The management of acne
vulgaris and use of isotretinoin (accutane) should involve specialists including internists
, dermatologists, and others.
Isotretinoin is effective for treating severe, refractory nodular acne but this medication is also associated with adverse effects and should be used with caution. It is felt to help treat acne by decreasing the size of sebaceous glands causing less sebum secretion and therefore inhibiting the formation of acne.
In general, this medication is primarily used for severe, refractory nodular acne but has been used in treatment-resistance acne, scarring acne, and other related acne conditions. Treatment is started at a lower dose then increased after one month of therapy then discontinued after four to six months without a taper. Often, other acne medications will be held while taking isotretinoin. Currently, this medication is the only acne medication that can permanently alter the natural course of acne.
There are significant side effects to be aware of. The medication can cause severe birth defects and you will likely be requested to undergo a pregnancy test prior to starting the medication. It can cause dry skin and dry mouth along with your skin being more sensitive to the sun. Importantly, there has been recent concern about an increased rate of depression so this should be monitored very closely if you start this medication.
It is not possible to develop a clear treatment plan without seeing the patient. It is the strong recommendation to continue to work with your dermatologist
in person to develop a treatment plan.