Is Isotretinoin (originally marketed as Accutane) Right for You? Let Treasure Valley Family Medicine Help You Decide.

Oral isotretinoin (originally marketed as Accutane) is the most powerful and effective medication for severe nodular acne. While many people might believe they need to see a dermatologist for such a treatment, the clinicians at Treasure Valley Family Medicine are experienced in treating all forms of acne, including those severe or resistant cases requiring isotretinoin.

Isotretinoin is a natural derivative of Vitamin A and can actually be found in the blood stream of healthy people. Given in high doses, both Vitamin A and isotretinoin have similar risks and side effects. It is important that those patients taking isotretinoin not take a Vitamin A supplement! One of the ways isotretinoin works is to reduce oil production.

Isotretinoin is not a first line treatment due to cost, side effects, and the potential to cause serious birth defects. While every patient is unique, we do not generally consider isotretinoin until a patient has failed to improve on 3 months of oral antibiotics combined with topical treatments. Nothing else compares to it in efficacy, however, as 85% of patients who take their prescribed dose are virtually free of new acne lesions after 4-5 months. Of note, it is normal that acne looks worse after the first 4-6 weeks of therapy.

Every patient considering isotretinoin must register with iPLEDGE, a program dedicated to preventing pregnancies that could be adversely affected by isotretinoin use. iPLEDGE requires that females of reproductive age have monthly pregnancy tests and use 2 forms of birth control. There is a waiting period of 30 days following the initial pregnancy test before a confirmatory test can be repeated and isotretinoin prescribed.

After every visit, patients must log into their online iPLEDGE account to review safety information. Women then have 7 days to pick up their prescription from an iPLEDGE-certified pharmacy while men have a 30 day window. Isotretinoin can only be prescribed for 30 days at a time and monthly visits are required for the 5-6 month course of treatment. Baseline liver function and lipids are screened and monitored throughout treatment as transient elevations are common.

The most common side effect of isotretinoin is skin and lip dryness. Dry lips are actually a good indicator of adequate absorption! This side effect can be managed by limiting sun exposure and vigorous activity, staying hydrated, and by using a thick protective ointment on the lips such as Vaseline or Aquaphor.

Other common side effects include:

• dry skin
• Itching
• mild nosebleeds
• irritation of the eyes

Depression and thoughts of suicide occur in less than 1% of patients. However, in an abundance of caution, if a patient has uncontrolled depression or anxiety, has recently been hospitalized for behavioral health, or has attempted to harm themselves previously, isotretinoin may not be appropriate. TVFM clinicians have many alternatives at their disposal for such patients. For more information, please read the patient information section of iPLEDGE at: Oral isotretinoin (originally marketed as Accutane) is the most powerful and effective medication for severe nodular acne. While many people might believe they need to see a dermatologist for such a treatment, the clinicians at Treasure Valley Family Medicine are experienced in treating all forms of acne, including those severe or resistant cases requiring isotretinoin.

Isotretinoin is a natural derivative of Vitamin A and can actually be found in the blood stream of healthy people. Given in high doses, both Vitamin A and isotretinoin have similar risks and side effects. It is important that those patients taking isotretinoin not take a Vitamin A supplement! One of the ways isotretinoin works is to reduce oil production.

Isotretinoin is not a first line treatment due to cost, side effects, and the potential to cause serious birth defects. While every patient is unique, we do not generally consider isotretinoin until a patient has failed to improve on 3 months of oral antibiotics combined with topical treatments. Nothing else compares to it in efficacy, however, as 85% of patients who take their prescribed dose are virtually free of new acne lesions after 4-5 months. Of note, it is normal that acne looks worse after the first 4-6 weeks of therapy.

Every patient considering isotretinoin must register with iPLEDGE, a program dedicated to preventing pregnancies that could be adversely affected by isotretinoin use. iPLEDGE requires that females of reproductive age have monthly pregnancy tests and use 2 forms of birth control. There is a waiting period of 30 days following the initial pregnancy test before a confirmatory test can be repeated and isotretinoin prescribed.

After every visit, patients must log into their online iPLEDGE account to review safety information. Women then have 7 days to pick up their prescription from an iPLEDGE-certified pharmacy while men have a 30 day window. Isotretinoin can only be prescribed for 30 days at a time and monthly visits are required for the 5-6 month course of treatment. Baseline liver function and lipids are screened and monitored throughout treatment as transient elevations are common.

The most common side effect of isotretinoin is skin and lip dryness. Dry lips are actually a good indicator of adequate absorption! This side effect can be managed by limiting sun exposure and vigorous activity, staying hydrated, and by using a thick protective ointment on the lips such as Vaseline or Aquaphor.

Other common side effects include:

• dry skin
• Itching
• mild nosebleeds
• irritation of the eyes

Depression and thoughts of suicide occur in less than 1% of patients. However, in an abundance of caution, if a patient has uncontrolled depression or anxiety, has recently been hospitalized for behavioral health, or has attempted to harm themselves previously, isotretinoin may not be appropriate. TVFM clinicians have many alternatives at their disposal for such patients. For more information, please read the patient information section of iPLEDGE.

 

Fighting Acne with Treasure Valley Family Medicine

Acne is one of the most common and distressing conditions encountered in primary care. By the time they see a healthcare provider, most patients have tried multiple, occasionally expensive, over-the-counter treatments and programs with varying degrees of effectiveness. The clinical team at Treasure Valley Family Medicine is uniquely qualified to treat even the most severe cases of acne.

Diet has a limited effect on acne. Foods that increase IGF-1 hormone levels can promote inflammation, oily skin and acne. Examples include high glycemic index (starchy/processed) foods and lactose sugar from milk. Greasy foods have not been proven to cause acne. Genetics also play a role as studies of identical twins suggest a higher risk of acne when it runs in your family.

Four main components directly contribute to the formation of acne pimples and blackheads: oil production, skin shedding, surface bacteria, and immune response. Over-the-counter (OTC) agents are usually first line. This group includes products with active ingredients such as:

These same very basic agents are present in the cheapest generic cream or the most expensive commercial multi-step program. Prescription topicals are generally more effective and contain such medications as:

More severe cases of acne are treated with short course of oral antibiotics such as minocycline and sulfamethoxazole/trimethoprim (Bactrim). Long-term antibiotic therapy is not necessarily more effective and can cause significant complications such as antibiotic resistance. Several of the antibiotics used to treat acne are also used to treat other conditions such as pneumonia and urinary tract infections.

The most powerful and effective treatment for severe, scarring, or nodular acne is a natural derivative of Vitamin A known as isotretinoin or Accutane. While Accutane, also sold under the names Absorica, Claravis, Myorisan, and Zenatane, is by far the most effective treatment for acne, it is not without risk. The clinicians at Treasure Valley Family Medicine take these risks seriously but also want to improve access to this remarkable medication by offering it to appropriate candidates with severe acne. Using a national risk management system – iPledge – we can help ensure isotretinoin is used safely.

Of note, women may have acne driven by hormonal changes. During the premenstrual time of cycle, pregnancy or middle age, deep tender nodules can develop. If using higher androgenic progesterone birth control pills that contain norethindrone or levonorgestrel and which drive up sebum (oil) production, we recommend you consider a lower androgenic alternative progesterone such as drospirenone, desogestrel, or norgestimate. The reason to switch is that lowering androgen hormones will reduce oil production. Spironolactone (Aldactone) is another prescription pill that lowers androgens and reduces hormonal acne.

Why see a primary care provider for your acne? Who else is more accessible and knowledgeable about all aspects of your health? Who better to provide comprehensive care including contraception (required for females on Isotretinoin/Accutane) and managing the side effects of treatment (which in uncommon circumstances includes changes to mental health). Our clinicians are trained and experienced in prescribing all forms of acne treatment including Isotretinoin/Accutane.