Accutane is a form of vitamin A. It reduces the amount of oil released by oil glands in the skin, and helps skin renew itself more quickly. The drug is mostly used for cystic acne. It was first developed for brain, pancreatic and other cancers. Its effects are systemic and nonselective.

Due to side-effects, Accutane is used in severe cystic acne and in acne that has not responded to other treatments. Acne treatment usually begins with topical medications (e.g., benzoyl peroxide and adapalene), followed by oral antibiotics and Accutane as a last resort. Many dermatologists also support its use for treatment of lesser degrees of acne that prove resistant to other treatments, or that produce physical or psychological scarring.

It is also somewhat effective for hidradenitis suppurativa and some cases of severe acne rosacea. The drug is used to treat harlequin-type ichthyosis, a usually lethal skin disease, and lamellar ichthyosis and is used in xeroderma pigmentosum cases to relieve keratoses. Accutane has been used to treat the extremely rare condition fibrodysplasia ossificans progressive. It is also used for treatment of neuroblastoma, a form of nerve cancer.

Accutane side effects

Increasingly higher dosages will result in higher toxicity, resembling vitamin A toxicity. Common side effects associated with Accutane therapy include: extreme severe acne flare, dryness of skin, lips and mucous membranes, infection of the cuticles, cheilitis, itch, rosacea, skin fragility, skin peeling, rash, flushing, nose bleeds, dry eyes, diffuse alopecia areata, eye irritation, conjunctivitis, reduced tolerance to contact lenses, hyperlipidaemia, raised liver enzymes, permanent thin skin, headaches, temporary or permanent hair thinning (this could start or continue after treatment), myalgia and/or arthalgia, back pain and hyperhidrosis.

Infrequent side effects are mild acne flare, raised blood glucose level, decreased libido or erectile dysfunction, increased erythrocyte sedimentation rate, and fatigue

Rare side effects: impaired night vision, cataracts, optic neuritis, menstrual disturbances, inflammatory bowel disease, pancreatitis, hepatitis, corneal opacities, papilloedema, idiopathic intracranial hypertension, skeletal hyperostosis, extraosseous calcification, psychosis, depression and decrease in bone mineral density.

Dosage

The dose of Accutane patients receive is dependent on their weight and the severity of the condition. High-dose treatments are administered between 0.5 mg/kg/day to 2 mg/kg/day (usually at 0.5 to 1 mg/kg/day, divided into two doses), for a total treatment of four to six months. In some rare cases where the patient's acne is severe or unresponsive, the initial course may last up to nine months. A second course may be used at least eight weeks following the cessation of the initial course if severe acne recurs. Efficacy appears to be related to the cumulative dose of Accutane taken, with a total cumulative dose over each course of 120-150 mg/kg used as a guideline. Shorter, higher dose treatments or uninterrupted double courses should be used only as a last resort, due to adverse side effects. Each additional course, however, has a higher probability of cure.

Lower-dosage treatments, such as 10-20 mg/day (approximately half the high dosage treatments above), are also highly effective, with greatly diminished side effects. However, such lower dosage courses may be associated with higher relapse rates, requiring additional courses, especially if not taken for sufficient time.

Interactions

Do not use this medication if you are allergic to isotretinoin or to parabens, or if you are pregnant or may become pregnant.

To make sure you can safely take Accutane, tell your doctor if you have any of these other conditions:

• a personal or family history of depression or mental illness;

• heart disease, high cholesterol or triglycerides;

• osteoporosis or other bone disorders;

• an intestinal disorder such as inflammatory bowel disease, ulcerative colitis, or Crohn's disease;

• diabetes;

• asthma;

• an eating disorder (anorexia nervosa); or

• liver disease.

Accutane is a tetratogen and is highly likely to cause birth defects if taken during pregnancy. A few of the more common birth defects this drug can cause are hearing and visual impairment, missing or malformed earlobes, facial dysmorphism, and mental retardation. The manufacturer recommends pregnancy be excluded in female patients two weeks prior to commencement of Accutane, and they should use two simultaneous forms of effective contraception at least one month prior to commencement, during, and for at least one month following Accutane therapy.