Isotretinoin is a vitamin A derivative that is FDA-approved for severe, recalcitrant nodulocystic acne or acne that is unresponsive to antibiotics. Since acne is driven by hormones (especially dihydrotestosterone and other androgens), nodulocystic acne is a common issue in both men and women. It is also used for acne that is associated with physical or psychological scarring. It has been used since 1982 and is by far the most effective acne medication on the market. One pill a day (with food) for 6 months is the usual course. Isotretinoin causes severe birth defects in women who become pregnant.
Since this is not an issue for men, there are fewer restrictions for taking it. This medication is very effective for acne, resulting in a “cure” in 1/3 of patients, “almost a cure” in another 1/3, and a significant improvement in the other third. The vast majority (>95%) of patients tolerate the medication very well without any problems. However, there are numerous minor side effects and some controversial major side effects. The minor side effects are very common and include: dry lips, dry eyes, dry skin, muscle aches (similar to muscle soreness after intense weight lifting), and increases in cholesterol and liver enzymes.
Depression and suicide was first associated with isotretinoin use in 2000, when a US Senator from Michigan believed the medication led to his son’s suicide. Since then, no scientific study has conclusively proven that isotretinoin causes depression and suicide, it has merely been associated with it. It is well known that patients with acne, just from facial disfigurement, are more likely to be depressed than the general population. In addition, studies have proven that treatment of severe acne with isotretinoin actually improves self-esteem and decreases the risk of depression and anxiety.
Isotretinoin has also been associated with inflammatory bowel disease (IBD), which is a gastrointestinal disorder that results from chronic inflammation in the walls of the intestines. In fact, there have been dozens of lawsuits in the United States that have stemmed from the link between the two. However, not one case of IBD has ever been proven to be caused by isotretinoin. In fact, many experts (including clinicians at Dana Point Dermatology) believe that IBD is the result of a systemic inflammatory process. In other words, patients with inflammation in the skin (acne) are more likely to have inflammation in the intestines (IBD); isotretinoin is not a factor.
Dana Point Dermatology’s Bottom Line: Acne can be severe in guys and lead to permanent scarring. Isotretinoin is a great option for many patients without a lot of downside risk. Since isotretinoin is a powerful medication, always seek guidance from a board-certified dermatologist.
