Accutane misconceptions and realities as explained by Pediatric Dermatologist Dr. Swanson in Boise

In the video below, Dr. Swanson clears the air about the misconceptions and realities about using Accutane for acne.  Accutane (aka Isotretinoin) has been used to treat acne for decades and is safe when precautions are taken. Dr. Swanson explains the very serious risks, and is able able to address any concerns about the drug.  Ada West Dermatologists aim to educate patients about the many options they have for achieving clear skin.

“I’m big on providing a list of options to my patients and their families. I’m not going to force one treatment down anybody’s throat. I will present a list of things that are all reasonable and let the conversation and the patient and their family’s feelings kind of guide the treatment decisions.”

— Dr. Swanson, Pediatric Dermatologist at Ada West Dermatology

Dr. Swanson explains the pros and cons of using Accutane for treatment of acne. Dr. Swanson is a highly experienced expert in the field of pediatric dermatology. She likes to offer her patients options and education so that they are able to make an informed choice in their skin health issues. This video explains many misconceptions and the risks that come with using accutane for acne. Learn more about Dr. Swanson in a personal video interview here.

 

For your convenience we’re posted the transcript of Dr. Swanson’s Accutane explanation here:

0:00 Why is accutane a big deal?

I thought it would be nice today to talk a little bit about Accutane, which is a medicine that we commonly use to treat acne in patients because there are a lot of misconceptions out there about Accutane that I hear about from my patient population. And I think it’d be nice to put some information out there to set the record straight if you will. So Accutane is a medicine that’s been around since 1980, and it’s a pill that patients take for five to six months and it works a hundred percent of the time to clear up 100% of the acne. And for 85% of people it’s permanent. They never have acne again, it’s the only acne medicine that works that way.

Now, Accutane is kind of a big deal. You have to come in every month for an office appointment with your dermatologist. If you’re a female, you have to submit a urine sample at every appointment. You have to have your blood drawn twice while you’re on it, and it makes your skin dry and your lips chapped. But it’s a wonderful medicine that can really be a life changer for a lot of patients and their families that have been dealing with really severe acne. The most common side effect by far is dryness.

1:01 Dryness and what you can do about it.

Everybody gets dry chapped lips, dry skin. Sometimes you get a little bit of eczema. Sometimes you’ll even get a little bit of nosebleeds. The dryness really happens to everyone, but it’s manageable using lotion, using chapstick, using eyedrops, using nasal sprays. All of these things help minimize it.

1:23 Aches – who gets them

Some people get achy on Accutane and people most commonly feel it in their lower backs. It tends to be mild. And it’s a little bit more common in boys than girls.

1:34 Bloodwork how often and why

We have to do blood work for Accutane. So we have to do it twice. Once before you start the medicine. And once after you’ve been on it for two months, we’re checking liver tests and triglycerides, which is a form of cholesterol. The lab monitoring is actually much better than it used to be. We used to check people on Accutane every month with blood work. And then about four years ago, the guidelines changed to just twice, which is very nice.

1:58 Mood issues, depression and anxiety side effects

The medicine has rarely been associated with mood issues, things like depression. And so I always ask my patients if they have any prior history of depression or anxiety, um, because that’s important information for me to have to, um, uh, sort of, um, estimate their risk. And every month at our Accutane followup appointments, me or whoever, whichever dermatologists you see to prescribe Accutane will ask you about your mood and make sure that you’re doing okay.

In reality, the risk of depression on Accutane is exceedingly low. I’ve been in practice for 11 years and I’ve had six patients become depressed and have to stop Accutane. And Accutane is a medicine I prescribe every single day. So it happens, but it’s really quite rare. And the good news is, is that those six patients, they stopped their medicine and they went back to normal. It doesn’t produce any long term mood issues.

2:51 Is there a bowel disease connection?

And then there used to be commercials from lawyers talking about a possible association with inflammatory bowel disease, which means things like Crohn’s disease. We’ve done numerous studies showing that there’s no association here and there’s no increased risk of inflammatory bowel disease on Accutane. I haven’t seen a commercial from a lawyer for a really long time. So hopefully those warnings are going away.

3:12 Can I drink alcohol with accutane?

Because Accutane is metabolized by the liver, we do check liver function tests for patients who are on Accutane. And we don’t want other things hurting the liver at the same time, alcohol being one of them. So if you are an adult 21 years of age and older, and you were enjoying a glass of wine with dinner, that’s okay. But we would discourage people from doing much binge drinking on Accutane, just because you don’t want to put too much stress on your liver.

3:42 Will it change your vision?

Some people experience eye dryness on the Accutane, and that can cause blurry vision and things like that. So we treat that with eyedrops. Um, and then rarely Accutane is a derivative of vitamin a and if you have too much vitamin a, you can have difficulty seeing at night. And so we don’t see this with Accutane all by itself, but if somebody is on Accutane and also taking, um, vitamin a supplements or, you know, just a lot of vitamins that have vitamin a in them, then they can start having trouble seeing at night.

4:16 Will I have hair loss issues? Telogen effluvium on Accutane.

So, um, a lot of people, that’s a very common misconception. They may have read or heard about people having hair loss issues while on Accutane. So there have been reports of patients on Accutane undergoing something called telogen effluvium. So telogen effluvium is where your body is going through a stressor. It can be emotional, it can be physical like a surgery. It can be having COVID and recovering from that. And your body just decides that it has bigger fish to fry, and it’s going to focus its energy more on what it needs for its general health and wellbeing. And so it puts your hair in a shedding phase. And so you get a programmed hair shedding called telogen effluvium. And there’ve been a few people on Accutane that have experienced a telogen effluvium just from the stress of going through the whole Accutane process. Prescribing Accutane every day for the past 11 years, I’ve only had maybe two or three patients that have developed telogen effluvium. So it’s really not very common.

5:13 The biggest deal: birth defects

The biggest deal for Accutane and why it has kind of a big deal feel to it is because it causes horrible birth defects. If a woman takes it while pregnant, now it doesn’t do anything to a woman’s fertility or for her ability to have happy healthy kids down the road. But if you got pregnant and you were taking it at that time, it hurts the baby. And so that’s why the medicine is so highly regulated. It has no increased risks of birth defect issues for boys on Accutane ever. It’s just females who get pregnant on the medicine. The medicine is very bad for that baby. That’s why we have to do the urine sample every month for females, we actually have to run a urine pregnancy test on it. Girls have to answer questions every month about how they know this medicine would hurt a baby. If they were to get pregnant and they have to pledge that they are preventing pregnancy.

6:06 Do you have to be on birth control while using accutane?

One misconception about going on Accutane is that you have to take a birth control pill. If you are a female going on Accutane, that’s actually not true. The program has several options of pregnancy prevention that you’re allowed to choose from. And one of them is abstinence, meaning that you’re not going to have sex. So you do not have to take a birth control pill in order to go on Accutane. The risk is real. The birth defects are awful. It’s every dermatologist worst nightmare to have a patient get pregnant on Accutane, but it’s important to realize that it doesn’t do anything longterm to disrupt fertility or the ability to have happy healthy kids down the road. In fact, Accutane is out of your system 20 days after you stopped taking it. So it would be perfectly normal and healthy to get pregnant even a month after you finished the medicine.

6:50 Insurance coverage for Accutane

Accutane is very well covered by insurance. It’s generic. In fact, some people have heard that Accutane has been removed from the market. The reason people might have heard that is because brand name Accutane. They discontinued that a long time ago. Accutane as a medicine is 41 years old. It came out in 1980. So the brand name fell to the wayside a long time ago. We have four excellent generic versions of Accutane that we considered to be all equivalent to each other. And those are very well covered by insurance. Um, we also work with a pharmacy that offers a discounted cash pay price. If for some reason, insurance isn’t covering it.

7:28 Isotretinoin is the generic name

Isotretinoin is the generic version, generic name of Accutane. I think we all still refer to it as Accutane, even though brand name Accutane was discontinued a long time ago. But the generic name is isotretinoin.

7:45 How is Accutane related to tretinoin (known as Retin-a)

How’s it related to tretinoin? So tretinoin is in a member of a class of medicines called the retinoids and we have three topical retinoids. Actually, now we have four topical retinoids, adapalene and tretinoin, and tazarotene are the generic ones. Accutane is in that family, but it’s a systemic retinoid. So they’re targeting similar receptors in the skin. That’s what they all have in common. But certainly, they are different formulations of medicines in the same family. So they are kind of sisters or maybe even cousins to each other.

8:19 How old should a patient be before trying accutane?

In terms of age of treating patients on Accutane, the youngest patient that I’ve ever treated was nine years old. And actually in the same year, I had two female nine-year-old girls with just horrible nodulocystic scarring, and both of them ended up having to go on Accutane.  It’s very unusual to have acne that severely insignificantly at such a young age. Those were unusual circumstances. The classic age for a patient going on Accutane is probably somewhere between 13 and 18. These two particular nine-year-olds, because of the significance and severity of their acne, I had them see a pediatric endocrinologist for a hormone workup and evaluation, just to make sure that all was okay. It was. They just happened to have really severe acne, so we started them on Accutane. So there’s no defined age restriction for Accutane.

We basically use it when we need it to control significant acne. The youngest patients that I have put on Accutane have been nine years old, but there are no rules or regulations about how young you can go. It’s just who needs it, which actually brings up a good point. Who needs Accutane?

9:30 There are 2 groups of good candidates for accutane

I think there’s two groups of people, two groups of kids, teenagers, adults that could benefit from Accutane. The first are the people with just horrible nodulocystic scarring acne. You know, I walk in the room and before I even sit down just a quick glance at the patient, I’ve already decided in my head that they would be a good candidate for Accutane because of the severity of their acne. The other group of patients are the patients that have tried really good medicines. They’ve used good topicals. They might’ve taken oral antibiotics. Maybe if they were a female, they tried a birth control pill or something like that. And they weren’t able to see the results that they wanted to or needed to. And so that I think is the second group of patients that could benefit from going on Accutane.

10:20 How does Accutane work?

Accutane works by shrinking your sebaceous lands. Sebaceous glands are kind of the Mecca of acne — they’re at the center of it all. And when you go through puberty, the hormones of puberty change your sebaceous glands, they make them bigger and they change the consistency of the oil that is secreted by those sebaceous glands. And that’s largely what causes acne it during puberty. What Accutane does is it shrinks those sebaceous glands down to where they were before puberty down to where they’ll be after puberty. And for most people that is permanent shrinkage, which is why Accutane offers a permanent cure for the acne.

11:00 When should a person get help for acne and what are the options?

I would say any time somebody is dealing with acne and is bothered by it, bring them on in there’s all sorts of stuff that we can do. We have tons of different topical medicines that we can use things that can be applied topically to the skin to help minimize and prevent the acne.  We have oral medications that aren’t Accutane that we can utilize in boys and girls to help treat the acne. So I think anytime anybody is struggling with acne, bring them on in. We can help. There are so many things that we can do to help these days. It’d be a shame to just kind of suffer in silence. We can help and I’m big on providing a list of options to my patients and their families. I’m not going to force one treatment down anybody’s throat. I will present kind of a list of things that are all reasonable and let the conversation and the patient and their family’s feelings kind of guide the treatment decisions.

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