Accutane

What is Accutane?

Accutane® is a famous branded version of the generic medicine isotretinoin. Other branded versions include Absorica®, Amnesteem®, Claravis®, Myorisan®, and Zenatane™. Isotretinoin is a form of vitamin A. It was originally approved for the treatment of acne in 1982.

Accutane-style medicines are most famous for treating very severe acne, especially scarring acne. One of the most classic types of severe acne is cystic acne, where the acne spots are large, deep, swollen, painful, and prone to scarring.

In the past, Accutane-style medicine/isotretinoin was generally reserved for only the most severe forms of acne. These days, most dermatologists (including the dermatologists at Saguaro Dermatology) also consider using isotretinoin for patients with moderately severe acne with scarring. Even patients with mild acne may be a candidate for isotretinoin treatment if they have scarring and have failed other reasonable medical treatments.

How does Accutane work?

Accutane works by targeting the sebaceous glands. It essentially slows the production of sebum–the oil secreted by the sebaceous glands–and makes it less sticky, which in turn reduces the chances of pores becoming clogged.

There are many correct ways to do isotretinoin treatment. Some dermatologists recommend 6 months of high-dose isotretinoin. Some dermatologists recommend a certain amount of medicine as determined by the patient’s body weight. Others prefer treating until the acne is well-controlled for 3 months. It is also common to take a lower dose for the first month to “ease into the treatment.”

The average patient would be prescribed Accutane for 4 to 6 months, but some need more and must be “retreated” for an additional 4 to 6 months. Accutane “cures” about half of those people who take it so that they never need to do anything else for acne. The more Accutane one takes, the greater the chance of cure.

At Saguaro Dermatology, we don’t believe in a “one-size-fits-all” approach. We work with our patients to come up with a custom plan which may involve a combination of these endpoints.

Who is a candidate for Accutane in Phoenix or Mesa, Arizona?

Potential Accutane candidates looking to receive acne treatment are healthy teenagers or adults with severe nodulocystic acne or even mild or moderate acne that hasn’t responded to conventional treatments. Essentially, any patient with scarring acne potential can be considered.

Previously, isotretinoin used to be thought of as the last resort medication, but now we are seeing dermatologists use the medication earlier in the acne treatment process. This is due to the growing safety concern for the overuse of antibiotics in acne patients.

If you think you would be a potential candidate for Accutane, please contact the Saguaro Dermatology office to learn more or schedule a consultation.

Isotretinoin has more risks, inconvenience, and costs than many other acne treatments. It is a controversial medicine for two main reasons: the risk of birth defects if a patient becomes pregnant during treatment and severe side effects.

There is a very high chance of birth defects if a patient becomes pregnant with isotretinoin in their blood, so everyone agrees that pregnancy needs to be prevented during treatment. The current system to prevent pregnancy is called “iPledge”. Every patient who takes isotretinoin must register with this program. The specific requirements of this program vary based on a patient’s ability to become pregnant, but they may consist of a very detailed informed consent process, monthly pregnancy tests, and screening for side effects. Most patients that can become pregnant will take birth control pills or use other contraception methods.

Reports of serious side effects that have been reported during treatment with isotretinoin include an increase in types of cholesterol, particularly triglycerides. It is a good idea to check cholesterol before starting isotretinoin. It is unusual for young healthy patients to have high cholesterol, but it is important to remember that high triglycerides may be genetic—they may run in the family. Significantly elevated triglycerides may increase the risk for heart disease, cause cholesterol to build up in the skin, or even cause a dangerous condition called pancreatitis. It is important to establish a baseline before treatment. If isotretinoin causes significant increases in cholesterol, it is rarely permanent, and patients can expect levels to go back to normal after stopping treatment. Mild elevations in cholesterol may be managed with exercise, fish oil supplementations, or other medicines. It is also possible to use lower doses of isotretinoin for patients at high risk for elevated cholesterol.

Another potential severe side effect is inflammation of the liver. It is important to significantly limit alcohol intake during treatment. There is not an agreed-upon “alcohol limit.” Many dermatologists recommend or require complete avoidance of alcohol. It is likely that an occasional alcoholic beverage is safe during treatment, but exactly how much alcohol is safe is unclear.

Another controversy about isotretinoin and Accutane-style medicines is past reports of potential mental health side effects. There are reports of patients on isotretinoin with depression, psychosis, and suicide. It is also known that young patients with severe and scarring acne also appear to have an increased risk of depression and suicide. If isotretinoin can cause psychiatric side effects, it appears to be rare. It is worth noting that patients can stop the medicine at any point during treatment. A history of depression does not necessarily mean a patient cannot take isotretinoin. The use of isotretinoin in patients with a history of mental health challenges should be undertaken with caution and a “team-based approach”—with the involvement of a mental health professional. Interestingly, patients may have significant improvement in self-esteem with the improvement of scarring acne. If you have any questions about the possible association between mental health risks and isotretinoin, discuss them with a board-certified dermatologist.

Common, less severe side effects may include chapped lips, dry and itchy skin, dryness of the nose and/or mild nosebleeds, irritation of the eyelids and eyes, joint and muscle pains, temporary hair thinning, rash, headaches, and increased sensitivity to the sun.

At Saguaro Dermatology, patients often ask about the use of isotretinoin in the greater Phoenix area in Arizona. Isotretinoin may cause dryness of the skin, eyes, nose, and lips. This may present a challenge in a dry climate like Phoenix. Isotretinoin may also cause extra sun sensitivity. Patients may get rashes from the sun, get sunburns more easily, or cause sun poisoning. In some parts of the country, dermatologists prefer to prescribe isotretinoin in the fall, winter, and spring—specifically for patients to avoid the sun. With 300+ days of sun per year in many parts of Arizona, if dermatologists in Phoenix waited until there was no sun to prescribe isotretinoin, it would never happen! In the experience of many dermatologists, sun-related side effects from isotretinoin are more pronounced with significant changes in sun exposure (like someone from a colder winter climate going on spring break to Florida), more than with moderate regular sun exposure. Patients should be extra careful to wear sunscreen, avoid sunlight at peak UV hours, and wear long sleeves, sunglasses, and a hat. A particularly good trick is to get a good lip balm with SPF and to use it daily.

How much does Accutane cost?

At Saguaro Dermatology in Phoenix and Mesa, Accutane visits are billed out as an office visit. The cost involved will depend on a patient’s insurance and pharmacy benefits. For more information, please contact Saguaro Dermatology.

Frequently Asked Questions about Accutane

If safer and cheaper options will work, most patients should not rush into isotretinoin; however, isotretinoin may be the only treatment strong enough for many patients. Additionally, isotretinoin is more likely to give more permanent progress compared to many other acne treatments. The majority of patients who take isotretinoin have long-term improvement.

You do not have to stay out of the sun entirely. Patients should be extra careful to wear sunscreen, avoid sunlight at peak UV hours, and wear long sleeves, sunglasses, and a hat.

It is advised to limit alcohol consumption during treatment as both alcohol and isotretinoin can raise blood triglyceride levels.

For the most part, yes. Waxing, laser hair removal, micro-needling, facials, chemical peels, and some laser treatments are considered safe while taking isotretinoin. There are some skin treatments and procedures not recommended in the beginning stages of treatment. Always consult with your dermatologist before undergoing any other skin treatments.

Recently, accutane patients have taken to social media claiming the medication made their noses smaller. Dermatologists say that isotretinoin cannot actually “shrink” your nose, but it may make the nose look less “bulbous” because of its effect on the oil glands in that area.

Our Approach and Expertise

Our board-certified dermatologists and professional staff are dedicated to providing you with the highest quality of care, innovative practices, helpful resources, and state-of-the-art technology to prevent and treat a multitude of skin disorders for patients in the Phoenix and Mesa area. We will know the specifics of your health history and treatment and will be able to respond to any concerns you have. Treatments provided by Saguaro Dermatology are always customized to an individual patient’s needs, lifestyle, and priorities. Our physicians are experienced in acne treatment and are ready to help you achieve the results you desire.

Saguaro Dermatology Reviews

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Itaro Elaisa

“I totally recommend this place to anyone who’s looking for a dermatologist who’s professional, informative, respectful and very helpful. They are quick to solve your problems and get you home.”

Wendy L.

I had an awesome experience with Dr Hamann and staff. I was very comfortable and i was able to have all my questions answered without feeling rushed. The staff was courteous and welcoming.

Robert P.

Staff was friendly, & on time. office is super clean!! Doctor was awesome, felt like a family member taking care of me.

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Kristin U

“Dr Dathan and the team were very helpful, kind and knowledgeable. Plus, there was no wait time so I was able to get back to work faster than expected. I would highly recommend.”
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Sally S.

“Very friendly and professional. I had a great experience, Dr. Hamann was very good at answering my questions and concerns. I will certainly come back for another visit.”

Amanda C.

Great doctor and friendly, professional staff. The doctor spends time listening and answering questions, something rare to find anymore. The office is beautiful and very clean. I love all the artwork with saguaros.

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Kylin L.

“The office was recently renovated–it is a beautiful, clean, and calm environment. I would highly recommend this practice for anyone who is looking for a general dermatologist.”

L

Dr. Hamann is very knowledgeable, nice, and professional. You can tell that he truly cares about his patients by the way he operates. He took the time to listen to all of my concerns then address them with good, well-informed answers.

Saguaro Dermatology | Phoenix Dermatology

About Saguaro Dermatology

Our comprehensive dermatology clinic is dedicated to providing you with the highest quality of care, innovative practices, helpful resources and state-of-the-art technology to prevent and treat a multitude of skin disorders. Led by Carsten R. Hamann, MD, PhD, Dathan Hamann, MD, FAAD, Michael McBride, DO, Millard Thaler, MD, Mohs Surgeon and Jenna Wald, MD, Mohs Surgeon, our passionate team looks forward to serving you with respect and compassion.

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