What is Accutane

Accutane (isotretinoin), or Roaccutane as it is known in parts of the world, was discovered in 1979 when it was first given to patients with severe acne, most of whom reacted with dramatic and permanent clearing of their acne symptoms. It is a vitamin A derivative (13-cis-retinoic acid) that is administered orally in pill form with a meal that contains an adequate amount of fat,1 normally for 15-20 weeks (3.5-4.5 months),2 although it is also sometimes prescribed at lower dosages for up to six months or longer. It was originally recommended for people with severe acne that did not respond to other treatments,3 but has gained in popularity in the past 25 years and is prescribed more and more frequently for less severe acne.4-6 This practice is controversial because Accutane is a serious medication that can cause severe birth defects as well as potentially long-lasting side effects to the user. Accutane need not be paired with other medications.7

How does Accutane work?

How Accutane (isotretinoin) Works Exactly how Accutane works on a cellular level is unknown but we do know that it affects all four ways that acne develops. 1. It dramatically reduces the size of the skin's oil glands (35%-58%) and even more dramatically reduces the amount of oil these glands produce (around 80%).8-9 2. Acne bacteria (P. acnes) live in skin oil. Since oil is dramatically reduced, so is the amount of acne bacteria in the skin.9 3. It slows down how fast the skin produces skin cells inside the pore, which helps pores from becoming clogged in the first place.10 4. It has anti-inflammatory properties.10 Although acne may get worse within the first month of Accutane use for about 30% of patients, the ultimate results are usually dramatic.11 Accutane works to achieve partial or complete clearance of acne in about 95% of people who complete a cycle, regardless of whether they have inflammatory or non-inflammatory acne.12 The majority of people who take it see their acne effectively cured, experiencing long-term remission of acne symptoms. Studies show an average relapse rate of around 33%, and in these cases sometimes a second course is given.7,9,12-17 This relapse rate is dose-dependent.13 Patients who receive a cumulative dose of 100-120 mg/kg see the best results and lowest relapse rates. Patients who receive a lower dose relapse more frequently. Daily dosage depends on how much the patient weighs; 0.5 mg - 2 mg/kg is typical.15 Low and intermittent dosing: Researchers have published several studies attempting to gauge whether people with mild to moderate acne can achieve long-term remission of acne with lower dosages of Accutane. Initial data is showing that patients with mild to moderate acne may be able to achieve long-term remission with significantly lower dosages, and thus suffer less side effects,18-20 including lower incidence of scarring. For people with more severe acne, staying on a lower dose of Accutane for a longer period of time until the full 120mg/kg cumulative dose is achieved may be a way to produce long-term remission with significantly less side effects.21 Intermittent dosing (taking Accutane only 1 week of every month) appears to work less well, producing significantly poorer outcomes for more than half of the patients studied

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