt like ####. However, it did clear up my skin and I enjoyed lovely clear skin for two years. BUT THEN, my acne came back. And it's back in a major way but I refuse to ever go on accutane ever again.

Oh, and I also have since struggled with liver, gallbladder and digestive problems that reared their head in my first pregnancy at age 27 - I ended up having to deliver my daughter early because my liver wasn't functioning properly (cholestasis was the medical term), and I've since suffered from severe gallbladder attacks (the most painful thing I've ever experienced, and yes I'm including labour in that list).

None of these liver and gallbladder problems are anywhere in my family history, and I'm pretty young to be experiencing them. So I do attribute them to the accutane. So now my liver is compromised, my gallbladder sucks and I bet I will likely have surgery to remove it eventually, AND I still have acne. It was NOT worth it for 2 years of clear skin.

why do you attribute your gallbladder issues to Accutane? By far the most common cause of acute cholestasis IS pregnancy

[theg69]

People have to be careful re: causation and correlation.
There is no doubt that Accutane possesses many side effects and should be reserved for more serious cases of Acne.
I think Street Pharmacist did a very good job clarifying the side effects and the evidence to date. I apologize for the lengthy post - but I have posted the most recent evidence up to date re: inflammatory bowel disease and Accutane. The evidence is controversial and mixed. (see below)

For my patients, it is an individual decision, and I always refer them to a dermatologist for a second opinion (especially if they are female). While I do not favour its use, I have to admit that it is very effective and have seen some excellent results in some patients.

Someone mentioned that there are just as good medications with fewer side effects. The sad news is that this is false. There is nothing as good as Accutane in the treatment of acne. If it wasn't for the side effects, it would likely be routine therapy.

The following information is from a reliable source and meta-analyses are the best scientific studies - Inflammatory bowel disease includes Crohn's and Ulcerative colitis, while Isotretinoin is the generic name for Accutane:

Inflammatory bowel disease — Observational studies have found conflicting results on the relationship between isotretinoin therapy and inflammatory bowel disease (IBD). A 2012 meta-analysis of three case-control studies and two additional unpublished studies did not find a statistically significant relationship between isotretinoin therapy and IBD (relative risk for IBD 0.94, 95% CI 0.65-1.36) [37]. The individual results of the three published case-control studies and a subsequent population-based cohort study are briefly summarized below:

A nested case-control study of 2008 patients with IBD and 19,814 matched controls found similar rates of isotretinoin use among the IBD and control groups. In the study, 1.2 percent of patients in the IBD group received isotretinoin prior to a diagnosis of IBD, and 1.1 percent of patients in the control group received isotretinoin prior to the date of IBD diagnosis for the corresponding index patients with IBD (odds ratio [OR] 1.16, 95% CI 0.73-1.77) [38].
A nested case-control study of 2159 women with IBD and oral contraceptive use and 43,180 matched female controls found that isotretinoin treatment did not appear to increase the risk for IBD [37]. The study adjusted for potential confounders, including a diagnosis of acne and the use of oral tetracyclines (adjusted risk ratio for IBD 0.99, 95% CI 0.52-1.90).
A nested case-control study of 8189 subjects with IBD and 21,832 matched controls found an increase in risk for ulcerative colitis among patients who had received isotretinoin (OR 4.36, 95% CI 1.97-9.66) [39]. The absolute risk for the disease was small, estimated at 14 excess cases within a population of 4428 patients with ulcerative colitis. A statistically significant relationship between Crohn’s disease and isotretinoin treatment was not detected (OR 0.68, 95% CI 0.28-1.68).
A 12-year cohort study of 46,922 patients treated with isotretinoin, 184,824 patients treated with topical acne medication, and 1,526,946 untreated controls (all between the ages of 12 and 29) did not find a significant association between isotretinoin use and IBD on primary analysis (rate ratio 1.14, 95% CI 0.92-1.41) [40]. Although an association between isotretinoin and IBD was detected in a subgroup of patients aged 12 to 19 years (rate ratio 1.39, 95% CI 1.03-1.87), a similar association was detected between the use of topical acne medications and ulcerative colitis (rate ratio 1.19, 95% CI 1.00-1.42), suggesting that acne may contribute to risk for IBD. More studies are necessary to determine whether isotretinoin therapy is a risk factor for IBD. Until additional information is available, during discussions of the potential adverse effects of isotretinoin with patients, it is reasonable to mention that although an increased risk for IBD has been reported, a relationship between these disorders remains to be proven.


Hope that's informative!

[theg69]

Originally Posted by Street Pharmacist

why do you attribute your gallbladder issues to Accutane? By far the most common cause of acute cholestasis IS pregnancy

Agreed. I would suggest there are other risk factors causing the gallbladder issues. Pregnancy, weight gain, and even the female gender increases the risk of gallbladder disease.

Again, there is the correlation vs causation debate, especially when we are trying to delineate long term effects. That's the fallacy of taking a controversial drug. We are prone to believe that ANY illness that befalls us in the future will be attributable to that particular medication/intervention.

Best example of this is the autism/vaccination issue.

[Peanut]

Originally Posted by Street Pharmacist

why do you attribute your gallbladder issues to Accutane? By far the most common cause of acute cholestasis IS pregnancy

Because my liver was impacted. From accutane. Which led to the cholestasis, IMO. All the acute gall bladder attacks have been post-pregnancy.

Also the depression, digestive issues (which I didn't even get into), and that fact that I STILL have acne, would lead me to never recommend this drug to anyone.

I never claimed to be a doctor, and obviously the guy can make his own decisions. But he was asking for opinions/experiences, and those are my opinions and experience.

[Peanut]

Originally Posted by theg69

Agreed. I would suggest there are other risk factors causing the gallbladder issues. Pregnancy, weight gain, and even the female gender increases the risk of gallbladder disease.

Again, there is the correlation vs causation debate, especially when we are trying to delineate long term effects. That's the fallacy of taking a controversial drug. We are prone to believe that ANY illness that befalls us in the future will be attributable to that particular medication/intervention.

Best example of this is the autism/vaccination issue.

So all the class action accutane lawsuits related to liver disease, crohn's, colitis, etc. are all because of the "fallacy" that this drug is controversial?

[Street Pharmacist]

Originally Posted by Peanut

So all the class action accutane lawsuits related to liver disease, crohn's, colitis, etc. are all because of the "fallacy" that this drug is controversial?

There were lawsuits against vaccine makers because of autism. Does that mean it's true? Sorry, but I fail to see what the number off lawsuits has to do with evidence. Crohns has been repeatedly shown to have the same incidence in non Accutane users as Accutane users. Should we base or safety information on number of lawsuits and emotion or evidence?