George Woodbury MD 3/31/2023
Acne can have negative effects upon a person’s mood and self-confidence. And the most severe type of Acne – Nodulocystic Acne – can be really stressful for patients. The good news is that we Dermatologists now have a growing number of new options for Acne treatment, for people with dry skin, combination skin, or oily skin. One option for people with severe cases of Acne who may have failed multiple oral antibiotics is a medication called Accutane or Isotretinoin. Let’s take a look at what’s involved in Accutane treatment, my perspective being that of a Board-certified Memphis Dermatologist in Cordova TN, since 1993.
The best Acne treatment depends upon what type of acne the patient has presented with, be it comedonal acne (blackheads and whiteheads), papular acne (raised bumps), or nodulocystic acne, which is the most severe type. We Dermatologists also work to customize our treatment recommendations to whether the patient has oily skin, combination skin, or dry skin.
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Comedonal acne is usually managed with one of five categories of medications, from over-the-counter benzoyl peroxides and salicylic acid washes and gels to prescription medications including Retinoids (Vitamin A preparations), to topical (meaning for use “on top of the skin”) dapsone (Aczone® Gel).
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Papular acne is often managed with courses of oral antibiotics, to reduce redness and what’s called inflammation in the skin, from antibiotics like doxycycline and minocycline to sulfa medications. Rule #1: do NOT pop pimples, which simply leads to increased risks of leaving scars. Sometimes we consider an oral medication called spironolactone. We sometimes consider topical antibiotics including Cindamycin and Erythromycin. Sometimes we employ topical Winlevi® Gel (Clascoterone), an anti-hormonal medication that can reduce risk of scarring.
Since 2022, Dermatologists have also been able to use a promising new oral antibiotic with a quicker onset of action – Sarecycline® – and a newer retinoid gel – Trifarotene®. There is also a variation of acne – called Pityrosporon folliculitis or fungal acne – which can be treated with prescription antifungal medicines.
For severe cases of acne we Dermatologists consider a five months’ course of oral isotretinoin treatment, sometimes also called Accutane treatment, which works by drying up the oil glands and which is quite effective, but requires strict avoidance of pregnancy while on treatment, and monthly bloodwork. The goal of using Accutane for severe acne is to cut down on the risk of scarring – some of which can be severe – from underlieing Acne. And one of the real advantages of Accutane is that it is one of the few Acne treatments that tends to put Acne into remission – meaning that it clears Acne up and keeps that Acne clear when one comes off of Accutane – though as many as half of patient have a relapse after about six to eighteen months after coming off of Accutane
Accutane does have a substantial risk of causing severe birth defects if one becomes pregnant while on the drug or within 30 days of the last pill, so it’s mandatory for women of childbearing potential to use two forms of pregnancy prevention while on Accutane, and for one month thereafter.
Isotretinoin or Accutane may also be associated with mood changes, and there are ongoing studies on whether Accutane therapy is associated with increased risk of suicide. Many of these studies have not shown an association with suicide.
There is also the possibility that Accutane can be associated with inflammatory bowel disease (Chrohn’s Disease or Ulcerative Colitis). Many of these studies have not shown an association with inflammatory bowel disease.
There are other less common side-effects not listed here – including a severe breakout of Acne when some patients go onto Accutane – called Acne fulminans – as well as possible decreases in night vision and hair loss related to Accutane treatment – and other side-effects - so Accutane – though an effective medicine for Nodulocystic Acne - requires close supervision by the Dermatologist - with monthly office visits and monthly labwork.
​After 25 years of practicing dermatology, in 2016 I decided to establish a skincare products company - Big River Silk Skincare™ Inc. – of which I am the President - to manufacture and distribute organic skincare products for people going onto prescription therapies: AmberSoy™ Soap Gel and the GlycoShea™ Creams and Lotions. These products have been used for many years by thousands of acne patients in Tennessee and Arkansas, and they’re now available nationally. For more on these products, go to https://www.Bigriversilkskincare.com.
So if you or a family member has complexion issues or acne, consider getting a checkup from a Board-certified Dermatologist. My own Memphis Dermatology practice since 1993 has been with Rheumatology and Dermatology Associates, as a Cordova Dermatologist, in Tennessee (www.Rheumderm.com or www.Bigriversilkskincare.com) (1-901-753-0168). Or you can find a Dermatologist in your own neighborhood by going to the American Academy of Dermatology web site, AAD.org, then plugging your zip code into the “Find a Dermatologist” tab.
George Woodbury Jr. M.D. (01/24/2023)