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Everything You Need to Know About Accutane Before Taking It

Accutane may bring up images of acne-cursed teens, but adults well into their twenties and thirties are going on it. It's a pretty potent drug, so we're getting all the important questions answered for anyone who might be considering going on it--like me.
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Photo: IMAXtree

Photo: IMAXtree

The word 'Accutane' may conjure up images of acne-cursed teens, but adults well into their 20s and 30s are going on it. It's a pretty potent drug, so we're getting all the important questions answered for anyone who might be considering going on it--like me.

I've been plagued by breakouts pretty much my whole adult life--nothing cystic or marring, but just enough to be a pain in the ass. Worse, I have chest and back breakouts too. So after 10-plus years of going on and off different regimens, my doctor--celebrated NYC dermatologist Dr. Bobby Buka--suggested maybe it was time to bring in the big guns.

"Accutane used to be a medication that we only used for nodule super-scarring patients," Dr. Buka tells me, "but now we also use it on patients who are moderate that have been on antibiotics or other medications and haven't gotten better."

And it turns out it's not uncommon to prescribe the drug to patients well past their teens. I had a lot of questions about Accutane, so I hopped on the phone with Dr. Buka to get all the info I needed. From busting common myths to mitigating the side effects, here's everything you should know about Accutane if you're thinking about taking it.

(Oh, and P.S.: "Accutane" is a brand name that's no longer on the market--its pharmaceutical name is isotretinoin-- but since that's how most people know the drug, that's the name I'll be using.)

Who is an ideal candidate for Accutane? Dr. Buka puts patients on the drug who either have severe, scarring acne or those, as mentioned, who haven't had results with other treatment combinations.

But more importantly than that, women who are considering going on the drug should not have any interest in getting pregnant while on the drug, because it can cause some serious birth defects. Before you get prescribed, you have to fill out a bunch of paperwork, take two negative pregnancy tests, and use at least two forms of birth control--most commonly the pill and condoms--while using it.

For Dr. Buka, it all comes down to one thing: Responsibility. "A good candidate is someone who is communicative with me, compliant with getting the medication on time and doing lab work, and relating things back to me," he says.

How does the drug work? The synthetic vitamin A found in Accutane does two things: one, it drops the bacteria count in the hair follicle, making it an "inhospitable" place to live; two, it regularizes the keratinization of the follicle. In other words, "Accutane helps the steady flow of dead skin slough off the body as opposed to being stuck in the follicle." Hence, fewer breakouts.

How long will I be on Accutane? Your time on the drug is determined by a sort of math problem which involves total dosage over time. Dr. Buka explains that his average patient spends four months on the drug, but that is dependent on how strong a dosage they can handle.

"You can take a rowboat there with 20mg doses and get there in eight months, or you can take a speedboat with 120mg and get there in four," he offers as an analogy.

What kind of side effects can I expect? Most patients Dr. Buka sees experience harsh dryness, especially around the lips and eyes. He warns that you'll need to stay hyper-vigilant about moisturizing, reapplying throughout the day. Try using First-Aid Beauty's Ultra Repair Cream and a lip balm like Burt's Bees or Aquaphor. And Dr. Buka says about one in 20 of his "really active" patients will notice joint pain, which goes away once treatment ends.

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Dr. Bobby Buka

Dr. Bobby Buka

He adds that--knock on wood--in the thousand-plus patients he's treated, he personally has never seen any of the more serious side effects that they test for each month, which include liver inflammation, changing of blood cell counts (red or white), and an increase of fats in the blood.

In recent years, the drug has also received some negative press for increasing the likelihood of irritable bowel syndrome--but Dr. Buka says not to worry about it. "Just six months ago they released a double blind test and there was not a higher incidence of IBS," he assures me.

Wait, doesn't Accutane make you super depressed? Most studies, including all of the major ones, don't support this common Accutane myth that emerged in the drug's early years--in fact, many show the opposite effect of patients feeling happier with their acne gone.

There is one small study which runs counter to these, and it's why Dr. Buka asks all his patients if they have a family history of depression. Still, he says the drug "doesn't cross the blood-brain barrier," so he doesn't feel that Accutane can cause or worsen mental illness.

Is there a time of year that's better to take the drug? "It's kind of like, pick your poison," Dr. Buka jokes. The dryness can be particularly unbearable during the cold months of winter, but increased sun sensitivity can also put a damper on your summer beach plans.

Can I drink while on Accutane? One or two drinks is fine by Dr. Buka. "After that, we just don't have enough data to comment," he cautions, "but the liver clears both alcohol and isotretinoin, so it would make me nervous."

Should I use anything else to mitigate breakouts while on Accutane? "The nice thing about Accutane is that it is one of our few monotherapies, so we don't want you to be on anything else," Dr. Buka says. That means you can stop all the antibiotics (if you've been on any) and topicals. In terms of cleanser, you'll want to use something gentle, like Cerave or Cetaphil.

"My ideal patient doesn't need anything after, and certainly not during," he summarized.

Will my acne come back? Dr. Buka says about one in every 20 will need a second treatment, and some may need a mild retinoid treatment after. But most make it through without any.

--- I'm now just over two months into treatment and already I'm seeing great results and (so far) none of the negative side effects. As mentioned, though, it is a really difficult drug to get--before I can fill my monthly prescription, I have to get a blood test, a negative pregnancy test, have my doctor answer questions on the iPledge national database, answer a series of questions about the importance of birth control, and pick up my prescription within seven days of my doctor visit or else I have to start everything over. And I cannot schedule my next appointment until exactly 30 days after my last visit--which, considering I work full-time, is a bit of a nuisance--and I've still got a ways to go before it's over with.

It can do great things, but you definitely have to take this drug very seriously before considering an Accutane regimen for yourself.