Doctors' Answers to "Frequently Asked Questions" - Accutane

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 08/11/1999]
Question: I am a female in my late twenties who has been on accutane for two courses. While the results have been mostly successful, I have been noticing a reutrn of acne on my lower face and neck. There are two options I am considering: 1. going on accutane for a third course or 2. taking one accutane pill a week indefeinitely-- I hear this is an increasingly common treatment some doctors are giving. In either case, I believe I will have a problem finding a doctor to prescribe me accutane, as I had difficulty the last time, since most doctors are too concerned about their own liability to prescribe the medicine to a woman in her child bearing years (even though I am on birth control). So my questions are, what do you know of the effectiveness of the one pill a week treatment, and also, how to find a proaccutane doctor (in the MAnhattan area) without going to dozens of appointments first (my former doctor was ina nother city). Thanks!

Answer: Well, it does work. As to the doctor, I'd call around and see what their office policy is. Some would require, monthly pregnancy tests-but you should be able to find one. There are on-line prescription services that might help.

Accutatne [posted 1/11/99]
Question: I have extremely oily skin (face, scalp, chest, back) and moderately bad acne. 12 months ago I started a 5 month course of accutane (80 mg/day) with extremely pleasing results (drier skin, no acne). But the last two months, my oil production has returned to levels I had before the Accutane, and about 4 weeks ago, I began breaking out again. I have very good hygiene, and am using salicylic acid products. But I can see my old skin returning. I want to do another course of Accutane now. Is this safe? Is it recommended? Before I ever took accutane, I tired almost everything (Benzoyl Peroxide, a range of topical and oral antibiotics, sulfur preparations) and I never achieved clear skin with them. Accutane is the only thing that has worked, but I am frustrated that the effect was so short-lived.

Answer: Usually, we cycle accutane. 3-5 months on and restart when this problem reoccurs. This is the usual course and restarting the Accutane will be necessary.

Accutatne [posted 1/8/99]
Question: I am a 25 year old female and have been on accutane for 3 months. I got results almost immediately and currently my face is clear except for some scarring. I was wondering if I should go off of it now or stay on it for the 4 months as my dermatologist recommended.

Answer: Well, we usually cycle it to reduce other potential toxicities. The cycle length is usually dependent on results, however, 3 or 4 probably doesn't matter much.

Accutane [posted 1/5/99]
Question: I just received a prescription for accutane 20 mg bid from my family practice doctors with no recommendation for special soap, lotion, or antibiotics to accompany my treatment. The doctor plans to treat me for 3 months then "see how it goes." My cousin just started the treatment as well for the first time and is taking 40 mg bid and has been prescribed oral antibiotics for the first month to enhance healing of existing acne. What is the recommended effective dose and length of time one should be treated for? Is a higher dose more effective in the long run and minimize need for future treatments?

Answer: This medication is usually started in small doses and advanced until the acne responds. Then it is cycled as necessary with the aim to diminish long term therapy. Risk in men is pretty small and focuses on liver toxicity in the main. Women can have severe fetal abnormalities along with its other risks.

Accutane and facial laser surgery [posted 1/4/99]
Question: I went on accutane on 3 separate 5 month cycles. My last cycle was completed three months ago. I have excellent results. No scarring at all. Why do I have to wait one year before I can have laser resurfacing done to my face? My plastic surgeon told me that there is a one year waiting period before any resurfacing can be done, but he didn't tell me why. I can't find any supporting facts to explain this. If I only have to wait one month before getting pregnant, why must I wait one year for laser surgery? ".

Answer: I'm not sure. You'll need to ask him.

Accutane & Dry Skin [posted 12/02/98]
Question: My question is about Accutane and the effects of it with the use of a "body building supplement". Will the use of Accutane counter the effects of DHEA and Androstiene? I have been taking accutane for about two months now. I have a bad case of acne problem (as told by my doctors). I want to take DHEA and androstiene because I heard it was really good for boosting up the testosterone Levels and to help build muscles. I have taken it before and it does do what it says. The side effects I have encountered from taking it is a severe acne problem. I break out with acne really bad. So the question is " does Accutane lessen the effects of DHEA and androstiene" and If so "how can I prevent it".

Answer: Accutane will help acne vulgaris no matter what the trigger. However, the superficial lesions you see are probably only the tip of the potential iceberg in terms of side effects.

Accutane & Dry Skin [posted 12/02/98]
Question: In 1983, at the suggestion of my dermatologist, I began taking Accutane. My doctor said it was a new drug which showed promising signs of curing acne. Indeed, the drug worked miracles. My cystic acne has been reduced by 99% ever since. I am now 36 yrs old, and the skin on my face is getting increasingly dry. Particularly around my eyebrows, cheeks, and ears. My skin is constantly flaking. Moisturizers can't keep up. Hydrocortisone cream helps a little. Washing my face with soap greatly exacerbates the problem. Do you know if this is a problem experienced by "early " accutane users? Also, what can I do to help the problem? I almost wish the oil was back in my skin!

Answer: Accutane is only supposed to work when you take it. However, oil production does decrease markedly as one ages (the reason that teens have most of the acne). Have you changed birth control pills or any medications? Also, this may be something different like seborrhea which would respond to a dandruff shampoo(apply full strength and let it sit for a couple of minutes).

Accutane and Alcohol [posted 12/01/98]
Question: Hi, I have been taking accutane for about four weeks, and my question is, would that be ok if I drink alcohol once a week, I mean a drink or two, and what are the side effects if so.

Answer: Occasionally is ok.

Accutane and Cholesterol Levels [posted 11/10/98]
Question: I'm in my second month of accutane for the second time. I know it works, and the side effects are tolerable. But I'm really worried about cholesterol levels, how much is too much? My cholesterol increased from 207 to 249 in the first month, how high can I go? When should I stop? I'm also VERY tired, I just want to sleep ALL day if possible, is this normal for a 25 year old on accutane?

Answer: Usually accutane is pulsed for a couple of months on and a couple of months off. This is usually tolerable to cholesterol levels for a short time (2 years or so).

Is There a Limit To The Number of Accutane Treatments a Person Should Undergo [posted 11/4/98]
Question: I am a 37 year old female who has been treated with accutane for cystic acne three times. The acne clears up as long as I am on the medication and remains clear for about one year after therapy. My new dermatologist suggests a fourth treatment. I am a little concerned about taking it for the fourth time since I had heard that two treatments are the lifetime limit. Is there any truth to this?

Answer: No limit, but insure you have birth control-that is the major risk. Liver functions need to be followed;but, there is no limit to the number of times to take the drug.

Concerns About Sporanox for Fungal Infection While On Accutane [posted 11/4/98]
Question: I am currently taking Sporanox for a fungal infection on my toenails. I also have cystic acne and my dermatologist is putting me on Accutane. Are there any interactions between the drugs? I would like to know if perhaps I should wait to finish the Sporanox and then start the Accutane.

Answer: Well, nothing obvious;but, they both can affect the liver and I really would be reluctant to combine these drugs. The fungal infection will be there after the acne is treated. Also, Accutane tends to be used episodically, cycle it with the Sporonax rather than take them together.

Isotretinoin/Accutane Potential Liver Damage Concerns [posted 10/29/98]
Question: I have heard that the drug - Isotretinoin is very toxic, and it can damage the liver. And the drug - Xepasone is a steroid, and is is harmful to the body for prolong intake, are the above true? I am not able to find any information on these 2 drugs, can you help me out? Thank you.

Answer: Isotretinoin can be toxic if not monitored. In usual doses with regular liver function tests, there is usually no damage to the liver. I'm not familiar with Xepasone, do you have a generic or other name?

Accutane & Height [posted 10/28/98]
Question: Are there any studies to indicate a connection between the drug, Accutane, and height? I have two teenage sons who both took accutane, stopped growing around the same time, and I have since heard there may be a connection.

Answer: Not to my knowledge.

Accutane for Inflammation of the Hair Follicle and Scalp Problems [posted 10/28/98]
Question: I have had foliculitis of the scalp for 25 yrs I took a 2 mo. Treatment of accutane 15 yrs Ago and the condition went away for about 10 yrs. I took it again about 5 yrs ago for 10 days and have not had the problem until about a year ago. I took tetracycline for a year until its effectiveness wore off. I recently took accutane again but for only 6 days. Its amazing how effective it is for me. After only 2 days of treatment. My condition cleared up almost completely. My dermatologist has instructed me to take the accutane until my condition clears up and then retake it when it reappears again. Only taking enough to clear the scalp. Will my body develop a resistance to the accutane if I take it in small intermittent doses? My lips start to peal and my eyes get extremely dry when taking accutane but returns to normal after the treatment. If I keep taking the accutane, is there a chance that the dry lips and eyes will be a permanent condition? I wonder if other people with my condition know that accutane is a very effective treatment. It was very embarrassing to have zits on my scalp. Accutane was an answer to my prayers.

Answer: There will be no resistance to the accutane, the dryness will go away after about 10 days to 2 weeks after stopping the accutane(corneal ulcers are another matter-but less commonly seen).

How Soon Before Surgery Should You Stop Taking Accutane [posted 10/28/98]
Question: I'm 18 years old, female and am currently on Accutane. In just 3 weeks I've seen a remarkable improvement in my skin. I have yet 2 months to go and am very confident my face will totally clear up. Anyway, I'm planning to get a nose job done in about 3 months from now and was wondering if it's safe to have a surgery like this performed after a month off accutane. If not, how long should I wait? I'm just asking because someone told me that accutane makes your skin very sensitive and it won't recover from bruises. Thank you so much for your help.

Answer: Well, I'd wait a couple of months anyway. One is probably ok;but, scarring from plastic surgery is unforgiving.

Surgical Concerns While On Accutane [posted 10/21/98]
Question: I am taking accutane right now. And I am also about to have mandibular jaw surgery. Keep in mind, all incisions during the surgery are made in the inside of my mouth. My dermatologist says to wait until after I am off accutane before I have the surgery in case it effects the healing process. While the oral surgeon says that accutane won't effect the healing at all. It is a big deal whether or not I can take accutane while having the surgery, because if I can't then I have to postpone the surgery for 6 months later. So, can I have jaw surgery and take accutane at the same time?

Answer: Probably not a big issue;but, theoretically could be, go with your surgeons opinion.

How Long Does Accutane Cause Dry, Chapped Lips? [posted 10/20/98]
Question: I have been taking Accutane for a month, and my lips are chapped, the corners of my mouth are cracked and painful. Is there anything I can use to minimize this, and will is continue for the duration of my treatment?

Answer: It tends to last for as long as you use accutane. Sun block(available in lip gloss) helps as does constant use of vasoline jelly or something to restore the oils to your lips.

Accutane Induced Hair Loss? [posted 10/13/98]
Question: I have been off accutane for about 3 yrs., but am wondering if I'm still suffering from it's side effects. I have been experiencing major hair loss. I can actually pull 2 or 3 strands out as I run my fingers through my hair. My mother's dad had very slight hair loss, and my father's dad was pretty much bald. Neither really lost their hair until their late fifties. I guess my question is, is this an effect of the drug, and is their any way to cure or stop the hair loss, even though my hair seems to grow back.

Answer: Not the accutane, there are several medical conditions which can cause the problem, the easiest to diagnose and fix is hyper/hypothyroidism.

Affordable Accutane [posted 10/1/98]
Question: I really like your web site. I am trying to get information on an affordable way to get on accutane therapy if my healthcare provider does not cover it. Any suggestions?

Answer: I have some patients who travel to Mexico for lower prices on drugs. US prescriptions are filled for long periods of time in Mexico at about 1/2 price or lower.

Accutane and Potential for Liver Problems [posted 9/29/98]
Question: I have heard that Accutane has been implicated in liver toxicity. At 10mg/day, how great is the potential for liver damage? What is it about the structure of the drug that causes damage to the liver?

Answer: Accutane is very close in structure to vitamin A-in high doses a known liver toxin-presumably since it is stored in the liver. You should have ongoing liver function tests performed on this drug( at first every 3-4 months and then 6-12);but, in general, few problems would be expected at 10 mg. Also, many physicians would use the drug 3-4 months and then have a 6-8 week "holiday" to avoid any risk of hepatotoxicity.

Accutane and Alcohol [posted 8/13/98]
Question: I have been on accutane for almost 2 months, and so far everything has been great. I was wondering if drinking alcohol affect will affect me? I am afraid to drink because, I am afraid that is may hurt me. Could you respond back to me and tell me if it is ok to drink alcohol while on accutane?

Answer: There is no contraindication or warning associated with the ingestion of alcohol and Accutane.

Accutane [posted 8/11/98]
Question: I have been on 40 mg twice daily for 4 weeks. I was told to wash with any kind of soap and to use Sol Bar 50 sunscreen morning and night as a moisturizer. I have been having breakouts that are worse than when I was not taking accutane. Do you know if it could be the sunscreen or possible improper soap? Prior to this accutane treatment I was taking minocycline twice daily for 2 years in addition to using Retin-A. I stopped taking minocycline 2 weeks ago.

Answer: Did the problem start when you stopped the Minocycline? Sounds like it. Often in severe cases you need two modalities, that is Accutane plus a systemic antibiotic. I would restart the minocycline - check with your doctor.

Accutane and Colitis [posted 8/10/98]
Question: I had my colon removed due to a long battle with colitis. Six months after my surgery, I started Accutane for my cystic acne. Are there any side effects of Accutane that may occur due to my internal pouch. For example, stomach ulcers and pouchitis?

Answer: Accutane can cause cracks around the lips called cheliosis. However, I have not heard of mucosal ulcers or trouble with ostomies, etc. You'll need to try and see, but I suspect you'll see no problems.

Accutane Effects [posted 8/7/98]
Question: I have taken the drug Accutane on three different occasions for the treatment of acne. While the results are not perfect my acne has subsided some. I read that Accutane interferes with vitamin A metabolism. I also read that there is a risk that interruption of vitamin A metabolism might alter normal skin growth, maintenance and repair. Is it possible my metabolism has been so screwed up by the drug that my skin cannot function normally and is subject to consistent breakouts due to the possible malfunctioning of vitamin A metabolism? If so is it possible to reverse this and how would I go about doing it? What kind of doctor would know how to diagnose something such as this?

Answer: This would not be a problem with Accutane, since vitamin A metabolism is not permanently affected. The effects are theoretically possible while taking the drug. However, in clinical practice, I have not seen these types of effects.

Accutane [posted 8/5/98]
Question: I am a twenty-one year old female who completed a five month course of Accutane (for acne) about six months ago. Over the past two months my acne has been slowly coming back. My dermatologist has given me topical treatments to help with the problem, but they have limited effects. I am wondering how my dermatologist will decide if I am going to require a second course of Accutane? If I do require another treatment, what are the chances that my condition will return again?

Answer: You restart the Accutane based on the scarring potential of the acne. Most patients require ongoing treatment since their basic biochemistry doesn't change with the Accutane. Treatment is commonly over 3-4 years at intervals as the acne waxes/wanes.

Accutane Side Effects [posted 8/4/98]
Question: A lot of information is available on the dangers of women becoming pregnant while using accutane. What are the dangers of men using accutane and getting a women pregnant? What are the risks to the mother and especially the child?

Answer: Seems to be much less, but there is concern about this as well. Currently, not a contraindication to the drug. The effect seems to be on the fetus itself and not on the sperm and egg. More research is needed.

Accutane for Skin Cancer [posted 7/27/98]
Question: Can you give my any reference for use of Accutane for skin cancers? - Success and duration of treatment.

Answer: I have never used it for this. I would check with the scientific department of Roche: 800-526-6367.

Accutane [posted 7/24/98]
Question: How effective is accutane and what are the risks and side effects?

Answer: Accutane is an extremely effective in the treatment of Acne Vulgaris. Many patients have near complete resolution of their acne. It will take a while to work (6-8 weeks) and there are some potential risks. Cholesterol may be elevated and there have been a few cases of association with inflammatory bowel disease, liver toxicity has occurred, and the most potentially serious is pseudotumor cerebri (an elevated pressure in the brain). It is absolutely contraindicated in pregnancy and is known to cause severe birth defects. However, most patients have few/no problems taking the drug.

Accutane [posted 7/24/98]
Question: I have been taking Accutane for three weeks, and I am developing severe breakouts. Can I use Retin-A to calm them down?

Answer: I wouldn't until you give the Accutane some more time. It usually takes 6 weeks for results.

Accutane an Sun [posted 7/16/98]
Question: I was wondering if Accutane is bad to take if I am going to be in the sun over spring break?

Answer: There are some cases of sun sensitivity. The face and sun exposed areas tends to be easily sunburned. I would be very careful of sun exposure while taking this medication unless you have a gradual exposure without problems.

Accutane
Question: I have been taking Accutane for approximately 1.5 months. I also had laser surgery on my eyes to correct nearsightedness. The procedure was a large success but I am experiencing corneal hazing. Corneal hazing is caused by the build up of collagen on the cornea. It seems to be a lot of hazing. Does Accutane increase the production of collagen or protein? If Accutane increases protein/collagen production might I have a problem losing the corneal hazing?

Answer: There is no obvious relationship between Accutane and corneal problems.

Accutane
Question: How close is Vitamin A to Accutane? Would taking a daily dosage of Vitamin A help at all?

Answer: They are structurally similar, although accutane is a different chemical. Topical Vit A might work-- system doses probably won't. Big doses of Vitamin A can be lethal, which is why you can't buy it by itself.

Accutane & Blood Levels
Question:Today I started a course of accutane because I have had acne for 8 years and nothing has worked on my face yet. I hope Accutane is going to work for me. I have taken all of the topical and oral medications that are on the market to kill oil and bacteria, so far nothing has worked. I am worried about my blood levels, they are elevated and I hear that Accutane will raise them even more. Cholesterol 261 Trigleserates 361. It is genetic in my family to have these high levels, both mom and dad are on cholesterol lowering medicines, Questerine and Mevacore. I'm 23 years old and still fighting this skill disease, in your opinion do you feel that I will be fine in the rest of the treatment? I am going to be monitored closely by my internist and my dermatologist. I will take a book test once every 2 weeks. They feel that I will be fine if closely monitored. I'm a college student who lives 100 miles from home and it is hard to see my doctor on a regular basis, once a month is what I have been doing.

Answer:I think their monitoring program will be fine-they will be able to pick up elevating cholesterol before it is a problem. You should be able to get the tests done locally and mailed to your doctor. Most physicians could do this on the phone-pay him if necessary.

Accutane Results
Question:Could you please share the results of patients using Accutane?

Answer: Accutane works pretty well at the price of reddened skin. I'd use it if you have severe acne vulgaris.

Side Effects
Question:How serious are the side effects of the acne medicine Accutane?

Answer: Accutane(isotretinoin is a variation of Vitamin A. Consequently, the toxicity is similar to Vitamin A toxicity-chelitis(mouth sores),-90%, conjunctivitis, bone hyperostosis, arthralgias. Rare but severe reactions include pseudotumor cerebri(increased pressure in the brain)-it should absolutely not be used in women who could become pregnant. However, in general the side effects are pretty minimal.

30 Year Battle
Question: I am 49 and have had excess oil, enlarged pores and get pus daily on my nose. I have fought with this since I was 19 and wonder if accutas inould be too severe of a medication to help me. I have taken sumycin and tetracycline, but now get nauseated whenever I try to take these two drugs. Would accutane be a drug that I should consider to cure my problem for good?

Answer: Sounds like a good option, generally well tolerated without side effects-avoid pregnancy.

Night Blindness
Question: I know that Accutane causes night blindness in 1% of its users. I have been wondering why it does so.

Answer: It is similar in structure to Vitamin A-a vitamin needed for night vision. It seems to have some effect in some patients in blocking effective night vision.

Accutane & Pregnancy
Question: I am a 25 year old female. My doctor would like for me to start accutane. I have tried Differn, Rentin-A, Benzamycin, SalAc Wash, Brevoxyl, Azelex, and Murad. Nothing has seemed to work. Currently, I have been using differn and my face has broken out the worst in my entire life. I would have no problem trying accutane except for the fact of the birth defects. I am not sexual active now. However, I do plan on having children within the next five years. What is the current research on the long term effects of accutane for child births? Can you refer me to look anywhere for help?

Answer: The fetal toxicity of accutane seems to be limited to the time the drug is taken. While there is a washout period, it does not persist as a risk factor. I would ask the company if you have further questions-Roche 800-526-6367.
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