Isotretinoin/Accutane: A General Review

Retinoids, otherwise known as chemical relatives of vitamin A, regulate various cell growth related functions. Perhaps the most famous retinoid is isotretinoin (Accutane). Over the last 10 years it has grown to become a relatively controversial but yet very effective pharmaceutical drug. Its primary medical use is treatment of severe acne.

Initially developed in the 1960s in Switzerland with the intention of treating skin care, the compound did not show any promising results. Over a decade later, isotretinoin was reinvestigated and showed promising results for treating cystic acne. Over the years the drug has faced medical controversy over its side effects (both short term & long term) in addition to various lawsuits. In 2009 Accutane (the brand name drug) was pulled from the USA market however it is currently sold in its generic for (isotretinoin) and under other brand names such as Roaccutane & Amnesteem.

Isotretinoin has often been used as a last resort type of treatment for acne or when the acne is overly severe. Standard treatment of acne often begins with benzoyl peroxide or salicylic acid. Natural treatment methods such as usage of tea tree oil have also been shown to be equally effective. If those treatments are not successful, the next step often involves a topical retinoid (ex. Tretinoin) combined with a topical & oral antibiotic. Clindamycin is the commonly used topical antibiotic whereas minocycline is the commonly used oral antibiotic. While these treatment methods help keep the acne under control to an extent, they are often not overly effective and some patients decide to pursue isotretinoin given its proven efficacy.

The drug is given in varying doses for a span of 5-10 months. During this time there is an initial worsening of the acne for a couple weeks followed by major improvements. Given the potential for hepatotoxicity (liver toxicity), regular blood work is done to ensure normal liver function. The drug is also a known teratogen, meaning it is severely harmful to a fetus and hence women are not able to take this drug if planning on becoming pregnancy.  There is also a need for topical intervention as the skin and mucous membranes in the body dry out when taking isotretinoin.

Although isotretinoin has faced controversy both medically and legally over the years, there is no doubt it is highly effective for those able to tolerate major risks to their health.