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Should I take isotretinoin for severe acne?

Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision
Acne will improve over time for most people. For some people, though, acne is more difficult to treat. Isotretinoin (such as Accutane, Amnesteem, Claravis, or Sotret) is a strong medication that can reduce the emotional and physical scarring of severe acne. However, use of this medication can have severe side effects. Consider the following when making your decision:

You may want to take isotretinoin if:
You are bothered by severe acne that does not get better after several months of medical treatment.
A parent or sibling had severe acne with scarring.
Your acne causes emotional anxiety, low self-esteem, or depression.
You may not want to take isotretinoin if:
You can control your acne with other medications or treatments.
There is any chance that you could become pregnant.
You or members of your immediate family have a history of severe depression.
Medical Information
What is isotretinoin?
Isotretinoin is a powerful and effective medication used to treat severe acne that cannot be cleared up with other medications, including antibiotics. It is a man-made retinoid (derived from vitamin A). You usually need to take isotretinoin for 3 to 6 months.

Isotretinoin works by unclogging skin pores and shrinking oil glands.

What are the risks of taking isotretinoin?
The most serious side effects of isotretinoin are severe birth defects in infants of women who become pregnant, and miscarriage while taking isotretinoin. Except these risks, other serious side effects are rare.

The U.S. Food and Drug Administration (FDA) warns that using isotretinoin may be associated with depression, psychosis, and, in rare cases, suicidal thoughts or suicide attempts. The link between isotretinoin and depression is not clear and it is being watched very closely. For more information on isotretinoin and depression, talk with your doctor to decide whether isotretinoin is right for you or your child. If you or your child is taking isotretinoin and experiences signs of depression, see your doctor for treatment.

Less serious side effects affect almost everyone who takes isotretinoin. These include dry skin, dry mouth, chapped lips, nosebleeds, dry eyes and difficulty wearing contact lenses, and increased skin sensitivity to sunlight. These side effects usually are not bothersome and can be treated with moisturizers, artificial tears, and other products. If you have dry eyes while taking isotretinoin, you may have to wear glasses instead of contact lenses.

Isotretinoin can cause higher-than-normal levels of certain fats (triglycerides) in your blood. High levels of triglycerides may make you more likely to develop certain health problems, such as heart disease. For this reason, all people need to have their blood checked for triglyceride levels before starting this medication, and every 4 to 6 weeks while taking it.

Headaches and muscle or joint pain are less common side effects that you can usually treat with Tylenol or anti-inflammatory medications. Muscle and joint pain are more common in people who exercise regularly.

If you need more information, see the topic Acne Vulgaris.

Your Information
Your choices are:

Take isotretinoin to clear up severe acne.
Continue to use other treatments for your acne.
The decision about whether to take isotretinoin takes into account your personal feelings and the medical facts.

Deciding about isotretinoin treatment Reasons to take isotretinoin Reasons not to take isotretinoin
In 85% of people, isotretinoin clears up severe acne or significantly decreases pimples.1
Isotretinoin can prevent scarring from severe acne.
Isotretinoin can prevent anxiety, depression, or loss of self-esteem caused by severe acne.
If acne comes back after you take isotretinoin, it is usually not as bad. You can take another course of isotretinoin to treat a relapse of acne.
Isotretinoin may prevent years of severe acne and scarring.
Taking isotretinoin may help you avoid years of costly treatment.
Are there other reasons you might want to take isotretinoin?
Isotretinoin causes severe birth defects in infants of women who become pregnant while taking isotretinoin.
You must use two forms of birth control to avoid becoming pregnant while you are taking isotretinoin and for at least 1 month after you stop taking it.
In rare cases, using isotretinoin may be associated with depression, psychosis, and suicidal thoughts or suicide attempts. The link between isotretinoin and these conditions is not clear but it is being watched very closely. Isotretinoin may not be appropriate if you have a history of depression or a family history of depression.
Isotretinoin causes temporary side effects, including dry skin, eyes, and mouth. Other side effects include increased triglyceride levels, headaches, and muscle and joint pain.
While using isotretinoin, you'll need regular blood tests to check liver function and to monitor cholesterol and triglyceride levels. If you are a woman taking isotretinoin, you will also need regular pregnancy tests while taking the medicine.
Isotretinoin is expensive.
Are there other reasons you might not want to take isotretinoin?


These personal stories may help you make your decision.

Wise Health Decision
Use this worksheet to help you make your decision. After completing the worksheet, you should have a better idea of how you feel about taking isotretinoin. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

My acne makes me feel self-conscious and unattractive. Yes No Unsure
Sometimes I worry about my complexion. Yes No Unsure
My mother (or father) had severe acne. Yes No Unsure
I am in my early teens and am concerned about having acne through the rest of my teens or later. Yes No Unsure
I am concerned about the cost of acne treatment.  Yes No Unsure
I am a woman and I am willing to use two kinds of birth control, such as birth control pills and condoms to prevent pregnancy while taking isotretinoin. Yes No Unsure
I am worried about scarring. Yes No Unsure
I am worried about isotretinoin's side effects and having regular blood tests. I am a woman and am worried about having regular pregnancy tests. Yes No Unsure

Use the following space to list any other important concerns you have about this decision.












What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to take or not take isotretinoin.

Check the box below that represents your overall impression about your decision.

Leaning toward taking isotretinoin
   Leaning toward NOT taking isotretinoin

         

Return to the topic Acne Vulgaris.

References
Citations
Harper JC (2005). Acne vulgaris and rosacea section of Diseases of the skin. In RE Rakel, ET Bope, eds., Conn's Current Therapy, pp. 893–896. Philadelphia: Saunders.