Before starting isotretinoin, here's what dermatologists need you to consider
Before starting isotretinoin, here's what dermatologists need you to consider
Show Caption
Hide Caption
Carcinogenic chemical found in popular acne creams
The safety of skin care has come under scrutiny as elevated levels of the carcinogen benzene have been found in acne creams.
unbranded - Newsworthy
If you're someone who's experienced recurring bouts of cystic acne, you'll know there's no one-size-fits-all approach to keeping acne flares at bay. Clearing your skin can feel like a bit of a waiting game, and if you've cycled through rounds of hormonal therapies, oral antibiotics and topical retinoids to no avail, you've likely considered isotretinoin as a possible acne treatment.
Isotretinoin is a powerful oral retinoid that can be prescribed to treat resistant cystic acne. The medication's acne-fighting benefits have been backed by science for decades, but it's important to be aware of a few serious risks. Here's what dermatologists need you to know.
What is isotretinoin? What is Accutane?
Isotretinoin is a potent derivative of vitamin A that shrinks oil glands in the face, chest, back, shoulders and upper arms, says Dr. Richard Antaya, director of pediatric dermatology for Yale Medicine. The medication was first approved by the U.S. Food & Drug Administration in 1982 under its original brand name, Accutane. Accutane itself isn't actually sold in the U.S. anymore, and has since been replaced by different generic formulations of isotretinoin, explains Antaya.
Isotretinoin lowers sebum production in the skin; sebum is a waxy, oily substance that's meant to protect the skin from moisture loss. The sebaceous glands that live under our hair follicles secrete sebum. When we produce too much sebum, and the sebaceous glands become infected, acne may develop, says Dr. Andrew Wong, a primary care physician in Westport, Connecticut, and Fairfield County regional medical director for Hartford Healthcare.
By removing the underlying mechanism of acne (sebum production), isotretinoin unclogs pores and quells skin inflammation. 'I always tell my patients, decreasing the oil (or sebum) takes the wind out of the sails of acne,' says Antaya. The results are palpable: With just one course of isotretinoin, the majority of patients will see a great improvement, and in many cases, a near-complete clearing of acne, Antaya says.
How isotretinoin works, plus who is a good candidate?
Isotretinoin could be a great option for those in search of a long-lasting solution to their cystic acne. That said, the medication does have severe potential side effects, which is why it's not for everyone. There's a few reasons why a dermatologist may prescribe isotretinoin:
Your acne is persistent. You've tried multiple treatments for acne—from topical retinoids to benzoyl peroxide to oral antibiotics—and your acne still isn't clearing up.
You've tried multiple treatments for acne—from topical retinoids to benzoyl peroxide to oral antibiotics—and your acne still isn't clearing up. You have severe, nodular cystic acne. Topical medication is rarely, if ever, effective for treating nodular cystic acne. If you haven't responded well to other oral acne treatments, including oral antibiotics or hormonal therapies, that's when a dermatologist may consider prescribing isotretinoin, Antaya says.
Topical medication is rarely, if ever, effective for treating nodular cystic acne. If you haven't responded well to other oral acne treatments, including oral antibiotics or hormonal therapies, that's when a dermatologist may consider prescribing isotretinoin, Antaya says. You have severe acne scarring: Severe acne can be disfiguring, leaving permanent scars, says Wong. Isotretinoin can't get rid of scarring, but as your skin clears, it may improve the appearance of scars, and help prevent new ones from forming.
More on cystic acne: Cystic acne can cause pain, shame and lasting scars. Here's what causes it.
What are the risks of isotretinoin?
The decision to start isotretinoin isn't one that should be taken lightly—it's a medicine that carries significant risks. Isotretinoin shrinks the oil glands and thins the epidermal barrier, which could cause dryness of the skin, lips and nose. Other potential side effects include joint and muscle pain, eye irritation, elevated blood fat levels and in rare cases, liver damage.
Isotretinoin is known to cause severe birth defects and miscarriages in people who are pregnant, says Wong. For this reason, isotretinoin isn't the kind of medication that can be prescribed on a yearly basis; it has to be renewed every month. 'We have strict safeguards in place to make sure we get positive feedback that someone is doing well with the medicine, and that they performed a pregnancy test during that month,' Wong explains. Patients must enroll and adhere to the iPLEDGE program, an FDA-mandated registry to help prevent pregnancy in patients taking isotretinoin.
Isotretinoin has also been associated with depression and suicidal thoughts, though the American Academy of Dermatology says there currently isn't enough evidence to determine a clear link. Patients will be screened for possible signs of depression or suicidal ideation before isotretinoin is prescribed. 'So, I strongly recommend that if an acne patient suffers from depression, the dermatologist works with the mental health professional to ensure the patient can undergo a course of isotretinoin,' says Antaya.
In case you missed: How do antibiotics work, what happens to your body when you take them? We've got answers.
Can isotretinoin cure acne?
If your dermatologist has determined you're a good candidate for isotretinoin, know that it could take two to three months before you start to see a significant improvement in your acne, and four to six months (or potentially longer!) for it to clear—though the results are long-lasting. After completing a single course of isotretinoin, around 85% of patients will experience a long-term clearing of skin, says Wong.
Today, isotretinoin still stands to be the most clinically effective treatment for severe acne. 'Even though isotretinoin has been available for over 40 years, if you ask most dermatologists, we will still list (isotretinoin) as one of our favorite medications, because it is consistently effective and therefore provides significant benefit, both physically and emotionally, to our patients,' Antaya says.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Medscape
13 hours ago
- Medscape
When Junior Residents Challenge Chief Attendings
Life as a medical student is far from easy. Every day, you grapple with a vast course load, erratic shifts during clinical rotations, stress, anxiety, and burnout. Yet, once you've reached the summit of that academic journey and are conferred with your medical degree, you start your residency, shiny new objects surrounded by much more experienced people. As a young resident or medical student, the mere idea of disagreeing with an attending physician in a position of power may raise hairs. After all, junior residents and students often look up to attendings, seeing them as versatile healers who can seemingly fix any ailment as they attend to the wards they lead. As a third-year medical student on call late at night, Suresh Mohan, MD, found himself in disagreement with a senior physician — the chief resident — over the treatment of a patient, which then escalated into an acute emergency. 'I quickly realized [about this senior physician] 'I think you're letting your ego get in the way of doing the right thing for the patient.' That was the first time I disagreed with the way that I watched this person manage something…I realized it was a very human emotion that got in the way of them doing the right thing,' said Mohan. Bleeding Trachea, Bold Dissent Mohan is now an otolaryngologist and surgeon at Yale Medicine, New Haven, Connecticut, with a specialty in reconstructive and cosmetic surgery for the face, head, and neck. But the experience he had as a third-year student still resonates with him. With few people around to help, Mohan found himself relatively alone. 'Sometimes, you're the only trainee in the hospital…the only doctor in the hospital that's responsible for all the patients that need ENT [ear, nose, and throat] care,' he said. While on call late that night, Mohan and his chief resident were called in on a consult for a patient's bleeding trachea after the patient had undergone a tracheotomy earlier that morning. During a tracheotomy, a surgical opening is made in the neck and a tube is inserted directly into the trachea. It is usually performed by an otolaryngologist. Bleeding from tracheotomies can range from minor oozing due to irritation or suction trauma to life-threatening hemorrhages if a major vessel is involved. Upon seeing the patient, the chief resident said there was nothing to worry about and they will continue to monitor the patient. An hour later, Mohan was called again, but his chief maintained that everything was fine. 'Of course, in the back of my head, I'm wondering if it's bleeding more,' said Mohan. Within the next few minutes, they were called two more times to see the patient, and yet his chief was adamant that no further action needed to be taken at that time. 'Eventually a code was called…we were rushing over there…and it turns out the trach was not fully in the airway,' Mohan said. 'The patient was having trouble breathing and causing more to happen from that…it escalated quickly into a much more acute emergent situation.' Mohan and the team started yelling for instruments, trying to get the trach tube back in place in the patient's trachea. Fortunately, they were able to secure the airway. One of Mohan's biggest takeaways from the experience: 'It doesn't matter if they call you three times, you still need to do the right thing.' Post-Bariatric Bleeding Incident As a third-year general surgery resident, Joshua Rarick, MD, found himself on call and alone at Covenant Hospital in Saginaw, Michigan. In the late evening during a 24-hour shift, a patient's vitals began to drop following a Roux-en-Y gastric bypass. Rarick had not personally performed the initial surgery, but as the resident on call, he had to respond to nurses messaging him with concerns about the patient's blood pressure dropping. 'To me, it looked like the patient was probably bleeding, so I had called the attending to update them,' he said. Rarick tried to temporize the bleeding, but his attending didn't agree. After a few hours of fluids, during which the patient would transiently respond, eventually the patient's vitals and pressure came back down because she was still bleeding. '[My attending] disagreed with my plan to go back to the OR [operating room], but eventually we had to go back to the OR because there was a bleeder that we needed to clip,' Rarick said. Rarick is now a fourth-year general surgery resident. He said these types of interactions aren't uncommon, and not all disagreements end with tempers flaring. 'Sometimes, attendings disagree with you, and they say, 'No, let's do this instead,' which is normal,' Rarick said. 'But that was one of the first times that there was an actual disagreement with what I thought the plan should be.' Advocating for Optimal Patient Care As a medical student or junior resident, if you truly feel a patient's case isn't being properly handled, don't be afraid to speak up in a conciliatory manner. 'There are many situations where seasoned attendings are so specialized, their knowledge in other areas of the field might be lacking or just not up to date,' said Mohan. 'So especially as residents who are on top of all the latest info, you have an opportunity to educate, but doing so in a way that's palatable is really important.' But what if an attending disagrees with a junior resident's or student's concerns, and the latter still feels strongly about the mishandling of a patient's case? In extreme cases where all other resources are exhausted, you'd want to contact a hospital ombudsman, clerkship director, site director, or even faculty mentor, said Mohan. 'If there's something egregious happening, and the resident or student doesn't feel comfortable approaching in a direct format, ombuds people are able to report a concern,' he said. Mohan listed an order of resources to consult before this, however. 'First, look it up to understand if your question is reasonable. Two, talk to a resident to try to get some more knowledge. Then, if you're still not feeling comfortable, and gently assuming that the attending is not receptive, I think finding other faculty mentors is probably the next place to go. And if you're really feeling lost, then contact an ombudsperson.'
Indianapolis Star
a day ago
- Indianapolis Star
Firehook crackers recalled: See list of affected states
Firehook of Virginia is voluntarily recalling one lot of its artisan-baked crackers because the product may contain undeclared sesame, a known allergen. The affected products, also known as Firehook's Classic Sea Salt Organic Crackers, were sold at retail stores in 11 states, including Connecticut, Massachusetts, Maryland, Maine, North Carolina, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Virginia. The recall was initiated on May 30 after the company discovered that the "sesame-containing product" was placed in packaging that did not reveal the presence of the ingredient. The Alexandria, Virginia-based company issued a formal notice, shared with the Food & Drug Administration, on June 4. The error was the result of a "temporary breakdown" in the company's production and packaging process, which caused the wrong labels to be applied to the product, Firehook of Virginia's subsequent investigation found. "People who have an allergy or severe sensitivity to sesame run the risk of serious or life-threatening allergic reaction if they consume these products," reads the company's notice. However, no illnesses have been reported to date. Here's what to know about the Firehook crackers recall. Need a break? Play the USA TODAY Daily Crossword Puzzle. Recall alert: Millions of brown eggs sold recalled: See list of affected products Consumers who have purchased the product are urged to return it to the place of purchase for a full refund, or to toss the product. The company urges consumers who have purchased the product to return it to the place of purchase for a full refund. (Consumers may also toss the product if they are not interested in a refund.) Relevant product information, including the best by date, universal product code, and the look of the packaging, can be found below. Product information:
Yahoo
a day ago
- Yahoo
Dr. Pepper Is Being Recalled Right Now—Here's What to Know
Over 19,000 cases of Dr. Pepper Zero Sugar are being recalled. This is because select cans of the 'zero sugar' product may contain sugar. The recalled soda was sold in three an ongoing recall on Dr. Pepper products, according to the Food & Drug Administration. This is due to mislabeling for their zero-sugar soda. The products impacted by this recall are Dr. Pepper Zero Sugar aluminum cans sold in 12- and 24-packs. Approximately 19,203 cases were affected and were sold at retail locations in Florida, Georgia and South Carolina. The recalled cases contain a production code of 'XXXXRS05165' and best-by date of February 16, 2026, printed on the packaging. Although the soda is labeled to be 'zero sugar,' the cans may contain the full-sugar product, thus the recall. The FDA just classified this recall as a Class II, meaning that the recalled product could cause 'temporary health consequences' if consumed. Check your Dr. Pepper Zero Sugar, and if it contains the recall information, dispose of it or return it to your place of purchase for a potential refund. For questions about this recall, call 1-888-INFO-FDA (1-888-463-6332). Read the original article on EATINGWELL
