For patients with severe cystic acne or for patients with moderate inflammatory acne that has proven to be resistant to oral antibiotics, isotretinoin is the most effective acne treatment available. In fact, it is the only medication that effectively controls severe cystic acne. Commonly sold under the brand name Accutane, isotretinoin is a vitamin A derivative that is administered in pill form.

Isotretinoin is an extremely powerful drug that stops all the changes in the skin that cause acne. It kills bacteria and reduces inflammation.

At the same time, it shrinks the sebaceous oil glands, reducing sebum production by up to 90 percent. It also slows up the growth of skin cells, which helps unblock hair follicles. Un-clogging the hair follicles allows pustules and cysts trapped below the surface of the skin to work their way to the surface of the skin, where they burst and heal. Consequently, many patients find that their acne actually worsens in the first month of Accutane treatment but starts improving thereafter. Anthony C. Chu explains: “In the first month on Roaccutane [the name for isotretinoin in Great Britain] acne can worsen.… In most patients acne slowly reduces in the first two months, but there is then a more rapid response and, again in most patients, the acne clears completely in four months.”

Taken for a period of four to nine months, isotretinoin is effective in 98 percent of all cases. However, in some cases acne symptoms return after isotretinoin treatment ends. In these cases, patients may begin a second cycle of isotretinoin treatment. A patient describes her experience:

After a few weeks on Accutane, my breakouts stopped dead in their tracks. I experienced no breakouts whatsoever for the remainder of the time I took the prescription. People with fantastic skin would come up to me and say, “I wish I had your skin.” It was pretty incredible. However… I was not one of the lucky ones. Although my skin has been more manageable since Accutane, I have experienced serious breakouts since ending my cycle. Even so, I remain very thankful that I took it. I would describe my acne now as light to moderate thanks to Accutane, and with my current regime [use of topical treatments] I stay clear.

Isotretinoin has also been linked to psychiatric problems such as depression, violent behavior, and suicide attempts. Scientists do not know why a drug that targets the skin affects the brain. They theorize that isotretinoin may lower serotonin levels in the brain. Low levels of this brain chemical have been linked to depression, violence, and suicide. However, this link is controversial. It is unclear whether isotretinoin actually causes these problems or if the emotional impact of acne itself, combined with normal mood swings common to adolescents, is the cause. According to the Food and Drug Administration (FDA), a government agency that sets standards and regulations for the safe use of drugs, between 1982 and 2000, 147 people being treated with Accutane either committed suicide or were hospitalized for suicide attempts. The administration also reported one hundred violent acts committed by people taking Accutane in 2002. One such act involved an Accutane patient who flew a small airplane into a skyscraper in Tampa, Florida, in January 2002, damaging the building and killing himself.

The number of attempted and actual suicides among Accutane users, according to Hoffman-La Roche, the drug company that manufactures the drug, is comparatively lower than that for all U.S. citizens ages fifteen to twenty-four, the age group most likely to be treated with Accutane. But for individuals who experience psychiatric problems while taking isotretinoin and their families, the danger that the drug presents seems clearer. For instance, Accutane has been implicated in the 2002 suicide of a fourteen-year-old in Palo Alto, California, who jumped in front of a commuter train while being treated with the drug. It is also a possible factor in the 2000 suicide of Michigan congressman Bart Stupak’s son. According to the congressman, “The side effects of Accutane are not worth it.”³⁰ In fact, the congressman would like to see to the drug banned until further studies into its psychiatric effects are completed.

Although the drug has not been banned, due to these and other cases it is illegal for doctors to administer the drug until patients Page 37 read a detailed medical guide, which describes the possible health risks that isotretinoin presents. The patient must then sign a consent form stating he or she is aware of the risks.

Another health risk that female patients are warned about in the medical guide is the risk of damage to unborn babies. Because everything that enters an expectant mother’s bloodstream also enters the fetus’s bloodstream, when expectant mothers take isotretinoin, the drug’s powerful effect can harm the developing fetus. According to the FDA, 35 percent of babies born to mothers treated with the drug during their pregnancies are born with birth defects. These defects include physical deformities, undeveloped organs, blindness, and mental retardation. Isotretinoin can also cause the death of the fetus before birth, premature births, or the death of the newborn baby.

For this reason, the FDA prohibits the dispensation of isotretinoin to pregnant women. In addition, female patients must take two pregnancy tests before the drug can be prescribed, and women are warned not to become pregnant while taking the drug. Therefore, birth control is mandatory for sexually active women taking isotretinoin, as are monthly pregnancy tests. In addition, women are warned not to become pregnant for at least one month after stopping use of isotretinoin, since it takes at least one month for the drug to clear a person’s system. A fifteen-year-old who took Accutane recalls her experience: “My doctor asked me if there’s any chance I was pregnant—right in front of my mother. It was embarrassing to go for the pregnancy test every month.”³¹

Despite the controversy surrounding isotretinoin and the side effects and possible health risks of other acne treatments, it is clear that acne treatments can lessen acne symptoms and help people have smoother, clearer skin. “Sure there were health risks,” a former acne patient explains. “But I still can remember the teasing, embarrassment, and humiliation the pimples caused. That was a hundred times more dangerous and painful than anything any medicine could possibly do to me. Getting treatment changed my life.”