The Benefits and Risks of a Accutane Acne Drug
Acne plagued Julie Harper throughout high school and college. She depended on makeup and wore her hair down over the side of her face. She gave up chocolate and french fries, only to find that neither made a difference. And she went through medicine after medicine, from over-the-counter creams to oral antibiotics.
These were not occasional pimples that vanish after a couple of days. This acne covered her face and left scars on her neck. “I had tried everything and felt frustrated all the time,” says Harper, now a physician and assistant professor of dermatology at the University of Alabama-Birmingham–a career she chose due in large part to her struggle with acne.
Harper finally found a successful treatment nine years ago at the age of 22. She took a drug called isotretinoin (trade name Accutane) and watched her skin improve in just a couple of months. By the third month, her acne had disappeared. She says with clearer skin came more self-confidence and higher self-esteem.
Considered the biggest breakthrough in acne drug treatment over the last 20 years, Accutane is the only drug that has the potential to clear severe acne permanently after one course of treatment. One course, which is typically five months, results in prolonged remission of acne in up to 85 percent of patients. A member of a class of drugs known as retinoids, Accutane is highly effective. But it doesn’t work for everyone, and some patients need more than one course of treatment. Dr. Harper took a second course of Accutane one year after the first and has been free of severe acne ever since, now only occasionally using a topical medication.
No other acne medicine works as well for severe acne. Patients generally have to keep using other medications because they only suppress acne temporarily. But as powerful as Accutane can be in improving patients’ lives, its adverse effects can be just as powerful. The drug is known to cause miscarriage and severe birth defects. Patients taking Accutane may develop potentially serious problems affecting a number of organs, including the liver, intestines, eyes, ears, and skeletal system. And some patients taking Accutane have developed serious psychiatric problems, including depression. More rarely, patients have developed suicidal behavior and killed themselves.
Because it is a high-risk drug, Accutane should be reserved for cases of “severe recalcitrant nodular acne,” according to the product’s labeling. This type of acne is resistant to standard acne treatment, including oral antibiotics, and is characterized by many nodules or cysts–inflammatory lesions filled with pus and lodged deep within the skin. These lesions can cause pain, permanent scarring, and negative psychological effects.
“Sometimes people tend to dismiss the impact of acne because it’s not life-threatening, says Kathy O’Connell, MD, PhD, a medical reviewer for Accutane in FDA’s division of dermatologic and dental drug products, Center for Drug Evaluation and Research (CDER). “But patients with severe acne know all too well the very real suffering caused by this disfiguring disease.”
FDA approved Accutane in 1982, and since then, about 5 million people in the United States and 12 million worldwide have been treated with it, according to its manufacturer, Hoffmann-La Roche of Nutley, N.J. The number of patients taking the drug has increased, and half are females, most of whom are in their childbearing years (age 15-44). Because of concern about the drug’s risks, FDA continues to evaluate Accutane and work with the manufacturer to maximize safe use of the drug.
Tags: Accutane, Acne, Acne Drug, isotretinoin