What is Accutane and how does it work?

Accutane (also known as Isotretinoin), or Roaccutane as is also known in parts of the world, was discovered in 1979 when it was first given to patients with severe acne, most of whom reacted with dramatic and permanent clearing of their acne symptoms. It is a vitamin A derivative (13-cis-retinoic acid) which is administered orally in pill form, normally for 15-20 weeks (3.5-4.5 months). It was originally prescribed for people with severe acne that did not respond to other treatments, but has gained in popularity in the past 25 years and is prescribed more and more frequently for less severe acne. This practice is controversial because Accutane is a serious medication and causes side effects which can be as devastating as they are widespread.

Exactly how Accutane works on a cellular level is unknown, but we do know that it affects all of the four ways that acne develops.

1. It dramatically reduces the size of the skin's oil glands (35%-58%) and even more dramatically reduces the amount of oil the skin produces (around 80%).
2. Acne bacteria (P. acnes) live in skin oil. Since oil is so dramatically reduced, so is the amount of acne bacteria in the skin.
3. It also slows down how fast the skin produces skin cells inside the pore, which helps pores from becoming clogged in the first place.
4. It has anti-inflammatory properties.

Although acne may get worse within the first month of Accutane use, the ultimate results are usually dramatic. Accutane works to achieve partial or complete clearance of acne in about 95% of people who complete a cycle, regardless of whether they have inflammatory or non-inflammatory acne. The majority of people who take it see their acne effectively cured, experiencing long-term remission of acne symptoms. Studies show an average relapse rate of 25%, and in these cases sometimes a second course is given. This relapse rate is dose-dependent. Patients who receive a cumulative dose of 100-120mg/kg see the best results and lowest relapse rates. Patients who receive a lower dose relapse more frequently. Daily dosage depends on how much the patient weighs;0.5mg - 2mg/kg is typical.

Accutane need not be paired with other medications. For people who have problems handling Accutane, intermittent dosage is potentially an option and is being studied for effectiveness. Generic forms of Accutane may or may not be as therapeutic or safe. This is based on only one study which was performed in the UK in 2006. Out of the 14 generic brands studied, 13 failed to match Roaccutane (as it is called in the UK) in one or more tests and 11 failed in three or more tests. More studies like this one are needed to obtain better data on this subject.