This is a really good question, I'd love to know the answer too. My doctor was very keen to put me on Accutane but I said I wanted to continue with my topical treatment for another month first, to see if I continue to improve.

The thing that scares me is that if Accutane can have permanent/semi-permanent results for your skin, what are the long-term effects going to be for the rest of your body?

On Monday I begged my dermatologist to give me Accutane so I could go off of the Retin A Micro. She adamantly refused and explained that Accutane has numerous side effects that could last for a long time. She also said that when she used the medication, much less than half of her patients' acne never came back. She said that most of her patients' acne returned shortly after stopping the medication and that the costs weren't worth the risks. Also it is important to bear in mind (as unfair as this is) as women, we have to go on birth control and get a number of pregnancy tests while taking Accutane and shortly after even if we are not sexually active. Accutane winds up being very expensive.

Right now I am on Retin A Micro, .1, the highest dosage they make. And I will tell you with full sincerity that this medication is not something to be taken lightly. You have to be SO gentle with your skin while on it, you have to keep out of the sun, and you will likely have an initial breakout if you currently have acne. And the breakout is expected to last three months. I have been in tears after being on the medication for 4 and a half weeks because my face is covered in red pimples and marks and it wasn't before. I would wake up with at least 3 large papules a day and it was (is) emotionally devastating. My dermatologist didn't initially tell me what these first months would be like, so I was very upset. And those first months are why so many people stop using the medication.

HOWEVER. I think that the retinoids are beneficial in the long run (they fight aging, boost collagen, increase cell turnover etc.) and there are numerous scholarly articles on the subject. You really do have to be patient and you have to leave your face alone as much as possible. If you irritate it too much with other products you will make your acne worse. Just let the retinoid do its job, and give it at least three months. Hope this helps!

Since about 10 or 11, I've always had mild to moderate acne. At age 16, I decided to see a dermatologist because benzoyl peroxide and salicylic acid were not giving me satisfactory results. I was initially put on a regimen of Acanya (BP/Clindamycin), Epiduo (BP/Adapalene), and oral doxycycline. My acne improved somewhat, but my skin was terrible. It was chronically dry, red, and irritated. I eventually decided to eliminate BP from the regimen, and went on simple Clindamycin and Adapalene. My acne got no worse, but my irritation and dryness issues improved. I've been on this regimen for about two years, but I've been getting tired of the residual acne. My dermatologist suggested accutane, but I felt like that was a bit drastic for the level of acne I had. I don't like the idea of taking something that has some kind of effect on almost all of the systems in my body for a problem localized to a relatively small area of my skin.

Another option my dermatologist gave me was upping my adapalene script from 0.1% to 0.3%. I decided to go with this, but he mentioned that accutane would give semi-permanent results, whereas topical adapalene would only work while I was using it.

Which leads me to my question... Both accutane and adapalene are retinoids, largely affecting the same receptors in the skin, to similar effect. Adapalene is a completely synthetic retinoid, engineered to be more selective so as to reduce side effects. Accutane (isotretinoin) occurs naturally, and has less narrowly focused effects. However, they're both effective in reducing the formation of pimples, and presumably create that effect through largely the same mechanisms. So, why is it that accutane causes permanent changes in the skin, but topical adapalene apparently does not?

 

Accutane (oral isotretinoin) will actually shrink the sebaceous glands. Retin A will not.

Accutane works by shrinking the sebaceous (oil) glands. These grow back very slowly, by which time the patient has nearly always outgrown their tendency to acne.

But this is why many people here are on their third or fourth round of Accutane. Obviously many people do not outgrow acne. Your oil glands will still grow back even after Accutane. So what you'll get is a short-lived relief and then a return of acne.

accutane does not work through the skin it works through the brain and the brain affects the skin.That is why any topical retinoids(adapalene,retin A,topical isotretinoin-stiefotrex,tazarotene) do not produce permanent clearing of acne.Oral isotretinoin messes up your brain.I had to learn the hard way when i took this poison.Now i suffer from many permanent side effects.The permanent clearing of acne oral isotretinoin accomplishes is just a desirable side effect.

Accutane does not work through the brain. The reason why accutane works better than tretinoin is you are simply receiving a larger dose of the medication to all layers of your skin. Additionally, it treats all causes of acne: inflammation (it is anti-inflammatory), sebum over-production (it shrinks the sebaceous glands), abnormal disquamation resulting in microcomedone formation (it normalizes the rate at which your skin sheds itself reducing obstruction of the follicles), and bacterial proliferation (by shrinking the sebaceous glands, sebum production is significant reduced, thus cutting off the supply of food for P. Acnes). These precursers are highly interrelated and not causally (meaning, one does not necessarily cause the other, and reducing one does not necessarily change the impact of the others).

In terms of comparing accutane to topical retinoids, it is a matter of severity and response to treatment. For mild-moderate cases, many dermatologists would prefer to start with a topical retinoid. Topical retinoids reduce abnormal disquamation and comodeone formation, but it has very small effects on inflammation and no effects on sebum overproduction (thus little - no effect on bacterial proliferation). Combining BP or an antibiotic with topical retinoids takes care of the bacterial proliferation problem somewhat, but you still have inflammation and over production of sebum.

This is why people need accutane, it is the only drug that effectively treats ALL these issues simultaneously. It may come back, but not necessarily.

Also, accutane (isotretinoin) is NOT a natural retinoid. It is synthetic, just like adapeline.

oral isotretinoin gets absorbed by all organs so it does not go only to the skin.Assuming that oral isotretinoin works to permanently get rid of acne just because more of it goes to the skin is just wrong because only a small amount of it goes to the skin as all other organs absorb it too.You can apply the same retinoid(isotretinoin-brand name stiefotrex) topically and it won't get rid permanently of your acne no matter what you do or how long you will use it.The isotretinoin molecule is small enough to penetrate the skin and can reach all the skin layers also.The way oral isotretinoin works is through epigenetic changes in the brain/immune system.The effects on the immune system and brain then change the skin and all the other organs that is why there are permanent/long lasting side effects to many systems of the body.

Most people in this thread are unfortunately mistaken. Accutane does shrink sebaceous glands, and it does reduce hyperproliferation of keratinocytes, but these effects are largely temporary; the common observation is that oily skin returns 1 month after cessation of treatment.

Accutane functions by modulating the immune system. It actively changes the expression of certain receptors on white blood cells (best candidate right now is TLR2), and promotes apoptosis of certain types of these cells. Through these mechanisms, accutane sort of 'resets' the part of your immune system that interacts with the antigens that cause acne - most often bacterial antigens such as those displayed by P. acnes, but also perhaps food antigens. This is why people sometimes get sick more often while on the drug; their immune systems are not only temporarily handicapped, but are also encountering microbes everywhere for the first time...again.