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Nodular acne may be treated with an oral prescription retinoid medication known as Accutane. It works by controlling the waxy substance created by sebaceous glands. The treatment is only indicated for those with severe acne.

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Accutane (isotretinoin) is an oral prescription medication indicated to treat “severe recalcitrant nodular acne,” which has not been successfully managed by other medications first. Nodular acne is a severe form of acne caused by increased production of sebum, or waxy/oily substance, by very tiny sebaceous glands in the skin. Instead of small blackheads or whiteheads that are seen with acne vulgaris (simply referred to as acne), larger nodules appear on the skin. These inflamed, pus-filled, or bleeding lesions are larger than half a centimeter (5 mm) and there are many of them on the skin.

According to manufacturers, Accutane decreases the size of the sebaceous glands and prevents their “differentiation” or maturation. This leads to a reduction in the amount of sebum (oil/wax) produced by these glands. Over time, Accutane should improve or completely resolve the acne on the skin.

Accutane is not intended to be used for initial treatment of acne. Instead, it should only be considered when the usual medications, including oral antibiotics, do not work.

Accutane Acne Medication

Accutane (isotretinoin) is a retinoid which is intended to treat severe acne by decreasing the amount of the oily waxy substance produced by the sebaceous glands. Accutane is an oral medication taken as capsules. There are also other retinoids which are topical, which means they can be applied directly to the skin as a lotion, cream, or liquid. These drugs work on the “follicle cells” in the sebaceous glands. 

Topical retinoids include tretinoin, adapalene, and tazarotene, and they have much milder side effects than Accutane (isotretinoin). Other classes of medications used to treat acne include benzoyl peroxide, topical or oral antibiotics (erythromycin, clindamycin, tertracyclines), and hormonal therapies.

Isotretinoin and Nodular Acne Treatment

Isotretinoin (Accutane – Roche) may be known by other names outside the US. These include Roaccutane (Hoffman-La Roche), Amnesteen (Mylan), Claravis (Barr), Isotroin (Cipla), and Sotret (Ranbaxy). Isotretinoin is no longer sold under its brand name of Accutane, although it is still available from other companies as Isotretinoin.

Accutane is indicated for the treatment of severe nodular acne that has not responded to the typical conventional medications.  It is indicated ONLY for females who are NOT pregnant as it can cause severe birth defects.

Pregnancy Contraindications for Accutance Users

Accutane must not be used by females who are pregnant or breast feeding.  Avoid taking any other medicines or herbal products.  Do not drive at night until you know if Accutane has affected your vision. Accutane is contraindicated in patients that are having cosmetic procedures to smooth your skin, including waxing, dermabrasion, or laser procedures, while you are using Accutane and for at least 6 months after you stop. Avoid sunlight and ultraviolet lights.

Accutane is contraindicated in females of childbearing potential unless the patient meets all of the following conditions:

  • Must NOT be pregnant or breast feeding.
  • Must be capable of complying with the mandatory contraceptive measures required for Accutane therapy and understand behaviors associated with an increased risk of pregnancy.
  • Must be reliable in understanding and carrying out instructions.

Interactions with Other Drugs or Supplements

In some cases, it may become necessary to take more than one medication at a time.  This may increase the risk of certain side effects. Please consult your physician before taking multiple medications. If an interaction between drugs may occur, your physician may need to adjust the dosage to decrease these risks. Inform your physician of a complete list of any medications both prescription and over-the-counter medications including any nutritional supplements before taking Accutane.

Several of these drugs and supplements are:

  • Vitamin A supplements Vitamin A in high doses has many of the same side effects as Accutane.  Taking both together may increase your chance of getting side effects.
  • Tetracycline antibiotics.  Tetracycline antibiotics taken with Accutane can increase the chances of getting increased pressure in the brain.
  • Progestin-only birth control pills (mini-pills).  They may not work while you take Accutane.  Ask your doctor or pharmacist if you are not sure what type you are using.
  • Dilantin (phenytoin).  This medicine taken with Accutane may weaken your bones.
  • Corticosteroid medicines.  These medicines taken with Accutane may weaken your bones.
  • St. John’s Wort. This herbal supplement may make birth control pills work less effectively.
Important Note: Accutane must be taken exactly as prescribed. You must also follow all the instructions of the iPLEDGE program. Your doctor should explain this thoroughly.

Taking Accutane as Prescribed

The amount of Accutane you take is specially chosen for by your doctor based on your body weight, and may change during treatment.  Accutane is taken twice daily with a meal, unless your doctor tells you otherwise. Swallow your Accutane capsules whole with a full glass of liquid. Do not chew or suck on the capsule. Accutane can hurt the tube that connects your mouth to your stomach (esophagus) if it is not swallowed whole.  If you miss a dose, just skip that dose. Do not take 2 doses at the same time.  If you take too much Accutane or overdose, call your doctor or poison control center right away.

Accutane is a strong medication and as such has led to serious risks and side effects.  Prescribing doctors were instructed to inform their patients of these risks and confirm that they were:

Side Effects of Accutane

  • dry skin
  • severe stomach, chest or bowel pain
  • trouble or painful swallowing
  • new or worsening heartburn
  • diarrhea
  • rectal bleeding
  • yellowing of your skin or eyes
  • dark urine
  • back and joint pain
  • broken bones

Some of the more serious side effects include:

  • bad headache
  • blurred vision
  • dizziness
  • nausea or vomiting
  • seizures (convulsions)
  • stroke