If you suffer from severe or cystic acne, then you know the familiar feeling of being prescribed yet another topical by your dermatologist. You feel like you spend your whole life in your dermatologist's office, and you barely (if at all!) see results. If you are at this point and your medicine and toiletries cabinets are overflowing with topical creams, it may be time to mention isotretinoin to your derm.
1. "Accutane" vs. Isotretinoin
Isotretinoin is commonly referred to as Accutane, which is a brand that was pulled from the market in 2009. There was a lot of buzz around Accutane, including John Mullarkey's murder trial. Mullarkey murdered his 16-year-old girlfriend and claims that he was depressed and suicidal from the drug Accutane. During the case, dermatologist Mark Seraly of Peters testified that Accutane has "never been definitively linked to such problems" (Pittsburgh Post-Gazette). Mullarkey's defense fell apart and he was sentenced to life in prison with no possibility of parole.
Though it has never been proved that Accutane (or isotretinoin for that matter) causes depression and suicidal thoughts, because of the accusations against it, the drug clearly states it as a side effect. The manufacturer claimed to pull Accutane for economic, not safety, reasons. Still, to this day, Isotretinoin is generally not recommended to those with a history of depression.
2. Side effects
The side effects list is extensive, but remember, you probably will not experience all of these. The most common side effect (that you will most likely get) is dry skin and bloody noses. Isotretinoin essentially stops your body's production of oil and it works to get rid of your acne, but your skin will feel like a desert.
Again, there are warnings of depression, so it is important to be mindful of your mental health and be open and honest with your doctor about it. If you have a history of depression, Isotretinoin may not be for you.
Other (rarer) side effects include joint and muscle pain, eyesight trouble, and liver damage.
3. Requirements
If you are to be prescribed Isotretinoin, these are the bare minimum requirements to take the drug. iPledge (the program through which all brands of Isotretinoin is administered) is very strict about all of the following rules.
If you are a female, the most important one, is to use two effective forms of birth control if you are sexually active. For example, be on an oral contraceptive and use condoms. If you are not sexually active, you can declare abstinence. This is in effect because there are high risks of miscarriages and birth defects if you get pregnant while taking Isotretinoin. In addition to taking birth control or being abstinent, you must take a pregnancy test every month. In order to receive your next dose, you must have a negative pregnancy test.
For both males and females, you must get bloodwork done monthly. Generally, blood work is done a few days before your dermatologist checkup. As mentioned before, some side effects include liver damage. Your bloodwork monitors many things, among them is your liver enzymes. To further reduce the risk of liver damage, patients are advised to not drink alcohol while on Isotretinoin. Trust me, I've tried, and it showed up in my bloodwork. Your safest bet is to stay sober for those four to six months.
Finally, you must visit your dermatoist's office every month to make sure everything is going smoothly. They are also able to check out your skin and adjust your dosage if needed. Once approved by your doctor, before you are able to pick up your prescription, you must answer a couple of comprehensive questions on iPledge.
4. It does work
If you are able and willing to risk the side effects, get bloodwork, pregnancy tests, and complete online questions every month, know this: it works. It truly does work for many that receive the treatment and completes it. For some, acne may return, but you are able to go back on it for a few short months. Your doctor may not recommend it to you, but if you are getting tired of the same old topicals that aren't doing anything, it can't hurt to bring up Isotretinoin at your next appointment.
