Since the video sparked some interesting commentary here is a bit more information. I will never say that serious side effects don't happen, as this is the case with ANY medication. Here are some sources supporting the long term safety of isotretinoin. I wanted to go ahead and get these posted so any people considering Accutane could look at them. I think you will find these studies go along with what I described in the video. Isotretinoin Exposure and Risk of Inflammatory Bowel Disease jamanetwork.com/journals/jamadermatology/fullarticle/190229 1078 pts from 1995-2011 and 2006-2011, Mayo clinic Study did not show increased risk of IBD with prior isotretinoin use (if anything the risk decreased.) Despite this we still counsel our patients and screen for IBD before starting the medication. Laboratory Monitoring During Isotretinoin Therapy for Acne A Systematic Review and Meta-analysis jamanetwork.com/journals/jamadermatology/fullarticle/2471551 61 studies , 1574 patients, date from 1960-2013 Basically says we over monitor blood tests because the medication because while lab abnormalities are common they often self resolve and are not harmful. Despite these studies many dermatologist still check monthly labs. Psychiatric Adverse Events in Patients Taking Isotretinoin as Reported in a Food and Drug Administration Database From 1997 to 2017 jamanetwork.com/journals/jamadermatology/fullarticle/2737332 Anxiety and depression is higher in those with acne, you must consider this when looking at the data. Rate of completed suicide in patients taking isotretinoin may be lower than that of the general US population. On top of this our Accutane patients we see monthly providing a great opportunity to screen them for symptoms. Isotretinoin effects on bone www.jaad.org/article/S0190-9622(01)48092-3/fulltext Just a comment on this paper and to answer some questions about growth plate closure and such. Often times issues with isotretinoin and growth plate closure have occurred in children. Children being treat with isotretinoin for life threating cancers, these cancers often occur in young children around the age of 5. This is not an age range that we use isotretinoin in, so the growth plate closure is usually a moot point. Always has to be considered in younger patients with acne though. Risk of new-onset inflammatory bowel disease among patients with acne vulgaris exposed to isotretinoin www.jaad.org/article/S0190-9622(16)31289-0/fulltext There was no significant difference in the odds of developing IBD at 1 year between isotretinoin-exposed and unexposed patients with AV (adjusted odds ratio, 1.40; 95% CI, 0.95-2.05). With that said patients who are getting frequent checks with their dermatologist may be diagnosed sooner (than someone not coming in for checks.) Isotretinoin treatment for acne and risk of depression: A systematic review and meta-analysis Review of 31 studies, Isotretinoin isn’t associated with increased risk of depression but it actually tends to decrease depressive symptoms. Isotretinoin: controversies, facts, and recommendations www.tandfonline.com/doi/abs/10.1080/17512433.2016.1213629 Describes that when reviewing data there is weak evidence for increase depression, suicidality, or inflammatory bowel disease. Transient lab abnormalities are mild and not even worth stopping the medication. Long-term safety of isotretinoin as a treatment for acne vulgaris doi.org/10.1111/j.1365-2133.1994.tb08524.x Study of 720 patients, mean follow up of r5 years, but up to 12 in some patients. OF note most patients had a HIGHER dose than we typically give patients. 7.2% of patients did report mucocutaneous and some muscular symptoms, but the important thing is they were all mild. (dry eye, join aches, eczema flare up) There were no serious long term side effects. Isotretinoin for acne vulgaris-10 years later; a safe and successful treatment onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-2133.1993.tb11849.x Follow up on average of 9 years with 88 patients, some up to 10 years. Patients were questioned about and examined for cutaneous and systemic adverse effects of isotretinoin. This include mucocutaneous and musculoskeletal problems as well as infections. No long term clinical side effects were identified in any of the patients, and labs were taken from 28 and no biochemical abnormalities were noted. Roaccutane treatment guidelines: results of an international survey pubmed.ncbi.nlm.nih.gov/9252756/ 1000 patients, from several countries, Mucocutaneous side-effects occur frequently but are manageable while severe systemic side-effects are rarely problematic (2%). Essentially supporting that Accutane should also be used in more mild cases if scaring or psychological stress if caused by the acne.
Please don't be discouraged, it could easily be the same person with alt accounts thats leaving these accusatory and obviously false statements. Maybe its a stretch but some people believe in fox news, so it's not that suprising that some fall for these fear-inducing (and at best anecdotal) stories. It's helpful that you're educating people that are on the edge of potentially getting their life quality enhanced so much :) Keep it up!
As usual, most dermatologist just discusses the common "temporary" side effects but never mentions the serious side effects associated with the drug. Is the drug effective at clearing acne? Absolutely, but is it worth gambling your health? I'll admit that it works for the majority, but there's a sizable group of people who have been injured by this drug. This is a fact and not some anecdotal story to cause fear mongering. I say this because I've taken Accutane in the past and am experiencing the side effects after years of cessation. Accutane gave me dry eyes (MGD), osteopenia and chronic neck pain.What bothers me is that most dermatologist will downplay the side effects and mention that you'll be monitored closely with blood works to give you a some sense of assurance. They are oblivious to the fact that it could take years for the side effects to pop up for the patients to notice thus giving the dermatologist the false idea that they've never or rarely encountered patients who had long-lasting effects. Patients don't go back to their derma for dry eye, neither for IBS nor muscle pain. I went back to my derma after 5 years of not seeing her after the accutane course and told her about my condition and that people who have side effects from accutane aren't rare. I'll leave this tidbit, I've been to two nationally ranked eye centers at John hopkins (wilmer eye) and U Penn (Scheie). They have a questionnaire for new patients and would you like to know what's one of the first question? It asks patients of past isotretinoin use. It's very telling about the safety and supposed rarity of long term side effects when Jon hopkins and Upenn hospital has it on the top of their questionnaire.
Thanks for the comment, been involved with prescribing this since 2006 and have never seen a case of anything you mentioned. Wish you the absolute best. Everything in the video was based off of scientific publications of the latest research and not anecdotal stories like your comment.
Accutane was initially intended as a chemotherapy drug. They stumbled across it working for severe acne. So now it's prescribed to our teenage kids. After taking it and experiencing years of muscle pain, joint pain, chronic fatigue, IBS, nose bleeds, B12 deficiency, magnesium deficiency, low testosterone levels, excessive dry eyes (MGD), you don't go back to your dermatologist. So that's why this Doctor says he doesn't know of any of those cases. You'll spend years going to many different doctors in various departments, that don't know how one area of the body links to the other. This is literally poison for your body!! Start with your diet and try to cut out dairy and grains as much as possible, to determine whether you might have food sensitivities.
@yemuraichizema1867 am I sure? Are you referring to the comment about it being a chemotherapy drug? If so, please do your own research and you will discover the same. Everything else I commented is what my son has struggled with over the last 9 years.
Did an accutane treatment in 2019 and all I can say is I am SO sad I waited until my 20s were almost over to get flawed skin. I don't regret it at all, HOWEVER, I did experience telogen effluvium and lost so much of my hair 😥. I went from thick curly hair to dry, thin, limp hair. I keep a very healthy diet, take supplements that dermatologist recommended and make sure to be very gentle with my hair and it's finally growing back. I wish the cost of clear skin wasn't losing my hair... I wish I had known this could happen. It's so sad/frustrating to get rid of one insecurity, my acne, only to trade it for another one, super thin hair. Wishing everyone who goes through accutane health and success, and I hope you all are able to keep your hair ❤
Samantha thanks so much for sharing! So sorry to hear that you had telogen effluvium with your accutane course that that is terrible to develop something else that you prob have to think about everyday. Hopefully your dermatologist can make sure your labs are good and make some recommendations to help regrow some fuller hair with time. Chronic telogen effluvium is more rare but it does happen. Thanks again for sharing and I wish you the very best!
Hello, I have some questions: 1. If I get severe migraines frequently, is this safe to take? I have heard of brain swelling. Although it's rare, does it put me at a higher risk? 2. Is this medication safe to take on the keto diet? 3. I already have very dry eyes. How much worse do you think it would make it? 4. The doctor I saw put me on spironolactone and doxycycline. Is it safer? -I have recently seen a dermatologist and have told him everything above. He wanted to put me on accutane, but I am reluctant due to the issues I've been having. I am asking these questions for a second opinion and would appreciate your feedback! Thanks, Courtney😊
make changes to your lifestyle, sleep, diet (lots of fruits and vegetables), water, exercise, mental health. Completely avoid dairy, sugar, and gluten at least until your acne improves. Look for videos that talk about this, although dermatologists tell you that diet does not influence acne, lifestyle is key in treating acne. Try it and see, but be patient
Hey Dr MD, I just recently found your channel as I was looking for accutane videos that maybe tell the reasons why acne relapses after stopping it for some time but could not find any. I was hoping if you could state some reasons? I even took a second course but it was ineffective at treating my acne unlike my first time on it. My acne is back and I am feeling down. My dermatologist suggested I do yellow laser but it is still not as effective at treating my acne compared to accutane. I would like to hear your opinion on this.🥺
I couldn’t give you an exact reason why some do and most don’t. They way we dose it is what’s shown to cure most peoples acne permanently. Some people have to have 2 courses and incredibly rarely !
I'm almost a week on accutane for hormonal acne, currently 24 years old. How does it come that in Belgium they give lower dosages from 10mg to 30mg dependant on each case over a long time period and in the USA they give sometimes 80mg or more like that is very concerning to me. Could you explain this briefly please. By the way a very informative video. I have no side effects so far but I allready have slight dry lips year round so I'm pretty used to using vaseline each night on my lips. Also could it be a problem for me because I have allready atopic skin on some parts of my body
I’m so sorry that you had that side effect. Some hair thinning can happen in patients. I’ve personally had 1 patient with some reported hair thinning since 2006. Most cases as temporary, mild, and improve once off the medication. Wish you the best!
Doctor, could you possibly provide some feedback? Five months ago, my derm prescribed accutane. I barely had any acne to start with, but she said to use it. I always had normal skin (not too oily, not too dry - I was right in the middle). I started 60mg per day (30mg day, 30mg night), taking it for 7 weeks (I am 185 lbs). I quit after 7 weeks bc I noticed SEVERE dryness on my entire forehead: wrinkles, fine lines, dry visible pores. I’ve now been off Accutane for 3 months & the dryness remains. It’s like my forehead was stripped of 100% of its oil. It corresponds directly with the accutane making my whole forehead super red & pulsing while on it. It’s like crepe paper, like HUNDREDS mini horizontal fine lines that look like “crinkled saran wrap”. When I try to pull my skin up to see if all the crinkled skin flattens out, it doesn’t, all the lines just turn vertical. :,( It looks so fragile in this way & to the touch. I also get nosebleeds still, 3 months later! Ugh. The doctor that prescribed me it says none of this is due to accutane, which is just crazy. Before accutane, my whole life (37 years), my forehead had oil & no texture whatsoever. I also never got a single nosebleed my entire life. So frustrating to hear my prescribing derm say these effects are not due to accutane. So I’m asking around, and would like to know if you think this texture will go away & my sebum will return. I’m distraught. I’m heartbroken. I really am. Thank you for your time & consideration.
I share my case so you think twice before taking it. My acne problem started at the same pace as my bowel problems, so I believe both are related and the IBS began after antibiotics, so I believe my whole problem started after taking stupid antibiotics. Before taking accutane I had a lot of hair but I noticed in the shower that there was always hair stuck on the sink, so to some extend I believe that I was already losing more hair than normal people do but I didn't notice it because the growing rate was by far superior (I was 30 y old), so if you are already losing hair (while showering you will notice this) then likely accutane will have a negative impact in your future hair... one way to know is just show how much hair you lose in the shower to your friends and ask them if they lose the same amount, if they tell you that you lose more, then you are likely going to suffer a dramatic hair loss with accutane (TIP 1). My IBS problem was more of a loose stool type. On month 5 with a 20mg accutane dose per day (low dose) my lose stool slowly started to become harder. There was a week that was perfect, like the dream stool you want to have after living with IBS, but of course it kept getting harder and harder to the point that I had a constipation. So my advice is: "drink tons of water" (TIP 2). I guess I did but still it happened. So due to this, because I valued more my digestive system I stopped the medication and I didn't care anymore. Acne was gone but that doesn't mean that your face becomes like a baby butt, not really, only the bumps go away, everything else remain, dark spots are there, also your dry skin makes your face older and uglier so don't expect something beautiful. Of course if with acne you look like a monster, then definitely you will feel beautiful with dark spots and dry skin, in my case I only had horrible bumps on my forehead, which went away but the rest of my face suffered no improvement and actually looked worse due to dryness. I also had joint pain, that was horrible. Before accutane I used to run 5km in the park every other night, while on accutane after 1km I started having horrible joint pain and I couldn't continue. I went to the doc and they showed me that this liquid layer that is in the joints was thinner than before. This problem lasted even a year after stopping accutane, but it ended like 6 months ago, so 1.5 years later joint pain is gone :). Coming back to the constipation, well on the month that I stopped accutane, I experienced the most horrible nightmare. I lost the feeling to go to the toilet for one month. It was a horrible experience because I ate everyday but for a full month I didn't go to the toilet, I thought I was going to die from inside out, of course I could take this "strong" medicine for constipation (because the soft ones that you easily get in the pharmacy were no longer effective) but the doc told me that I may need to always use it to go to the toilet, he mentioned that some people live with that. I got afraid and that's why I tried not to take this "strong" medicine and instead did sports and many other things. It improved dramatically with psyllium grains (TIP 3), that was amazing, of course it slowly improved and today all is fine, actually it is even better than ever but this is due to a total change of diet. It is while changing my diet that my acne improved (yes because it came back later on), which confirms the relation with IBS.. so my advice here is: "if you suffer with IBS, be prepared to stop accutane if this condition gets worse, so likely you won't finish the treatment and be prepared for that" (TIP 4). As I said my acne improved more thanks to a total change in my lifestyle and diet, it does not necessarily mean eating healthier, it means eating different than before. For example believe it or not I started eating burger king meals and my IBS improved, as well as the acne, but of course I added multiple grains in my breakfast and so on but the key ingredient in my case is that I moved to a different country, got a different job, a different life basically, so I experienced a 180 degree change in my life and improvement came (TIP 5). Anyways, let's go back to the time I stopped accutane... once I stopped accutane my hair started to fall heavily. I said that I had a lot of hair so I didn't mind, according to me I was going to successfully pass this phase..however I forgot to add to the equation that I was already losing hair in the shower before starting accutane, so please add this to the equation (TIP 6). I suffered a hair volume loss that up to date, more than 2 years later, remains. Due to my age I guess there is no way back. I keep losing hair, today, the growing rate is identical to the losing rate, meaning that literally I don't need to go to the barber shop in months, before I had to go every month. Because of all what I said my conclusion is that accutane makes you age faster... for example if you are already losing hair it will make you lose hair faster. My skin up to date is drier than before and there is no way back because I'm also aging and with accutane it has been faster... we all are aging so expect that you will age faster with accutane, even after stopping it (TIP 7). Teens won't fell this because if you are for example 20 y old, then with accutane you will be 25, which is still good, but if you are 35, be mentally prepared that your whole body will look like a 40 y old person, be prepared that your dry skin won't go away because while aging you already lost the remaining collagen that you had, this is my assumption, so I think it was a mistake taking accutane because of this...and another thing that you should be prepared to is the fact that in your future you will have a different hairstyle... would that make you happy? think twice about it? (TIP 8).. For example in my case, as i said I got less hair volume on the front side, this is interesting because thanks to that now I can easily comb my hair backwards, in the past I couldn't because there was so much hair on the frontside. In other words, now I can have a totally different hairstyle than before, that is great, the big problem is that acne is back and my forehead sucks again, so I cannot profit from this new hairstyle as I need to cover my horrible forehead, and instead of combing it backwards, I comb it forwards and because there is less hair volume it looks crappy... so accutane was not worthy... specially because in my case I saw a dramatic improvement when I had 180 degree change in my lifestyle and diet... however... I do recommend accutane to people in their 20s..because even if you will age faster you will still look fine... your collagen is still great at that age :). For older people i recommend moving to a different country and dramatically change your diet.
Thanks for sharing your story and so sorry that you went through all this hardship I hope you have the right support around you both physicians and family to get you through everything. Wish you all the best.
I’ve been prescribing it for 6 years and before that was a nurse for 6 years so in the last 12 years I’ve never had a patient mention a single sexually related side effect to me
@@SwoleMDSkincare that is reassuring as my son just began this. If you google it, it says upwards of 30% have this affect and often permanent. There is actually a facebook group dedicated to Accutane side affects and ED is one of the top complaints along with Chrohns.
I'm a 19 years old girl, and my dermatologist recommended me this. After using it, my skin burns like it's burned by fire, and the area on the skin where I use it feels like plastic and burned Should I still use it or not?
Do not take this. I was 18th mths on this from 14- 16. Later down the road having a urologist about to refer you to the next step up. Do not take this ever. Made high school better. Having kids and no explanation for kidney stuff. You could not pay me to tell someone to take this. Because it comes back later.
@@SwoleMDSkincare i did, she told me 20 mg for 4-6 months a day. But i think (because of a lot of other videos online for dermatologist) it is not the right amount and it has to be more.
Accutane is dangerous. It is the only super effective treatment but I think it should only be given for severe acne. Do you know that the marines will not accept you if you have ever been prescribed this medication? Accutane can cause depression, anxiety and suicide and these do not necessarily go away after you stop taking it. I’m guessing this is because vitamin A is fat soluble and the brain is fat or maybe it effects the neurotransmitters during the teenage years when the brain is still developing. Either way, I know this medication works very well but it should be reserved for severe acne. We can treat scars but can’t bring anyone back to life.
I hear you Heather thanks for sharing your thoughts on Accutane. I agree it is the only super effective treatment for servers acne and I agree generally it should be reserved for severe scarring acne that’s be resistant to other treatments. The good news is we have lots of long term studies on accutane and it’s safety. Like with any medication there is risk which I always discuss with patients. Generally though most patients usually only experience temporary skin dryness!
Hayden that's certainly understandable! Good question, best to talk to your dermatologist. I havent personally seen this, but this medication is used in other conditions at much higher doses, and I know it has been reported in those situations!
Dr, I know it may sound ridiculous, but I have been using minoxidil foam once a day on my face in order to fill the bald spots of my beard (It was been working so far but still have a few more months to go). I am just starting my Accutane treatment and took my first pill today. Do you believe it's safe to put 5% minoxidil on my face while on Accutane? What about derma rolling? I would really like to do both simultaneously, but don't want to mess up my face. I think it's also important to say that I barely have any acne on my face, it's pretty much just cystic acne on my back and my chest. Let me know what you think. Thanks
I believe most people would say avoid derma rolling during Accutane. It only recently became "ok" to start doing cosmetic treatments shortly after a course of Accutane. Previously we use to wait 6-12 months as some worried that Accutane would delay healing. Seems that is old news in a way. Always best to talk to your dermatologist and get their opinion since they know you, the severity of things, and your acne the best!
I agree risk and benefits should be discussed with your dermatologist this is generally a treatment for people who have failed other acne treatments or are having issues with acne scarring. Fortunately we have many long term studies to support its benefit and safety.
I’ve never had someone have any issues with floaters or worsening floaters. But as always best to discuss medical treatment with your dermatologist directly.
accutane did not cure my acne. in 2019 i started to get really bad cystic acne. and then got on accutane 10mg daily for 1 year. acne cleared up within the first month. although one month after i got off, acne came back. my doctor prescribe another treatment of accutane, for 6 months. My skin was flawless while i was on accutane, but after i got off, it came back once again. i got on accutane again (yes this is the 3rd treatment), 20mg for 11 months. Again, flawless skin, but once stopped, the acne came back. Now, i still suffer from acne, and on top of that, my hair has thinned around 50%.
@@Anon-nv7bp the shedding happened throughout the treatment. but i never really took it seriously as i always had so much hair as a kid. Now, 11 months since the end of my last treatment, my hair had stopped shedding but it had thinned tremendously. i believe it will grow back, but might take time as i was on Accutane for nearly 3 years.
Please answer🥲🥲 Hi I'm using medicine for 2 month and my hair is shedding🥲 My front hair is so bad i can see my sculp im 17 Im using it twice a week should i reduce it to once a week? And for my hair to regrow what u suggest? Should i consume zink? And biotin
Thanks so much for the message!! You gotta talk to your doc about this right away. They know you best and they are the best suited to give you the best advice!!
I would talk to your dermatologist about this, I’ve been lucky to never have had one of my patients have a single sexual related side effect in the clinic since 2006.
Good question it’s not a side effect that I usually see in my patients! I usually counsel them to eat healthy while on it because it can make your cholesterol go up so maybe that’s why?
I have Telogen Effluvium during my accutane journey right now, took 120mg/kg over 8 months but I am supposed to stay on it for longer with 10-20mg per week. My hair shedding has stopped after starting 4 months ago, is it therefore possible that my hair will come back at such a low dosage? Also, since dropping my dose to 2x10mg per week I experience insane fatigue. Is this normal? Because I have never experienced this while taking it daily!
I would never say never. People react to medications differently, its not something I commonly see. Hair loss on accutane is less common than with other oral retinoids.
@@zhaohuang9907 same here, how is yours now? Im so scared this is never going to stop..I’m at 5 months stopping and my highest dose was 30mg in 3rd month.
I recently started acutaine 2 months ago. I am a runner and I lift weights almost ever day. I am 14 and have been having very sore legs and it is almost impossible to run. What do you recommend? (Track season is just starting so I need to get back to it)
I would discuss with your dermatologist! Sometimes we alter the dose depending on the side effects! Def would talk to your dermatologist since they know you best. I definitely see more muscle aches in my patients who are athletes.
The vast majority of people taking accutane have no issues with hair loss, in practicing 5 and 1/2 years I’ve had one patient with temporary hair loss during therapy. No great preventative strategy though! Great question!
I've been on accutane 3 times in the past 2 years every time it came back 1 month after a 6 month cycle. First two times were 80mg a day and 3rd time it was 120mg per day. Nothing works and I've tried the multiple creams and antibiotics. What do I do now? Dermatologist wants to put me back on accutane and says there is no other cure because my acne is hormonal.
make changes to your lifestyle, sleep, diet (lots of fruits and vegetables), water, exercise, mental health. Completely avoid dairy, sugar, and gluten at least until your acne improves. Look for videos that talk about this, although dermatologists tell you that diet does not influence acne, lifestyle is key in treating acne. Try it and see, but be patient
Thank you so much for posting this!! Such a great video. I have done two rounds of 60mg acutane, approximately 6-8 months in duration. I stopped my second round in March and unfortunately I’m starting to see my acne come back. What would your recommendations be?
Vanessa! So sorry to hear that you Accutane is coming back, did you complete two 6-8 month courses! It is super rare for someone to need a 3rd course, but best to talk about it with your dermatologist in person.
Hi Dr G. Thank you for taking the time to reply back. Based on your clinical practice do you feel a third course be effective or perhaps pursing other medications such as spironolactone?
Thankfully my primary concern was dryness. I would say my lips were always dry 24/7, despite which lip ointment or treatment I used. I wish this video was out prior to my accutane journey so I never tired Dr Gs lip ointment recommendation. My lab work was always normal, I live a pretty healthy lifestyle which helps, and my hair loss was very minimal. I did not experience any mental health issues. Hope that helps
@@SludgeMan90 I have been lucky enough to prescribe this medication personally and regularly follow up with my patients over the last 3 years. Before that time I worked as a nurse in a dermatology office for 6 years I helped with 100s if not 1000s of patient's on this medication. So you are right, I have been doing this just under a decade. You know how many patients I have encountered that have become permanently disabled from isotretinoin. Zero. I realize that my less than a decade of direct prescribing and following up with patient's isn't enough as this is basically anecdotal evidence. I put my trust in the preponderance of peer reviewed scientific evidence that supports isotretinoin as being a safe and effective treatment for moderate-severe / scaring / nodulocystic acne. There are long term studies that support this and I would say there is nearly no scientific disagreement among trained professionals in the healthcare field. I take the time to write this not because I think I will change your mind, which I am sure is already made up, but to ensure that other people watching this video or searching the internet for a solution to their severe acne don't write this treatment off, as it is simply the best one out there.
