Accutane or Not?

I wanted to share some things about accutane.  Isotretinoin is used to treat severe recalcitrant nodular acne (a certain type of severe acne) that has not been helped by other treatments, such as antibiotics. Isotretinoin is in a class of medications called retinoids. It works by slowing the production of certain natural substances that can cause pimples to form.

There are some huge controversies out there whether it's safe to use or not.  Some of the side effects are pretty serious.  Some are just more or less annoyances.  Some effects include an increase in cholesterol, depression, suicidal thoughts that come with the depression, dry skin and lips, bone aches, etc....  I read an interesting article recently about some studies they have done and are finding that said caused depression isn't actually a side effect of the accutane, but more a side effect caused by having acne itself.  The other likely side effects are tolerable or treatable and mostly temporary.  I want to share my experience with accutane.

My acne was getting to the point where I always had a huge break out.  My break outs were large cysts and nodules that would ache.  I couldn't pop them to relieve the pressure.  They were red and swollen and were almost disfiguring my face.  I was definitely going into a depression.  Here I am, a skin care specialist.  I'm supposed to have clear skin!!!  I had tried microdermabrasion, chemical peels, light therapy, very aggressive acne kits, and also mild kits for sensitive skin, maybe thinking I was doing too much.  Whatever I did, nothing worked, and it got worse and worse.  I didn't want to go to the gym.  I didn't want to go shopping.  Going to work was the hardest thing.  Luckily I had my own office, I could get there, shut my door, turn off the big florescent light and just work with low lamp light.  I didn't want anyone to see my face.  I was so embarrassed!  I had a hard time wondering why my boyfriend still wanted to be around me looking so hideous.  It was such a hard time of life.  I never wanted to try accutane because of the severe side effects.  I didn't want to jeopardize my health.  I put some deep thought and prayer into how I could get rid of this problem.  Accutane kept coming to mind.  I had friends who had been on it and they were fine, loved it, and had no more acne.  I started looking for a dermatologist that would possibly prescribe it, however I was open to any other suggestions.  I made the appointment and met with an awesome dermatologist in Riverton.  She examined my skin for about 5 minutes, asked me a few questions, and said that there would be no reason for me to not take accutane.  I was the perfect candidate.  I was so happy, I felt like there might be some hope.  I had to wait about a month and a half to do some testing before I could actually start taking the medication.  I was able to start taking it September 2010.  For the first few days, I was almost over aware of my body, waiting for any possible side effect to show it's head.  About 4-5 days after starting, I came down with a severe back ache.  I thought it was the flu.  It felt like a really bad case of the body aches.  After a few weeks, I was sure it was the accutane.  I started taking vitamin E and glucosamine chondroitins for the arthritis.  It helped lube my joints, but it still wasn't as bad as the mental pain of having a face full of huge swollen painful cysts.  The arthritis pain lasted pretty much the whole 6 months of treatment and for about 3 months after stopping.  My skin got pretty red, dry, and flakey shortly after starting, and I lived on Aquaphor and chap stick!  My body is back to normal as far as the arthritis goes, and my face is zit free.  I get an occasional pimple here and there, and they go away in a day.  I feel like I've gotten my life back.  The 6 months of treatment wasn't fun, but I would do it again for sure, if I ever have acne the way I did before.  I do recommend it for people who have severe acne and who are good candidates for the treatment. 

There are a few things that people need to be aware of!  The first and foremost, is that Isotretinoin's best-known and most dangerous side effect is birth defects.  You must use at least two forms of birth control while on accutane if you are sexually active, or will possibly be sexually active at any time during treatment.

Before taking isotretinoin or accutane,

• tell your doctor and pharmacist if you are allergic to isotretinoin, any other medications, parabens (a preservative), or any of the ingredients in isotretinoin capsules.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, herbal products, and nutritional supplements you are taking or plan to take.
• tell your doctor if you or anyone in your family has thought about or attempted suicide and if you or anyone in your family has or has ever had depression, mental illness, diabetes, asthma, osteoporosis (a condition in which the bones are fragile and break easily) or other conditions that cause weak bones, a high triglyceride (fats in the blood) level, anorexia nervosa (an eating disorder in which very little is eaten), or heart or liver disease.
  
• do not breast-feed while you are taking isotretinoin and for 1 month after you stop taking isotretinoin.
  
• plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Isotretinoin may make your skin sensitive to sunlight.
• you should know that isotretinoin may cause changes in your thoughts, behavior, or mental health. Some patients who took isotretinoin have developed depression or psychosis (loss of contact with reality), have become violent, have thought about killing or hurting themselves, and have tried or succeeded in doing so. You or your family should call your doctor right away if you experience any of the following symptoms: anxiety,sadness, crying spells, loss of interest in activities you used to enjoy, poor performance at school or work, sleeping more than usual, difficulty falling asleep or staying asleep, irritability, anger, aggression, changes in appetite or weight, difficulty concentrating, withdrawing from friends or family, lack of energy, feelings of worthlessness or guilt, thinking about killing or hurting yourself, acting on dangerous thoughts, or hallucinations (seeing or hearing things that do not exist). Be sure that your family members know which symptoms are serious so that they can call the doctor if you are unable to seek treatment on your own.
• you should know that isotretinoin may cause your eyes to feel dry and make wearing contact lenses uncomfortable during and after your treatment.
• you should know that isotretinoin may limit your ability to see in the dark. This problem may begin suddenly at any time during your treatment and may continue after your treatment is stopped. Be very careful when you drive or operate machinery at night.
• plan to avoid hair removal by waxing, laser skin treatments, and dermabrasion (surgical smoothing of the skin) while you are taking isotretinoin and for 6 months after your treatment. Isotretinoin increases the risk that you will develop scars from these treatments. Ask your doctor when you can safely undergo these treatments.
• talk to your doctor before you participate in hard physical activity such as sports. Isotretinoin may cause the bones to weaken or thicken abnormally and may increase the risk of certain bone injuries in people who perform some types of physical activity. If you break a bone during your treatment, be sure to tell all your healthcare providers that you are taking isotretinoin.