I’ve been on conventional topical and antibiotic medications to treat acne for almost two years, without much success. My dermatologist has prescribed acne, and I started the medication today.
Everything I see online about how Accutane works is akin to “well, we don’t really know.” What’s the straight dope?
Also - what is it about the medication that causes the horrible birth defects I read about so often in the documentation? Why wouldn’t this hurt me, also? I am male, for reference.
Correction - prescribed Accutane. Could be assumed from context, but I think I should be thorough.
As a former patient and one of the first ones on Accutane when it came out, I can tell you a good bit from personal experience.
<pharmacist hat ON>
My trusty Facts and Comparisons agrees that the mechanism of Accutane is unknown. Accutane is essentially megadoses of Vitamin A. Day 1 of pharmacy was the axiom that “the only difference between a drug and a poison is dose”.
I’ve seen some pictures of Accutane babies that used to be included with Accutane’s product information. They are beyond horrifying. Facts doesn’t comment on the mechanism of the teratogenic (unborn-related) side effects, either. The risks of using Accutane in a female of childbearing potential outweigh the benefits in many of the cases I’ve seen.
<pharmacist hat OFF>
Accutane, in my opinion, is very very overused for teens that do NOT have the sort of acne that I had. Retin-A cream was also being used on me with no success when I was in my upper teens and my mom was ready to try anything before my face wound up with the same scars as are now all over my back. No one knew what could happen to unborn children at the time. For a young male with severe cystic acne, it can be a godsend. For a young female, it could be quite the opposite.
My theory on the mechanism: Vitamin A causes photosensitivity-- a tendency for the skin to burn easier. Sunburn was one of the few things (while I had it) that was a sure cure for my acne. So, Retin-A, itself a very painful substance (in the large doses that my desperate mother rubbed all over my face) essentially causes a chemical sunburn. Accutane hits it from the inside, all over your body. The chemical sunburn causes the acne to subside without the pain and inflammation of the real sunburn.
It worked for me. My face (such as it is) is not scarred by acne the way my back is. People have difficulty believing my acne stories-- until I take my shirt off. I’m lucky that it didn’t do anything else to me other than run my triglyceride levels through the roof. I was being tested for cholesterol on a weekly basis while I was on Accutane. The total fat-and-grease-free diet I was forced to be on (to keep my TG level down) was the best pounds-over-time diets I have ever been on.
Rats, I hit submit before I was done.
Accutane is a real good example of the risk/benefit decision of drug therapy. Do the benefits outweigh the risks? Some kids I’ve seen — FEMALES mind you-- with maybe 3 pimples on 1 cheek are taking this stuff. I wonder how some derms can sleep at night.
miatachris, R.Ph. and Accutane survivor
Miatachris, I thought the protocol was to require females of child-bearing age to take oral contraceptives (or long-term contraceptives, like Norplant) while on Accutane. (I remember reading this in a brochure my derm. gave me when I went on it about 15 years ago) Is that not the case? Or do you think it still leaves too much risk?
I don’t know how it works, but the dermotologist had better give it to me when I go to see him next week. If he says I can’t go on it because I’m female I might just throttle him.
I don’t think it’s very likely though, from what I’ve heard, they make girls go on Birth control pills while taking Accutane, even if they’re not sexually active.
I sure hope it works, it’s my last hope.
Actually, while I was researching my first post I read the warning box on females and contraceptive use – the current protocols call for -two- concurrent methods of birth control at the same time.
It’s -my opinion- that young females should use Accutane only as a last resort and only after having, say, Norplant implants or using Depo-Provera. My wife is a pharmacist too, and she forgets to take her pills sometimes.
I can’t see your face, and I can’t see your heart. That’s why medical advice on a message board has to be taken with a quantity of salt.
It’s a double-whammy that the decision to take Accutane has to be linked to the decision of sex and contraception in the case of young females. That’s why, I think, the pictures used to be part of the package inserts. The shock value of the pictures was quite effective.
My pharmacist’s hat is way off here. These questions can easily cross the line into moral and life choices.
The fact that a little baby could be involved, and be horribly harmed, makes the decision a very heavy one. Please don’t take it lightly.
That’s what people always said to me when I was on Accutane. “You acne isn’t that bad…etc…” And from the standpoint of someone else I’m sure it didn’t LOOK that bad. But you have to see/feel it from my side. First of all I tried monocycline (sp?) as well as several topicals and they all made zero difference. Second, when I started Accutane I was a senior in college and decided that 8 years with out ever having a clear face was enough. Third I also had cystic acne. Which means that just becuase you can’t see the pimples doesn’t mean they’re not there. I usually compared mine to the size of an M&M under my skin and they hurt like hell. Fourth I also had HORRIBLY oily skin. I could at any given time wipe my forehead on a paper towel and leave a noticable mark and I really didn’t like that, I felt it was kinda gross. The oily skin was my biggest reason for wanting to try accuntane. I knew about it’s drying effects on the skin and discussed it with my derm and we decided that with all the issues I had with my acne (even though to someone else it looked like I had a decent complexion other then two or three (visible) pimples) that accuntane would be a good course of action. While it was several (5?) months of hell (including two in florida) I’m very glad I did it and don’t regret it at all.
That’s why, I think, the pictures used to be part of the package inserts. The shock value of the pictures was quite effective.
Does anyone know why the pictures are no longer included?
I beleive they still include some sort of a drawing in the packaging. I know what these babies are supposed to look like, but I’ve never seen an actual picture.
Yep, the drawing is sort of an outline or silhouette of an Accutane baby and its head. It was printed on the inside of the Accutane 10-packs the last time I saw one, a few months ago.
It should be noted that Accutane has been reputed in the “popular” press to lead to depression, and possibly a desire to harm oneself. I do not think that this has been proven, but it’s another item to research for people considering taking it.
A US Senator’s child who was taking Accutane committed suicide some time ago. There was a brief controversy over that and I think that the labeling was amended to include suicidal ideation as a risk as a result. No, it’s not proven, but when your daddy is a Senator it certainly can place things in the spotlight.
When your daddy is a senator, and you are overweight and have acne have a history of depression and the stats indicate that, although acne is something that makes people unhappy and housebound (which can lead to depression) the hundred of thousands of people who took Accutane have a lower incidence of suicide than the general population, yes, as miatachris points out, things hit the spotlight. Even if the drug has been on the market for almost 20 years at that point.
Accutane is also helpful for some skin cancers
http://www.nci.nih.gov/BenchMarks/archives/2003_05/feature_print.html As you’ve been told, the how is yet to be determined.
For a while, I was reading the drug company’s info about the pregnancy prevention program. This was the drug company’s info, and we can all make of that what we will. In any case, it showed that most of the cases were women who were getting the drug in Mexico or taking samples from work. One of the pregnancy cases was a nurse who was worried about oiliness during her period. Good lord.
Here are the rules for taking Accutane - http://www.fda.gov/cder/drug/infopage/accutane/smart.pdf
An enormous number of women have taken Accutane with no ill effects. Right now, I can’t find the number. You might want to ask your local pharmacist how often it is dispensed.