There are many Accutane myths and with them often come a little bit of truth. In this post and video, Dr. Swanson seeks to dispel the myths and clarify the truths to your most interesting questions. Will Accutane shrink your nose? Does it help with hormonal acne? And wait—can it stunt a teenager’s growth?! Dr. Lisa Swanson, a highly respected pediatric dermatologist, unpacks these wild questions and more. Her expert insight will help you decide if Accutane is the right step for you.
This is the transcript from Dr. Swanson’s Accutane video:
Will Accutane stunt a teenager’s growth?
Dr. Swanson: “This is a common question that I get asked because of course we want all our teenagers to grow up big and strong. And so any medicine that we give to our teenager, we wouldn’t want that to impact it. And there’s a lot of information out there about Accutane, especially on the internet, and some of it’s true and some of it is completely false, and some of it has a little bit of truth to it, but it’s been misunderstood or misinterpreted, and I think the growth concerns fall into that last category where it has some truth to it, but it’s been misunderstood and misinterpreted. We use a medicine similar to Accutane in young patients with a genetic skin disorder called Laic theosis. And these patients with Laic Theosis, they take a medicine like Accutane starting around age two, and they take it their entire lives.
And in those patients, they tend to have a bit of shorter stature, and people have wondered if that’s due to the Accutane over the years. We don’t even know for sure if it is, but that’s one of the hypotheses now because we note that with the use of a similar medicine in LaMere Theosis, that information has got kind of misinterpreted as potentially causing growth issues in teenagers on Accutane. And we have never seen growth issues in teenagers on Accutane. And it has to do with the doses we use. It has to do with the duration of treatment, and it has to do with the fact that we’re starting the medicine during the teenage years and not when patients are two years old. So can oral retinoids impact growth? Yes, they can. But does Accutane impact growth in teenagers? I would say no, it doesn’t.
Will Accutane help with hormonal acne?
Dr. Swanson: “Well, yes, because really, when you think about it, all acne is hormonal. Hormones are at the basis of pretty much all acne, whether you’re a boy or a girl, whether you’re a teenager or a patient. My age, hormones are at the crux of acne period, and Accutane is able to treat all types of acne. In fact, it’s the only thing that works for a hundred percent of patients in the world for acne. It’s the only thing that has that high degree of success. So it will work to treat hormonal acne. However, Accutane is a permanent cure for about 85% of the patients who take it. If you get recurrence of your acne post Accutane, that is a sign that the hormonal drive towards acne is strong in you. The force is strong in you. And so sometimes we can help mitigate that risk by using medicines in our female patients like a birth control pill or spironolactone, which can be used for acne that recurs after Accutane.
It can even be used post Accutane to prevent acne recurrence. So Accutane does work to clear up hormonal acne, but if you continue to have recurrences of your acne post Accutane, that’s a sign that that hormonal drive is strong. And if you’re a female, you might want to consider something like spironolactone or a birth control pill.”
Does Accutane get rid of blackheads?
Dr. Swanson: “Yes, it does. Accutane treats all types of acne. Comedonal, which includes blackheads and little white bumps, inflammatory, which are the red bump acne with the pustules and even nodular cystic acne. Accutane will treat all of it. Now, occasionally we’ll have patients who are four or five months into their Accutane treatment and they’re mostly clear, but they have some persistent, deep seated blackheads that just haven’t cleared up. In those situations, we’ll usually recommend a bit of an extraction to go ahead and extract those blackheads, and then the Accutane will prevent recurrence of them.
So occasionally we need to do something just a little bit extra for our patients on Accutane still experiencing some deep seated blackheads, but most of the time Accutane clears up everything a hundred percent of it.”
Will Accutane shrink your nose?
Dr. Swanson: “This is an interesting question that has a little bit of a multifaceted answer. If you are taking Accutane for acne and you’re a teenager, the answer is no. It will not shrink your nose. But sometimes we use Accutane off label for other purposes, and one of those purposes is something called rhinophyma, which is a form of rosacea that causes an overgrowth of the nose. And so there are some providers that will use Accutane in low doses to help treat rhinophyma and shrink the size of those patient’s nose. But if you don’t have that condition and you’re just on Accutane for your acne, it will not do that.”
Can Accutane make things worse before they get better?
Dr. Swanson: “Yes, it can. This is known as the purge. 10% of patients starting Accutane will experience a purge where they experience a worsening of the acne and things are brought to the surface during the first month of treatment. Now, often we can predict who those patients are going to be, and we can recommend some additional treatment to prevent the purge. Occasionally we don’t think a patient is going to purge and they do, but then we can initiate some extra treatment to calm down the purge. So the purge is a treatable, manageable, preventable thing that happens in about 10% of patients. So I wouldn’t be afraid to pursue Accutane treatment because you’ve heard about the purge. The purge is something we can deal with and nothing to be fearful about.”
Do you need to follow a special diet on Accutane?
Dr. Swanson: “Maybe a little bit. Accutane is a derivative of vitamin A, and so if you’re on Accutane, you don’t want to be eating a whole bunch of additional vitamin A. Now, most of the time, the patients who get into trouble with this are consuming vitamin A in excess without knowing it. Like in a nutritional drink. Some of those nutritional shakes like Slim Fast and Ensure will actually contain a great deal of vitamin A. So sometimes patients don’t realize that and they end up having trouble seeing at night. That is a symptom that you’ve had too much vitamin A. And so most of the time over exposure to vitamin A occurs as an accident. But if you are really addicted to carrots, you might want to reduce your carrot consumption while on Accutane, just because they are highly rich in vitamin A as well. The other dietary modification is that we want Accutane taken with a meal consisting of fatty food. It helps the absorption of the medicine, so you’re going to get more bang for your buck if you always consistently take your Accutane pills with fatty food, something like cheese, peanut butter, ice cream, meat, 2% or whole milk nuts, avocados, eggs, that’s going to help the medicine get absorbed better, which is going to help it work better for you.”
How long do you need to take Accutane?
Dr. Swanson: “For most patients, the typical course is about six months. Occasionally people need to take it a bit longer than that, but I would say on average it’s about six months. How many people need to take a second course of Accutane? Well, what I tell my patients is that for 85% of people, the first course is a permanent cure and they never have acne again, you still could get a pimple periodically because everybody gets a pimple periodically, but for 85% of people, they don’t get acne. Again, for those 15% of people who do notice some acne post Accutane, 10% of those, it is just mild recurrence and they might restart a topical acne medicine. And topical acne medicines actually work better after Accutane than before. So even if it’s a topical that you tried before, you took Accutane trying it after Accutane, it’s going to work better. And then 5% of patients go ahead and repeat a second course of Accutane. And so you can take a second course of Accutane if you need it. It’s perfectly safe to do so. And after a second course of Accutane, you have a 95% permanent cure rate. So it even gets more effective if you did need to take it a second time.”
