Clearing Things Up: When to Consider ‘Accutane’ for Serious Acne

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Jie Chen, RPA-C with Advanced Dermatology PC, Shares Tips on Isotretinoin Treatment.

Jie Chen, RPA-C

Isotretinoin offers a remarkable level of relief from severe acne. But it’s essential that patients are fully aware of and comfortable with what treatment entails.

If only acne’s damage stayed skin deep. “For some patients, it’s much more noticeable,” says Jie Chen, a certified registered physician’s assistant specializing in dermatology with Advanced Dermatology PC. “Persistent, serious ‘problem skin’ can cause disfigurement that can lead to depression. Especially for young people, unremitting acne can result in erosion of self esteem and create long-lasting emotional scars.”

Acne is one of the most common skin problems: The American Academy of Dermatology (AAD) reports that as many as 50 million people have some level of the condition, the result of factors such as hormones, genetics, and stress.

“A pimple pops up when our skin’s natural regeneration is disrupted,” explains Chen. “If pores get clogged with sebum skin oil, then dead skin cells can’t be expelled. Fortunately, we have over-the-counter products to clear up the pimples caused by milder forms of acne.”

More severe forms are tied to the naturally occurring skin bacteria for which problem skin is named: p. acnes. “Serious acne occurs when more of the bacteria p. acnes gets trapped, causing deeper levels of inflammation,” Chen continues. “As a result, pimples can merge, affecting larger sections of skin. And, at its worst, persistent, painful nodules develop.”

“With serious acne,” Chen emphasizes, “OTC treatments are limited and permanent scarring can result.” The first step to recovering from serious acne is to see a dermatologist: “We have very effective prescription treatments for serious acne,” says Chen, “including isotretinoin.”

Isotretinoin entered the dermatologist’s medicine cabinet in 1982, when it was approved as the brand Accutane. Today, the oral retinoid-based medicine is offered under other brands, including Amnesteen and Claravis.

“This is serious treatment for serious acne,” Chen notes. “It’s extremely effective because it addresses all of the root causes, including the extreme levels of inflammation. Over the last 36 years, millions of acne sufferers have had their severe acne clear up. That said, patients need to be fully aware of certain considerations and side effects.”

Chen offers the following 6 tips to patients considering isotretinoin:

1. The Rx “small print” is a big deal: “Isotretinoin can interfere with fetal development, resulting in birth defects,” says Chen. “The FDA requires both doctors and patients to participate in a program called iPLEDGE. For women of childbearing age, this includes using two forms of birth control and pregnancy testing. Also, in terms of side effects, check-ups may be needed to monitor liver enzymes and lipid levels, as they can be affected.”

2. Monitor how you feel and keep your doctor informed: “Some patients have reported that isotretinoin caused their depression or inflammatory bowel disease,” states Chen. “At this point, research hasn’t established a clear link with either. This year, the AAD reaffirmed its support for isotretinoin, as long as patients are aware of the possible risks and doctors monitor the situation.” Chen adds that some patients complain about lower back pain and vision change.

3. Stay proactive to minimize side effects: “During treatment, isotretinoin can dry out the skin and cause sun sensitivity,” notes Chen. “Don’t wait for problems to occur. From the start of treatment, patients should moisturize daily and drink plenty of water, as well as be sure to use sunscreen.”

4. Don’t be alarmed if at first your acne flares: “In some cases, patients see an initial spike in their symptoms,” notes Chen. “You can also talk with your doctor about starting off at a lower dose to acclimate.”

5. Take as directed: “Make sure that you follow your doctor’s instructions,” says Chen. “For example, for optimal absorption, it’s important to take it with a full meal.” Chen adds that patients are advised to not take over the counter vitamin A when taking Isotretinoin.

6. Stay the course: “Isotretinoin is extremely effective at clearing up acne,” Chen explains, “but a key goal of treatment is also to hopefully prevent any reoccurrence. The research here is quite clear: patients need to reach a certain level of cumulative medication. A patient who stops early is more likely to have a relapse.”

“Isotretinoin offers a remarkable level of relief from severe acne,” Chen concludes. “But it’s essential that patients are fully aware of and comfortable with what treatment entails.”

Bio: Jie Chen, RPA-C is a board certified physician assistant with Advanced Dermatology PC. She has a master’s degree in physician assistant studies.

Advanced Dermatology P.C. and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies.

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