So finally after years of suffering I have been given Accutane. It is a wonderful drug. Nearly 4 full months into treatment (40mg/day) I have had a near perfect complexion for the past month. The past few zits I have gotten have been petty and “normal” - i.e. not swollen massive craters of pus-filled infection. I have been purposefully delaying posting this question, however, now, near the completion of my treatment, I want answers.
First, what does Accutane really do? All the information I can find says the same standard line (shrinks sabaceous glands, etc). Although, if you really press they say that the exact mechanism behind Accutane is unknown. Is this true? Does it alter DNA-transcription?
Second, what are the real success rates? This one interests me most. I’m a member of an acne message board which hosts a large number of Accutane users. There are few who claim “success” with Accutane (I realize most who do experience successful remission would drift away from an acne message board). So, what are the success rates and how do they qualify them?
Third, for those who have personal experience with the drug, please share.
I took it back in the late 80’s. It worked pretty well for me. I had to put hand lotion on a few times a day though, or the backs of my hands would get dry and peel like a bad sunburn.
I don’t remember much more about it, being so long ago. I don’t get acne any more though, I haven’t since I took Accutane.
I was on Accutane as a teenager (I am 32 now). I was actually on the highest approved dose and although my acne wasn’t extreme (it was bad though), it was considered hereditary and very resistant to other types of treatments. I tried most of those and they did very little.
I was told that Accutane was effectively a cure for acne and it did that for me. The side-effects such as fading night vision and cracked lips were brutal and I was one of those people that got suicidal depression from it but it certainly cured my acne.
Sitting where I am now, I don’t regret taking Accutane. It has been a genuine cure and I have had good skin weeks after I started taking it until today.
I later went to graduate school in psychopharmacology where Accutane was occasionally referenced because of suicide and possible links to depression. I gathered that it is an odd drug in that it has side-effects well beyond most common drugs yet it has the ability to cure a chronic condition. It is rather unusual for a drug to be able to cure a chronic condition and make life-long changes. I know that it is a derivative of vitamin A but I never found out why it is so effective. It is like a little nuclear bomb for skin.
Not a personal anectdote, but my supervisor is taking Accutane. I’m not sure of the dosage, but he had to have it lowered because it was causing behavioral changes. It was making him extremely edgy and made him go off with little provocation. He still has two months of pills to take (2-3 per week).
Both me and my wife took it, she was about 5 years ago and I took it about 4 years ago. Both are still doing well. Of all the zits either of us get at this point, I’d see 75% of them disappear without ever even coming to a head. I’m still sensitive to light, but that’s it.
Also I think you nailed it with the bit about successful people not being on your message board, it’s like talking about how well a sleeping pill does or doesn’t work in a chat room at 3:00 in the morning.
Family member took it in her late 20’s when the old “You’ll grow out of it.” obviously turned out to be untrue. Worked pretty well. 10 years later she will still get occasional breakouts if she doesn’t use over the counter stuff like a benzoyl peroxide face wash, but the severity and frequency of breakouts dropped off immediately after the treatment.
It didn’t work for me, I just broke out worse. They attributed it to some initial phase but it never went away.
If you want to see a messageboard full of people for whom an acne treatment does work, try acne.org. The basic idea is to put the longest, biggest blob of 2.5% benzoyle peroxide along the underside of your index finger that you’ve ever seen and apply it to your face, twice a day.
My skin is now perfectly clear. I only break out when I skip! You have to use a lot of lotion (noncomedogenic of course, I use this) to counteract the dryness, and in fact doing this twice a day has made my skin look incredibly healthy.
As well I took it in the eighties , my doctor showed me the literature and I was rated about a medium in terms of severity. Only took six weeks for my skin to go from one extreme to the other and was quite startling in that the time frame to clean up versus the dermatoligists anti biotic approach of years.
Since they had me do a blood test for possible liver failure , I believe , that and the other annoying side effects that cropped up , I would concider it the nuclear option for treating acne.
It sure was expensive then , and glad my dad had a real good drug plan.
As an assistant in a dermatology office, I’ve a lot of experience there with Accutane. I don’t know exactly how it works, but I’ve seen hundreds of people take it, most with no ill effects save the extreme dryness it causes.
The pro-lifers have recently been able to enact tougher hoops for women of childbearing potential. Some fundamentalist groups want Accutane banned, but since that’s not happening, they’ve made it very inconvenient for doctors to prescribe it. Because around 5 babies are aborted every year because the mother was on it, so I’ve heard.
Now you have to have an ID card for it, fill out paperwork and send it in every month, and no more coming to the office for a new script if you haven’t filled your within seven days- you will wait until next month for a new one, no matter if you’re male or female.
Generic Accutane is available, and much cheaper than brand. One of my doctors won’t prescribe it, because he says they haven’t done extensive studies on the generic. The other three docs have no problem with it, but the generic can be somewhat less effective on severe cystic acne than the brand name.
Thank you for all your replies; I didn’t mean for this to turn into an anecdotal thread - though the stories are encouraging, mostly.
I am very interesting in finding out success rates and the background to the studies. Roche (makers of Acctuane) claims an 80% success rate, but I have to wonder about what they classify “success” as and how long after treatment they monitor the subjects. Accutane is clearly the nuclear option in acne treatment, I just worry that I got a cockroach of a zitmachine face.
alterego, the message board you mention is where I get much of my Accutane information from. Very informed people, but there is a lot of negativity surrounding Accutane there. Many people there claim to be on their second and third course - hense my suspicions surrounding success rates.
trublmakr, can you comment on the success rate of those hundreds of people you have seen take Accutane? Or better yet, a comment from the doctors on success rates?
I took the generic (Sotret, IIRC) from Oct. 04 through April 05 and so far so good. I have noticed this winter, since I don’t shower daily to prevent dry skin and freezing while waiting for the bus, and I work in a plant now that is usually quite warm, I get small white heads. In the general scheme of zit severity if zits were earthquakes, these would be a truck driving by. If I were more faithful to wash my face regularly and moisturize appropriately, I probably wouldn’t get them. I decided to take it after I had to get a cyst cut out of my shoulder since it had gone through skin and muscle clear down to the shoulder blade. I was told that most people never take a second course because they are pretty much cured, but if you aren’t after the first course, you can take a break for like 6 months or a year and then take another course.
FWIW, no properly controlled study has verified that depression is greater in people taking accutane than in the normal population that has acne bad enough to qualify for accutane. My dermatologist said that there was a senator (from Michigan?) whose son killed himself while on accutane and he went crusading to prove it was evil. The kid who flew a plane into that building in Miami to kill himself had been given a prescription for accutane, but had never filled it, so the ballyhoo about him killing himself because of accutane was not really true.
Accutane boasts a success rate of 85% for a year or longer.
And if it does come back, it’s usually much less severe, topicals work better on it, and you can always take a second course. We rarely have to have someone discontinue use because of liver damage, increased triglycerides, or depression. In fact, depression is listed as a side effect in only 1% of cases.
They are also doing treatments with blue light and intense pulsed light. You might want to research the various non-prescription treatments if you have the time and the inclination.
I took a course of Accutane about 10 years ago. I am very satisfied with the results. My acne cleared up and and has remained significantly improved since.
It is my understanding that, when taken exactly as intended, the success rate is very high, well above 90%. Lack of success is almost always due to some failure by the patient to take the doses exactly when needed. That is, if you forget a few pills during the 3 month period, the length of time the remission remains drops a lot. That is what happened to me. Those people who manage to take their pills exactly as needed and whose prescriptions are exactly as they need to be, do very very well with it. But small errors, either by the doctor or more commonly the patient, have large negative effects on the outcome. From what I understand, the majority of negative reports are from one or both of these causes.
That said, there are some people who simply don’t respond well to the drug. Their acne isn’t dramatically cured.
More importantly, there are SERIOUS side effects. Suicide is a documented (well widely reported) side effect of the drug. It is hard for people who don’t have that problem to understand, but I felt it. Patients simply don’t see anything wrong with suicide. The fear of death simply isn’t there. Suicide is no different than taking a short vacation. Now I never seriously considered suicide, but was able to think about the possibility in an amazingly detached way. My endrocronologist things accutane is a terrible drug that should be banned for it’s harmful side-effects. Except that she recognizes how critical it is to the people who need it. But it is a very dangerous drug. A couple of slices of pizza or a couple of cookies can land an accutane patient in the hospital and can destroy one’s liver. Almost happened to me. Being extremely careful with my diet prevented any serious problems, but the drug can do major harm in a very short time. Doesn’t happen any more, but high enough doses destroy the bodie’s ability to produce hair. All over. Forever. Fortunately the person I know is a guy, but he will never have any hair again. Those dose levels are never given now.
In spite of those problems, it is a wonder drug, and for the people that need it, it is an amazing improvement in their lives.
I took Accutane in high school. My acne cleared up while I was on it but came back as soon as the course of medication ended. There was no permanent improvement.
I also hated being on it because it dried out my lips and made them bleed. Fortunately that wasn’t permanent either.
In hindsight I regret taking it, but I had no way of knowing at the time that it wouldn’t work for me–my doctor told me it was “100% guaranteed to work.” (Then afterwards he admitted it sometimes didn’t work for females…for some reason he didn’t see the need to tell me that beforehand.)
I took it as a teenager back in 1985 and it worked great. Side effects for me were very dry skin, chapped lips, nose bleeds and extreme teenaged male surliness. Now, I was a pretty snarky fellow even before the Accutane but the mood swings while on it were something fierce. That being said I’m glad I took it.
From Facts and Comparisons 4.0 (standard drug reference): “Pharmacology:
Isotretinoin is a retinoid, which, when administered in pharmacologic dosages of 0.5 to 1 mg/kg/day, inhibits sebaceous gland function and keratinization. The exact mechanism of action of isotretinoin is unknown”
I hate to sound like an asshole, but skipping a few doses doesn’t make the treatment ineffective, eating pizza or cookies while on Accutane does not destroy your liver, and I have never seen any documentation of perminant hair loss. I feel you are misinformed and spreading misinformation. Studies that show that depression occurs more frequently in Accutane patients fail to take into account that people who live with the physical pain and embarassment of severe acne are more prone to depression than the general population.
I know people dispute that strongly. However, I lived it and later went into academic psychopharamcology and firmly believe that something can happen with Accutane that is psychologically severe. You can call that an anecdote, but bring enough of us together and it is a definitive study. Dermatologists have noticed that in some of their own patients since at least the 1980’s. Mine took it very seriously well I reported my symptoms even though I was at the end of my treatment.
I am glad I took Accutane but it almost cost me my life. A friend walked into my room when I had a rifle pointed to the top of my mouth. I have had clear skin ever since though and that type of depression went away for a long while as soon as I stopped taking it.
I admit that the studies are not clear yet. However, inconclusive studies don’t mean that it doesn’t happen. If it ever is shown, the phenomenon will be retroactively effective back to the first suspected case.