Accutane™ (AKA Isotretinoin) is a vitamin A derivative and it is the only known cure for acne.  It was first FDA approved in 1982 for treatment of severe nodular cystic acne. Since then, millions of people have successfully taken Accutane™ for the treatment of resistant acne. Dr. Craig Singer has personally treated more than 500 patients with Accutane™ with amazing results.

Yes it can. Original studies showed that 70% of people who complete a full course of Accutane ( cumulative dosing of 150 mg per kilogram) have permanent cure of acne. (Layton AM et al, British Journal dermatology 129 (3), 1993).  Some studies have advocated even higher doses of Accutane, 220 mg per kilogram, which result in even lower rates of relapse.

Those who are younger, under 16 years of age, often require a second course of Accutane to achieve permanent remission. However, patients should understand that even if their acne does relapse, it is usually not as severe as it originally was, and it is more likely to be responsive to conventional therapy.

The following people meet criteria for initiation of accutane:

1. Moderate to severe inflammatory acne (without scarring) that has not responded to conventional therapy (benzoyl peroxide, topical retinoids, topical and oral antibiotics, and adjunctive treatments).

2. Scarring, inflammatory acne inadequately controlled with conventional therapy

3. Those who are unable to discontinue oral antibiotic therapy without flaring of their acne.

4. Psychological scarring from acne

Accutane improves acne through a variety of mechanisms including anti-inflammatory, cellular differentiation, and sebaceous gland activity.

Simply put, Accutane shrinks the oil glands where acne causing bacteria thrive. This results in reduced bacterial counts and reduction in the body’s inflammation. In addition, it helps unclog pores.

It is true that there are a number of potential side effects to Accutane. However, the vast majority of these side effects are completely reversible.  Millions of people have taken Accutane over the past 30 years, enabling us to have good long-term safety data. If patients fully understand the potential side effects and how to minimize them, Accutane is a relatively safe drug to take.

The most common side effect of Accutane is extreme dryness, particularly of the lips. Most people need to apply lip moisturizers such as Aquafor, Chapstick, and other lip balms numerous times an hour. Your eyes may be dry with eyelid inflammation and we typically recommend artificial teardrops to minimize this risk– some people have difficulty wearing contact lenses, though most may continue to wear them. Sometimes, temporary decreased night vision is reported. Your skin will be dry as well and you’ll need to moisturize a couple times a day. 

At higher doses, you may experience joint aches, muscle aches, and low back pain. For some people this interferes with physical activity; however, most can tolerate these side effects.

You will also have extreme sensitivity in the sun, and you will be extraordinarily prone to sunburn. Therefore, you will need to take extra precautions if taking Accutane in the summer. – Some people defer accutane until the fall and winter because of this side effect.

Your skin will be very sensitive and will heal poorly with surgical procedures for up to 6 months after completing Accutane.  Therefore, we advise you avoid waxing, tattoos, piercing, elective surgery and laser procedures while taking Accutane and for 6 months upon completing the course.

Rarely, Accutane may cause your acne to flare in the first month or two of treatment, sometimes with severe flaring (acne fulminans).- This is usually minimized by starting out at a low dose of Accutane for the first month. In addition,pyogenic granuloma skin lesions may rarely develop in acne cysts as well as around fingernails.

Accutane can also elevate triglycerides and cholesterol, and may cause transient elevation of liver enzymes.- For this reason we do not recommend any intake of alcohol during the course of Accutane. Severe liver toxicity is extraordinarily rare and Dr. Singer has never had a patient (nor has he ever heard of anyone) who developed irreversible liver damage from Accutane.

1. The most serious side effect is the teratogenic effect on a developing fetus. For this reason, any female of childbearing potential must be on two forms of contraception or be strictly abstinent (for one month prior to the start of Accutane, during the entire course of Accutane, and for one month after completing Accutane). Studies show that fetal exposure to even tiny doses of Accutane results in severe malformations. Women who become pregnant while taking Accutane are strongly advised to terminate the pregnancy. It is important to remember that millions of women who have taken Accutane in their younger years have had no problems with future pregnancies.

2. There is controversy as to whether Accutane produces depression and suicide. In 1998, following reports to MedWatch, the makers of Accutane added an additional warning regarding possible adverse effects of “depression, psychosis and rarely, suicide. Following the new labeling however, larger studies failed to demonstrate a convincing link between Accutane and depression. Many studies suggest that severe acne is a risk factor for depression and suicide and that the majority of people who take Accutane have an improved mood (Accutane may act as an antidepressant for people who are devastated by their acne). To date, there have been no large well-designed studies that have definitively proven or disproven that Accutane causes or worsens depression. Dr. Singer has had a few patients who became moody and tearful or became angered easily after starting Accutane. These patients symptoms resolved immediately after discontinuing Accutane. If someone has a history of depression, and it is well-controlled/stable, Dr. Singer will prescribe Accutane as long as he works closely with the patient’s mental-health provider.

3. Accutane has also been implicated as a cause of inflammatory bowel disease, in the form of either Ulcerative colitis or Crohn’s disease. The data regarding Accutane use as a cause of inflammatory bowel disease is conflicting.  Some studies have shown no association while others have shown a 2 1/2 fold increased risk. No definitive cause and effect has ever been proven. Even in reports that demonstrate a possible causal association, the overall risk of inflammatory bowel disease in patients who take accutane is very small.

4. Accutane may rarely cause a condition called benign intracranial hypertension in which increased amounts of fluid develop around the brain leading to headaches and nausea. Fortunately this is a very rare side effect. Dr. Singer has only seen this once during his career.

Most people require six months of Accutane, and sometimes an additional month or two is needed.

We do require baseline fasting blood work before starting Accutane. And we will require additional bloodwork every month/ every other month during the course of Accutane.– this depends on dosing and whether or not patient has had any bloodwork abnormalities.

Women of childbearing potential will also need monthly pregnancy testing. This may be performed through either urine or blood. Home pregnancy testing is now permitted during the COVID-19 outbreak.

Two forms of contraception (one primary form and one secondary form)are required unless the female agrees to be strictly abstinent. Please see the I pledge program for further information.