Accutane

How Accutane TM and other Retinoids and Vitamin A Derivatives Work

Accutane TM is a molecule that is derived from the family named Retinoids. Retinoids are compounds that are known to have numerous mechanisms of action. They normalize epidermal growth and differentiation thereby preventing thickening of skin and clogging of pores; retinoids reduce sebum production and cause atrophy of sebaceous glands, thereby further preventing the formation of acne lesions (pimples) by preventing the formation of substrates for bacteria to use; retinoids inhibit bacterial growth in the skin and modulate inflammation through the inhibition of prostaglandins, leukotrienes, and proinflammatory cytokines, such as IFN-g and IL-1a, which are all pro-inflammatory molecules that tell the skin that it is under attack for foreign organisms (1, 2). Stopping these molecules is essential in preventing and dealing with acne.

Isotretinoin

Isotretinoin, also known as ACCUTANE (TM) is an oral form of a retinoid, a vitamin A derivative. Dosages of this Accutane (TM) come in 0.75 - 1.0 mg/kg/day depending on the severity of the acne and side-effects. The course of treatment averages 16-20 weeks in order to achieve a total dose of 120 mg/kg. If the acne does not fully clear or the
results are suboptimal, another cycle or course can be done. Accutane (TM) has numerous side-effects. These include but are not limited to the symptoms mentioned below. Please refer to the manufacturers guidelines and warnings prior to starting this medication.

Accutane (TM) Side effects

Alopecia (hair loss, however, this is reversible with stopping the medication), muscle and bony pain and abnormal liver enzymes. Abnormal changes in fat metabolism, such as increases in triglycerides and cholesterol. This is reversible on discontinuing Accutane (TM) and with improved education and by dietary precautions and counselling. The laboratory values of lipids and fats are followed by bloodwork on patients on Accutane (TM). Physicians should not allow lipids, cholesterol and fats to go double above normal values. Drying of the eyes, noses (leads to frequent nosebleeds), lips, hands and feet. Rare but serious side effects also include depression and changes in night vision.

When not to take Accutane (TM)

Accutane (TM), like all oral forms of retinoids can cause fetal defects during pregnancy. These agents are therefore teratogenic. All females of childbearing age must be on adequate birth control for 1 month prior to starting therapy with Accutane (TM) or any oral retinoid. A negative pregnancy test must be seen. Accutane (TM) can then be started on the second day of the next menstrual period.

Bloodwork and Tests Before Going on Accutane (TM)

Baseline bloodwork must be done before starting Accutane (TM). These are scheduled by your physician and include a complete blood count, beta-hCG (for pregnancy) liver enzymes (for damage to your liver), urinalysis (analysis of your urine), and fasting triglycerides and cholesterol levels, in order to compare on a monthly basis and after treatment for changes that may have occurred due to Accutane (TM). Therefore, these tests are repeated at 2 weeks, then 6 weeks, then 10 weeks, and finally at 14 weeks.

What else must be done before going on Accutane (TM)

Avoid excessive vitamin A, including through vitamins and other supplements as Accutane (TM) itself is a vitamin A derivative. Too much vitamin can cause increases in side effects of this medication. All topical drugs and therapy, as well as any topical irritants such as other thich creams and gels, should all be stopped in order to avoid excessive drying, as Accutane (TM) already drys the skin excessively. Antibiotics, such as minocycline and tetracycline, as well as any other drugs should not be taken. This is because headaches may become present secondary to increases in intracranial pressure.

Accutane (TM) Results

Accutane (TM) has great results. Approximately 3/4 of patients clear after a single course of Accutane (TM) treatment. A very small subset of patients will require a second course of Accutane (TM) after 3 months. If there is scarring acne present the use of Accutane (TM) is a must in order to prevent further scarring. This is all regardless of the severity of the acne.

References:

1. Katsambas AD, Stefanaki C, Cunliffe WJ. (2004) Guidelines for treating acne. Clin Derm. 22:439-444.

2. Krautheim A, Gollnick HPM. (2004) Acne: topical treatment. Clin Dermatol 22:398-407.