So what’s the catch with this “miracle” drug and why don’t doctors prescribe it to everyone? Accutane is controversial for many reasons, but principally because of its most insidious side effect: It has been proven to cause severe birth defects in nearly 90% of the babies born to women who were pregnant while taking it. Before physicians knew about this alarming hazard, and when it was first prescribed in France back in the 1970s before enough research had been conducted to establish its safety, more than 800 babies out of 1,000 were born seriously deformed. The only way to avoid this risk is to abstain from sex during treatment or, according to the information provided with every prescription, to use a minimum of two forms of birth control. If you are taking a birth-control pill, you still need to use a condom or diaphragm. You will need to discuss with your physician how long to continue using the extra birth-control precautions after you are done taking Accutane.
If you aren’t pregnant or are not trying to conceive, are there still risks? Absolutely. Commonly reported, although temporary, side effects of Accutane include dry skin and lips, mild nosebleeds (your nose can get really dry for the first few days), hair loss (I lost a small amount of hair that grew back when I finished the four months of treatment), aches and pains, itching, rash, fragile skin, increased sensitivity to the sun, headaches (mild to severe—mine were fairly mild), and peeling palms and hands.
A study in the Journal of Cutaneous Medical Surgery (April 2000, pages 66-70) followed 124 people through their course of treatment with Accutane. “The majority of patients experienced persistent dryness of lips. Dry eyes affected 40% of patients; this continued throughout treatment in 25%. Contact lens wearers were more likely to develop conjunctivitis. Lower back pain was reported early in about 30% of patients and fewer than 10% of patients would develop it later in the course of treatment. Joint pain was noted in 16.5% of patients at the first visit and there was little change with ongoing treatment. Hair loss was experienced in a small percentage but was rarely noted on more than one occasion. Headaches occurred in less than 10% and were occasionally severe, but most often intermittent and recorded at a single visit. Depression occurred in 4% of patients and tended to persist throughout the treatment. All these patients completed the full course of treatment.” The study concluded: “patients treated with [Accutane] experienced a predictable series of side effects. Some occurred fleetingly, but several persisted for the duration of treatment.”
More serious, although much less common, side effects include nausea, vomiting, blurred vision, changes in mood, depression (discussed later in this chapter), severe stomach pain, diarrhea, decreased night vision, bowel problems, persistent dryness of eyes, calcium deposits in tendons (doctors don’t know yet whether this is significant), an increase in cholesterol levels, and yellowing of the skin.
Understandably, many people, doctors included, are scared off by these side effects, above and beyond the risk to pregnant women. That’s why dermatologists recommend Accutane only to patients with chronic acne (large, recurring cysts or blemishes that can permanently distort the shape and appearance of the skin), or sometimes to people with less-severe acne that has not responded successfully to other forms of treatment. Many doctors won’t prescribe Accutane at all.
Although the high risk of birth defects and the other side effects should be taken seriously, it seems a shame that Accutane has been kept away from many acne patients. It is the most effective, short-term drug for acne available today. All other acne treatments require ongoing, tenacious adherence to the program and they don’t offer a cure. The public is largely misinformed about Accutane’s potential dangers as well as its potential benefit. Many doctors believe that if it weren’t for the proven risk of birth defects, Accutane would be prescribed almost as frequently as antibiotics. Not surprisingly, it is prescribed much more frequently to men. (Source: British Journal of Clinical Pharmacology, January 2009, pages 137-138.)
Given what I have learned, I wish somebody had told me about Accutane twenty years ago! It would have saved me a lot of time, money, and heartache. Although oral and topical antibiotics, exfoliants, gentle cleansing, staying away from products that aggravate breakouts, and using facial masks to absorb excess oil can work successfully for lots of people, for many people these questions remain: “When will I outgrow acne? How long will I have to struggle with the pain of breakouts?” Sadly, there is no telling if you’re ever going to outgrow it. People who don’t outgrow it, and lots of women don’t, are looking at years of applying topical solutions and taking oral antibiotics that sometimes work well and sometimes don’t. A short-term course of Accutane, following all precautions and being aware of side effects, is a seemingly small price to pay to avoid decades of stubborn acne.