For patients with severe cystic acne or for patients with moderate
inflammatory acne that has proven to be resistant to oral antibiotics,
isotretinoin is the most effective acne treatment available. In fact, it
is the only medication that effectively controls severe cystic acne.
Commonly sold under the brand name Accutane, isotretinoin is a
vitamin A derivative that is administered in pill form.
Isotretinoin is an extremely powerful drug that stops all the
changes in the skin that cause acne. It kills bacteria and reduces inflammation. At the same time, it shrinks the sebaceous oil glands,
reducing sebum production by up to 90 percent. It also slows up
the growth of skin cells, which helps unblock hair follicles. Unclogging
the hair follicles allows pustules and cysts trapped below
the surface of the skin to work their way to the surface of the
skin, where they burst and heal.
Consequently, many patients find
that their acne actually worsens in the first month of Accutane
treatment but starts improving thereafter. Anthony C. Chu explains:
“In the first month on Roaccutane [the name for isotretinoin
in Great Britain] acne can worsen. . . . In most patients acne slowly
reduces in the first two months, but there is then a more rapid response
and, again in most patients, the acne clears completely in
four months.”
Taken for a period of four to nine months, isotretinoin is effective
in 98 percent of all cases. However, in some cases acne symptoms
return after isotretinoin treatment ends. In these cases,patients may begin a second cycle of isotretinoin treatment.
A patient
describes her experience:
After a few weeks on Accutane, my breakouts stopped dead in
their tracks. I experienced no breakouts whatsoever for the remainder
of the time I took the prescription. People with fantastic
skin would come up to me and say, “I wish I had your skin.”
It was pretty incredible.
However . . . I was not one of the lucky
ones. Although my skin has been more manageable since Accutane,
I have experienced serious breakouts since ending my
cycle. Even so, I remain very thankful that I took it. I would describe
my acne now as light to moderate thanks to Accutane, and
with my current regime [use of topical treatments] I stay clear.
