Hi everybody,

I'm experiencing a moment of crisis. I'm sitting on my bed with a partially-opened packet of 20mg accutane capsules staring back at me. I was literally about to put my first dose in my mouth when I was wracked with doubt. My acne is confined to my face, but moderate and persistent. It has resisted every topical treatment, and I finally achieved some degree of normalcy with a year-long course of doxycycline. I went to my derm once the doxycycline started to lose its efficacy, and she told me my options were accutane or transitioning to another antibiotic (solodyn). She explained that the antibiotic will, in turn, stop working and my acne will resurface. I realized the only permanent option was accutane and I started to do research on side effects. After I freaked out about IBD and the like, my derm reassured me that I would experience a reduced risk of long-term side effects sue to my low (40mg at the peak) dose. To what extent is this true? I filled the prescription, and as I said before, am now terrified to start taking it.

The side effects about which I'm currently most concerned are erectile dysfunction, general brain impairment (here's a frightening study about that: http://www.pnas.org/...ent/101/14/5111 ), and premature epiphyseal closure (stunted growth). Can somebody please console me or offer a persuasive argument for/against accutane? I'm so conflicted....

 

Here's a study about IBD:

"In conclusion, the only evidence to support a causal association between Accutane and IBD consists of isolated case reports. These reports support a possible temporal association between isotretinoin and the development of IBD, though such observations may have resulted from chance, confounding, bias, and misrepresentation of the natural history of IBD. A causal relationship remains biologically plausible, but beneficial effects of vitamin A derivatives on intestinal injury have been reported as well. None of the other commonly accepted causal criteria are met. The lack of evidence does not necessarily indicate lack of a causal connection. However, in the absence of observational studies which assess the strength and consistency of the association and/or experimental studies which confirm such an association, any conclusions about a causal link are premature at best, and future studies are needed to enable a more rigorous assessment about causality. Until such time as that becomes possible, it is difficult to provide any substantive assessment of the IBD-associated risks of isotretinoin use. Therefore, while it remains possible that an association between isotretinoin and IBD will eventually be established, current published evidence is insufficient to support this claim."

There are a few newer studies about IBD and isotretinoin risk, most of them concluding that it doesn't cause IBDs. However as I don't have the full texts of those studies, I can't comment on the study quality. But for now, the researchers are leaning towards a "no".

The brain impairment study was conducted in mice. Mice does not equal humans. There is a newer study observing the brain in humans, which concluded: "Isotretinoin does not reduce learning and memory and our study suggests that it may instead lead to a dose-related improvement in specific aspects of hippocampal learning and memory. Retinoic acid functions in the hippocampus as the active metabolite of vitamin A, suggesting that this may be a limiting factor in the human hippocampus and addition of exogenous retinoic acid brings levels closer to an optimal state."

Now there are some reports of young teens receiving high amounts of the drug and having stunted growth. There is no hard proof of this, and isotretinoin is typically given to 17 to 21 year-olds and the slowing of growth may be confused with the stunting of height/growth. Also, stunted bones don't always effect height.

I also did a PubMed and Google Scholar search on erectile dysfunction and isotretinoin. There is a case report about six males getting erectile dysfunction but that was all I found. While it could be a very rare side effect, it may simply be correlational as those who take isotretinoin are depressed anyway, and depression itself can cause erectile dysfunction.

Isotretinoin is often demonized as a highly toxic, worst-thing-you-could-ever-consume poison on many "pro-natural" sites to scare potential patients from drugs and generally "Big Pharma" into buying "natural, safer herbal remedies". Also, fear often spreads like wildfire on the Internet, so it isn't surprising that some (potential and speculative) side effects are blown out of proportion for drugs.

If other treatments did not respond, then by all means go for it. Isotretinoin is the closest "cure" for acne, with 70% to 80% acheiving remission in one course.

If you're still concerned about the side effects, ask your derm to lower the dose for you.

Hope this clears things up for you and good luck on your course!

I was scared too. I talked to friends who had taken it before I started. No one had anything bad to report but dry skin and lips. They all said that the benefits far outweighed the side effects for them. I am a week in now and just keep telling myself that this is going to lead to good things in the end. Clear skin and no need to be on acne meds forever (I've been on them for 7 years now) sounds awesome to me and I just keep looking forward to that every day! So far so good. I'm happy that I have started, because the sooner you get started the sooner you get finished and have clear skin! I'm only 110 lbs and got started on 60mg/day because mine is so severe. Mine is only on my face too. My back and chest have always been perfectly clear, but having it on the face sucks the worst if you ask me because you can't cover it up and everyone sees/looks at your face first.... Good luck and hang in there! Be positive and I hope it all works out for you! This is a great place for support and questions for those of us who have concerns! I hope in 6 months we will both be happy and finally spot free once and for all!!

I was on 20mg a day for 2 months, I've been on 40mg a month for 4 months, honestly all the side-effects you're so worried about tend to be more prominent to those

on very high doses. When I asked my dermatologist if 20 mg was too low, he said that with a lower dosage, I would have less severe side-effects & he was right. I only had dry lips and dry skin! Thats it. So, I don't think you have anything to be worried about. I think people tend to read all these scary stories and think its something common, or that it'll happen to them, but with a low dosage I think you'll be fine.

so basically just take the first pill and try it out....one pill isn't going to kill u. see how you feel about it, honestly all that scary stuff you hear about barely ever happens. I was a little apprehensive about starting it but seriously it was an amazing experience and nothing bad happened to me and likely none of that extreme stuff u are worried about will happen to u either. Just remember you can stop taking them anytime u want but give it a shot! I bet all you will get is dry lips and all the usual stuff so go for it!