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In this episode of 'Skinside Out Where Science Meets Beauty,' Dr. Zain, along with Heather and Courtney, delve into the world of Accutane (Isotretinoin). They discuss what Accutane is, its benefits and risks, the potential side effects, and why it remains controversial. The hosts examine common misconceptions, the detailed process of using the medication, and share personal experiences to offer a comprehensive understanding of this powerful acne treatment. For anyone considering Accutane or seeking reliable acne solutions, this episode is a must-watch.
00:00 Introduction to Accutane
00:52 Understanding Accutane: Benefits and Risks
02:59 Side Effects and Patient Counseling
05:02 Rare Side Effects and Mood Changes
09:08 Accutane Dosage and Monitoring
17:47 Accutane in the Media and Female Considerations
18:56 Understanding Monthly Dermatologist Visits
19:07 The I Pledge Program Explained
19:23 Accutane Availability in Other Countries
19:42 Accutane and Breastfeeding Concerns
20:22 Debunking Accutane Myths: Fertility and IBS
22:19 Accutane and Mental Health Stigma
23:58 Navigating I Pledge Protocols for Diverse Patients
26:13 Personal Experiences with Accutane
31:23 Accutane for Teenagers and College Students
32:18 Conclusion and Final Thoughts on Accutane
Creators and Guests
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
29 Skinside Out - Accutane
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[00:00:00]
Dr. Zain: Welcome to Skin Side Out Where Science Meets Beauty. I'm your host, Dr. Zane, with Heather and Courtney. So today we're doing a deep dive into Accutane. What is Accutane? Why is it so controversial, and what misinformation is out there? So I'm gonna go right into it with Heather. So what is Accutane?
Heather: Accutane, or the generic name is Isotretinoin.
Um, this is a medication that we often use [00:01:00] for nodular cystic acne, but we can use it for other things as well. Um, it is a vitamin A derivative, so it's kind of like taking a very, very high dose of vitamin A. Um, this will help to kind of turn your skin cells over faster and help to treat acne. Quicker, but also it's the closest thing that we have to a cure for acne.
So, um, again, we can get, kind of, get into the nitty and gritty of it, but that's the, the basics of it.
Dr. Zain: And this is a medication that's been around for decades, has been very well studied. So it is often a tool that we use to treat many of our patients who are suffering from severe acne. Um, so when we're counseling these patients, um, we go through a lot of information with them.
So I think that it would be kind of helpful to kind of go over that discussion that we have with patients. So, um, Heather, when you see a patient who has severe acne. And they have tried other, you know, [00:02:00] options have not had resolution, are worried about scarring. What do you tell them? How do you present Accutane to them?
Heather: So I oftentimes will ask how much does their acne bother them? Because some people definitely are not willing to. Put in six to nine months of taking this medication. Um, especially if they've tried a couple different things. And if they have scarring, then I definitely lean towards Accutane or isotretinoin.
Um. But I like to do this kind of run through of everything so that they know the benefits and the risks. So, um, the benefits, again, it's the closest thing we have to a cure for acne. Um, it's going to not only clear up the acne, but it's going to minimize the appearance of your pores. Um, but it comes oil production, oil production.
this is not a reason to go on Accutane, but some people notice that they develop less oil in their hair, so that's a benefit. Mm-hmm. [00:03:00] Um, but it comes with some downsides. So there are some guaranteed side effects. There's dryness. Everybody will be dry. Everywhere. Um, your skin, your lips, your nose, your eyes, you can be prone to nosebleeds, so you may have to use things to help combat that, like moisturizer, nasal saline, gel, um, saline, eye drops and stuff like that.
Second guaranteed side effect is sun sensitivity, so you will sunburn easier. Um, much, much easier. So you really have to be cautious. It's not something that you have to avoid during the summer, summer months, but you just have to be really mindful of it.
Dr. Zain: Why is there sensitivity to the sun with this medication?
Heather: Because it is the, the vitamin a derivative of it. I'm not really sure the exact mechanism. Yeah. So
Dr. Zain: like the, um, you know, that top layer of the skin, um, with those dead skin cells, the stratum cornea, since there's such rapid turnover. That is thinner and it does make you [00:04:00] more prone to mm-hmm. You know, developing a sunburn.
So that is one of the reasons why we always advocate for sun protection, sunscreen, sun protective clothing, and, you know, just trying to be smart about, you know, their exposure because yeah, I've seen some pretty bad burns, um, with patients on Accutane.
Courtney: Yeah. And you know, both, um, Dr. Zane and I have been on Accutane before, and at least in my experience, um, being on Accutane and being out in the sun, you will know mm-hmm.
When you start burning. I mean, I remember getting lunch with some coworkers, uh, one day, and I was only out there 15, 20 minutes and. My chest started feeling really red, really hot. And sure enough, my coworker said, Courtney, you're burning on your chest, so it will happen fast. You'll, you'll notice it.
Dr. Zain: Yeah.
And you know, you have a patient who is, you know, very fond of the sun. Um, sometimes I counsel them to maybe do this in the fall and the winter time, so it's a little bit easier to be compliant and not burn. [00:05:00] So, you know, something to consider. Courtney, what are some of these rare side effects that can occur with isotretinoin?
Courtney: Sure. Um, so joint aches, muscle aches can happen and we do see that sometimes even in our more athletic patients. Mm-hmm. Or just patients who are more physically active. Um, sometimes people can get headaches. I think that's more rare. And, you know, I think headaches can come from anywhere.
Dr. Zain: Um, I think most of the people get headaches as a status of their hydration.
I, I was just about to say that. I feel like a lot of people are like, dehydrated. I, it's dehydration. I, it makes you dryer, so. Mm-hmm. Yep. I think it's a function of that.
Courtney: Yeah. And then I've heard of some even more rare side effects, um, such as, um, like night vision issues. Mm-hmm. Um, that one. Like I said, it's, I don't think I've seen any patients that have had that, but I know it's mentioned in the literature that has to do with the dryness as well.
Mm-hmm. With
Dr. Zain: the cornea and everything.
Courtney: Yeah. Some people will complain of some nausea or stomach aches. Mm-hmm. Um. Luckily I didn't have that and I'm pretty sensitive to medicine. But, um, [00:06:00] those are some of the other side effects that you can have. Um, the main other side effect that you really wanna be aware of, um, and this is kind of the controversial one, is mood changes.
So, um, you know, it's typically a. Not recommended if you have a history of major depression, , to go on Accutane, and I know we'll probably kind of get into that. There are reports of, you know, Accutane kind of shifting mood. You know, in my experience, um, a lot of patients that I've seen back for, you know, their facials and whatnot.
Actually have, um, a better mood because their outward appearance is in, you know, becoming better. Um, but that being said, you still wanna make sure, you know, if you're seeing someone, like a therapist or a psychiatrist, that you, um, get an okay from them before starting the medicine.
Dr. Zain: Yeah. I mean, you know, the major depression and suicidal ideation mm-hmm.
Those are things that I definitely. And looking at for like their history, because that can be, you know, concerning. It's not that I haven't put, you know, depressed patients on this medication, but [00:07:00] then I need to kind of form an alliance with their psychiatrist or therapist as well as their family network to make sure that you know they're safe while taking this medication.
Personally, I haven't seen too many cases of mood changes in my career. Um, I have seen them more often in male patients. Mm-hmm. Um, the teenage patients, and I think that there's a hormonal component to it as well. Mm-hmm. Um, so, you know, it's not common, but you know, it can happen. So especially for those who.
Have major depression who are not being controlled of medication. Um, suicidal thoughts, you know, I really, you know, try to find other ways to treat them for their acne. Mm-hmm. Um, it's those who are well controlled and have a good plan, um, and a good rapport with all their, um, therapists, their psychiatrists as well as us.
Um, I think then we can really help them as well, because sometimes they're depression. Is, uh, also related to how they feel about their skin. Mm-hmm. Mm. And how others [00:08:00] peoples view them. I mean, a lot of people get bullied, um, because of their acne. So, um, I definitely feel for them.
Courtney: Yeah. And like you said, I mean, the hormones I think play a big part.
I'm always a big believer in, you know, correlation is not equal causation. And when you think about your subset of acne patients or Accutane patients, I mean, majority are gonna be those. High school students, maybe early college years. And, you know, those are stressful times in, I think, anyone's life, regardless of the Accutane.
So I think that's why it's so important, yes, to monitor from, um, the prescriber standpoint, which I know we're normally asking in our follow-up questions every single month. You know, any mood changes, any thoughts of suicide, any feelings like you're gonna harm yourself or others. Um, but that being said, I think it's also important for, um, patients to know that.
That's not, um, necessarily a guaranteed side effect and that there are other things like hormonal components that will shift your mood regardless of the Accutane.
Dr. Zain: Yeah,
Heather: yeah.
Dr. Zain: And another side effect that, um, I wanna mention is potential hair loss. Mm-hmm. So, not common, but we do sometimes see retinoid induced hair loss.
It's [00:09:00] usually temporary. Um, it will, you know, come back after you finish your course of medication, but it's just something to look out for. Okay,
Courtney: so how is Accutane dosed?
Heather: It depends. Um, I think the general, um, consensus is that we're using a weight-based dosing, so one, one to one and a half milligrams per kilogram, um, dosing.
And so that. Ultimately kind of helps decide based on your weight, are you gonna be on this six months? Are you gonna be on it nine months? Mm-hmm. How can we titrate to get you to that gold dose? And it only comes in, um, certain milligrams, so we have to use, you know, two capsules a day, three capsules a day.
Um, but ultimately we're getting to this cumulative dose. Mm-hmm. And that pretty much is a calculation that we do based on your dose and your body weight, how long is it going to. Take to get to that [00:10:00] cumulative dose.
Dr. Zain: Yeah. So in the past, I found that many, uh, dermatologists just used, you know, six months for instance mm-hmm.
For all their patients. Mm-hmm. And, you know, it didn't take into account like body size, um, health status, et cetera. And what we found was that although many patients did very well, um, there were also many patients who relapsed mm-hmm. Um, down the road. And, you know, a lot of data has shown that higher cumulative doses, uh, tends to have a lower relapse rate.
So I tend to, you know, use a cumulative dose at 220 milligrams per kilogram body weight. Um, and I have pretty low recurrence, uh, or relapse rate with acne, whereas. You know, you may not be getting it anywhere near that. If you're just doing, you know, six months of a relatively lower dose of Accutane, you may get clear temporarily, but you know, a few years down the road it may come back and, you know, my goal is for [00:11:00] my patients to take this once and be done with it for the rest of their life.
Um, and, you know, I think sustainable results, um, I think would be the best. You know, goal that we can get for a patient.
Heather: Mm-hmm. The mainstay goal used to be like one 20 milligrams per kilogram. And so, you know, almost doubling that we, I used to see a lot of recurrence at the one 20.
Dr. Zain: Yeah. And when I was training, like I also like would see people doing one 50 mixed per kg.
Mm-hmm. So, you know, that's a huge variation. So I do think that that. That's what kind of correlates with the relapse rates.
Courtney: Yeah. And I know the other thing, um, you know, that you guys are looking for is that two month clearance, you know, towards that. Mm-hmm. The end of your Accutane dosing, you really don't wanna still be breaking out.
Mm-hmm. Um, I think once you have those two months of having clear skin and um, not developing any new lesions, it really helps, um, get an outlook on the sustainability of the medicine long term and not having that relapse. Yeah.
Dr. Zain: Mm-hmm. Heather, in terms of [00:12:00] monitoring these patients, what are we looking at monthly for these patients in terms of labs?
Heather: So, so for blood work, um, in the beginning, usually I'll check white blood cells and red blood cells, so like a C, B, C, complete blood count, um, CMP or complete metabolic panels. So we're looking at kidney, liver function, and electrolytes. And, um, cholesterol. So most commonly Accutane can be associated with increased liver enzymes and cholesterol, um, most commonly triglycerides, which is a type of cholesterol.
so we just wanna make sure if they are elevated, they're not getting too high. Mm-hmm. Especially with the triglycerides. If your triglycerides get too high, it can increase your risk for pancreatitis. Mm-hmm. Um, which is inflammation in your pancreas, which is usually like a very deep, painful. Very, very painful, um, kind of upper abdominal area.
And so we're monitoring that every month through blood work. Um, females, we have to do a pregnancy test too, which I, [00:13:00] I'll explain in a minute. Um, but the reason, the main reason that we do the CBC, the complete blood count is 'cause we wanna make sure that there's no underlying, um, condition going on. So, um, I actually had a patient.
Last week or the week before where I did his routine, um, initiation labs to get a baseline of everything. And he had white blood cells that are not normal on a complete blood count. And he, it kind of looked like he potentially could have leukemia. And so that's definitely not something that I would want to proceed with the Accutane.
Um. But usually, I mean, for the most part, oftentimes the CBC is normal. Yeah. Um, with the liver enzymes, you have to be cautious with other things that can elevate your liver enzymes, such as alcohol and Tylenol. So, you know, it's fine to have a drink every now and then while you're on the medication. It's fine to take Tylenol if you need to.
You just don't wanna [00:14:00] overdo it because if your levels increase, we don't know. Is it the Accutane or is it the alcohol? Um, and then kind of same with the triglycerides. You want to ideally strive for a healthy diet. However, Accutane can be absorbed better when you have healthy fats. So it's kind of trying to balance all of that out.
Dr. Zain: so along those lines, are there certain supplements, um, or medications that can help the efficacy of Accutane? Courtney, um, what do we typically recommend to our patients?
Courtney: Yeah, normally a fish oil, um, is, you know, a good supplement to have. Um, for those Accutane patients, it will help with the cholesterol and I think it does help, um, sometimes with the dryness that we're seeing as well.
Um, yeah, so the
Dr. Zain: Omega-3, um, you know, essentially essential fatty acids are really helpful.
Courtney: Yeah. Mm-hmm. , You know, separate of. Cholesterol, but Zyrtec or Allegra, um, any antihistamine I think, um, has been paired nicely with the Accutane just to help decrease. Sometimes even like flares. We'll see that initial purge [00:15:00] sometimes with the Accutane.
Um, it also helps with the itch too. Like your often dry, it's the rash, so yeah. Gonna help.
Heather: Yeah, about 30% of people notice the purge. So it can help, especially in the beginning.
Dr. Zain: Yeah. What, what is the purge?
Heather: Purge meaning like your so spooky. Yeah. Your acne gets worse before it gets better. Um, which usually if it'll happen, it'll happen in the first couple months, but, um, we often start at a lower dose and then work our way up to mm-hmm.
Um, the maintenance dose. And so I think that helps decrease the risk as well. Yeah.
Courtney: Nice thing about, you know, Accutane is once you are actually on the medicine, you won't be doing anything else. So you really just will be washing your face and moisturizing and of course wearing your sunscreen, but no other topical prescriptions, um, no other oral prescriptions.
In fact, um, it's dangerous to take, you know, the oral antibiotics with the Accutane. So you wanna really be careful. Especially if you get any kind of like, uh, infection where a doctor might say, oh, let me put you on, um, doxycycline or something. Mm-hmm. Yeah. [00:16:00]
Dr. Zain: Doxycycline has a interaction. It's a common acne antibiotic that we use.
Courtney: Yeah. So you really wanna make sure you're off of everything before you start.
Dr. Zain: Yeah. So what can patients do while they're on Accutane, procedure wise?
Courtney: Facials. Yeah. Um, so, and I'll say. Sometimes early on during the first month, sometimes I will do like a very light, like a sal acid peel. Um, just while that medicine hasn't really kicked in yet.
But, um, I do see a lot of patients for acne facials, um, where we're mostly doing more of like a hydration, um, and some extractions. I really like doing them early on in the treatment because I do think it helps control some of that risk of the purge. Um, you know, I always tell patients, especially with acne, facials, and regardless of Accutane, you know, if someone's just on a topical tretinoin.
But, um, I really like being able to get those, um, you know. Cores cleaned, and so the medicine is able to work better. Um, but it is safe to do throughout the [00:17:00] treatment. Um, more of like those hydrating facials, you know, and even sometimes midway through, I'll actually stop doing extractions sometimes by like month three or four because the skin is just so, um, delicate at that point that we're really just focusing on hydrating.
Mm-hmm.
Dr. Zain: Yeah. Yeah. And typically, you know, we don't recommend anything exfoliative. Chemical peels while on Accutane, um, light-based procedures mm-hmm. Lasers. Mm-hmm. Um, anything invasive? Um, waxing.
Courtney: Mm-hmm. Yeah. Yeah, that's what I was gonna say. You even wanna be careful about some procedures that you might not think of, but yeah.
Waxings a big one. I mean, essentially Accutane is, um, an oral tretinoin and, um, just like, you know, certain things with Tretinoin you wanna come off of, um, before things, you know, with Accutane, it's the same deal. Hmm.
Dr. Zain: Okay. So why does Accutane get such a bad rep? And like the media, like people just like always railing on it.
So tell us why.
Heather: Yeah, I think one of the biggest things has to do with [00:18:00] females. Mm-hmm. So it is considered teratogenic, meaning if a female is taking the medication and gets pregnant while on the medication, there are severe birth defects associated with that. So we have to be very strict about that for good reason.
Um, we have to see. The patients every single month in order to prescribe a 30 day supply. Um, with females, we have to do pregnancy tests every month. We have to do two pregnancy tests a month apart before even starting the medication for females. And so it's a very, um, rigorous process, but we definitely want to, you know, make sure that's not a risk.
You have to be on either two forms of birth control or abstain from sexual intercourse. Um, while take, doing the treatment, but also one month after coming off of it. 'cause it does stay in your system for about a month. So I think that's the biggest thing. They make us monitor males very similarly.
Obviously we don't have to do a pregnancy test mm-hmm. But, um, we have to see them every single month.
Courtney: Yeah. I [00:19:00] think it's important to note that that is not your local dermatologist protocol that is, um, regulated by the FDA. Mm-hmm. And so it's through a program called I Pledge. Um, and so the I pledge requirements, um, are not your doctor's office policies.
That's just the, um, the protocol that we have to follow in order to be able to prescribe that medicine.
Dr. Zain: Yeah. And it's kind of wild because I think it's for our patient's protection. Of course, we don't want any bad outcomes, but if you go into other countries, you can get Accutane over the counter. Mm-hmm.
Heather: Yeah.
Dr. Zain: Crazy people just take it like candy and,
Heather: yeah.
Dr. Zain: Yeah. Um. It always makes me a little nervous, uh, when I hear that.
Heather: We had a patient recently who did not say that she was breastfeeding. It wasn't in her chart at all. Oh my God. Yeah. Um, and then she, you know, she picked up her. Um, Accutane prescription, and then she called and was like, oh, hey, is this fine to take if I'm breastfeeding?
We're [00:20:00] like, no. Why didn't you tell us?
Courtney: Well, the packs are so funny because on every single, the packs come and there's, um, your AM and like PM pill, and on every single flap there's a. Pregnant woman and there's a big X. It's like, no, don't get. And it's every single, so you'll know when you're taking that medicine.
Heather: Yeah. And we did the pregnancy test and everything and she didn't think to say it. Yeah.
Dr. Zain: A common myth that I hear about is that, you know, once you take Accutane, it affects your fertility.
Heather: Mm-hmm.
Dr. Zain: Um, for males and females. So what's the truth behind that?
Heather: Um, it does not affect future fertility at all. Yeah.
In males or females.
Dr. Zain: Yeah. So I know plenty of patients who have had normal healthy babies. I've been on it, I had three beautiful babies, um, and plenty of other patients who have conceived, you know, like a month after, you know, being, uh, done with Accutane. Mm-hmm. So it's nothing to worry about for the future.
A lot of studies have shown that.
Courtney: Yeah. I think another big myth, [00:21:00] um, that I see, um, definitely online a lot too is, um, the correlation between, you know, if, if you take Accutane that you'll get IBS. I see that all the time. Um, and I think it stems from just, um, the fact that, you know, acne is an inflammatory disease.
Um, I, b IBS is an inflammatory disease. A lot of times acne we're finding is comorbid with many other inflammatory conditions. Mm-hmm. Um, and so, you know, I think. People, again, going back to correlations, not always causation. Um, I think people think that because they've taken Accutane that they can get IBS, but that's not true.
If
Dr. Zain: Yeah,
Courtney: if if you don't have ib you're not gonna get IBS from the Accutane.
Dr. Zain: Yeah. So I think that these patients typically have IBD. Mm-hmm. And when they take Accutane to treat their inflammatory acne, that clears up and, you know, they may be more. Focused on some other symptoms that they [00:22:00] may experiencing now that they don't have acne.
And I think that is kind of where it stems from. And there have been a lot of studies, meta-analyses that have shown that it is not caused by the Accutane, but just that they were present at the same time in the same patient who is genetically predisposed for whatever reason.
Courtney: Mm-hmm.
Dr. Zain: Yeah.
Courtney: Yeah. And then lastly, I know, um.
The, um, governor's son, what, what state was that?
Dr. Zain: Um, I forget which state it was. Yeah,
Courtney: it was up north. Um, there was a, you know, in fact, so the brand Accutane only recently came back on the market. Um, they'd actually, I think, taken the actual branded like true Accutane. So Accutane, like Heather had mentioned before, is the true brand name.
There's other trade names, like, um, you might hear Clavis or, um, Absorica or, you know, um, other brands like that. But Accutane was essentially a brand and isotretinoin being the drug. Um, but there was a governor or senator's son, um, this was years back, who had committed [00:23:00] suicide, unfortunately, on the medicine.
The politician essentially made like a really big deal about this, you know? And I understand that's your son. I mean, that's a tragic event. Um, but I think, you know, they had found out later essentially that he had been seeing a therapist way prior to the Accutane. Mm-hmm. Um, for suicidal thoughts.
Um, he was on, you know, other like medicines and whatnot. So I think a lot of that also like stigma of like, um, the severe, like mental changes kind of comes from that too.
Dr. Zain: Yeah. Yeah. My dad worked for Roche, which developed Accutane, um, back in the day, and, you know, I just remember when that, you know, that whole lawsuit happened and everything, so.
Mm-hmm. I mean, I think because that kid's dad was influential. Yeah. Um, and had the ability to really kind of make, you know, sweeping changes in the law happen. I think that's why this ultimately led to kind of the current state of how high reg, how highly regulated it is. Yeah.
Courtney: Yeah. And it is interesting, [00:24:00] um, you know, as we move forward, um, with our world.
I pledge has been, I pledge has been the same. And sometimes some of their protocols, um, are difficult. You know, I, you know, I think about like our transgender patients and our, um, patients of different sexualities and I pledge there is no, um. I'll use an example. I had a patient, you know, years back and, um, she was in college and she, um, she was a lesbian.
And so, you know, my doctor was like, well, you gotta be on the two forms of birth control. And the girl was kind of joking, like, don't worry, like I won't get pregnant. And my doctor wasn't really picking up on it, but I was like, oh, okay. I get it, you know? And finally she's like, no, I'm a lesbian. Like, I like, believe me.
Um, but it's, you know, it's unfortunately. I pledge, there's no, um, capacity to, to put that. If you have the ability to get pregnant, that's all that matters. You either have to be
Heather: Yeah. Abstinent or on those two forms.
Courtney: Yeah. So normally they'll do, um, you know, birth control pills, um, [00:25:00] uh, hormonal, IUD, um, implants.
And then normally the secondary, they're wanting you to use like a male latex condom or um, sponge or different, but it does have to be two forms. If it's not truly abstinate.
Heather: There are some providers that. Won't accept abstinence as a, yeah. Contraception.
Dr. Zain: Yeah. And I think that is. I think that's a little much.
Mm-hmm. I mean, I feel like you have to be able to trust your patients as well.
Heather: Mm-hmm.
Dr. Zain: Yeah. And it's almost kinda like paternalistic care. Um, you know what's best and you are gonna dictate how they, you know, how they behave essentially. Right. But I think you have to give a little faith into what your patients are saying.
Yeah. Um, it has to be this therapeutic relationship. Yeah. So that's something that I'm. Cognizant of. Yeah. And I think patients appreciate that when you do kind of have them, a little bit of agency over their own health.
Heather: Mm-hmm. Mm-hmm. Going back to the like, um, ability to get pregnant, like [00:26:00] if you have a uterus, there's an exception to that too.
Mm-hmm. If you're postmenopausal. Yeah. Mm-hmm. You don't have to do the pregnancy test every month. You don't have to be on two forms of birth control or if you've had the hysterectomy.
Dr. Zain: Mm-hmm. Yeah. Um, so I wanted to kind of touch about touch upon, um, our personal experiences on Accutane. So why don't we dive into Courtney's experience?
Courtney: No regrets.
Heather: You never washed your hair while you were on it.
Courtney: Girl, I, I might go back on it. Um, when you were like, that's. Not a reason to go. It's my reason. Um, no, I mean, you know, I was struggling with acne, um, all through high school. Um, I started working at a dermatology office when I was 21. . I had tried, you know, various prescriptions, but I was getting acne also on my chest and back, which those are just difficult areas to treat.
Mm-hmm. Especially the back. Yeah. , So I was fortunate. I think it's a little easier if you work at a dermatology office to do Accutane, you know, the monthly visits you're there anyways. But, um, yeah, I mean, I, I definitely have the [00:27:00] dryness, the sun sensitivity, but, um, overall I had a pretty, I think, easy experience.
Mm-hmm. Um, I was dosed for six months, , which at the time, I mean, you know, we're talking eight years ago. , And fortunately I think my weight at the time, I mean, I was, I was tiny, so I think it didn't matter that it was only six months. Um, now it might be a little longer, but, um, I enjoyed it. And yeah, I haven't had any flares.
I mean, I'll get a bump here and there. Mm-hmm. Um, sometimes like stress or if I like miss a couple days on skincare, something like that. But it's overall been a really, um, rewarding, uh, experience.
Dr. Zain: Yeah. And my experience was also very rewarding. Um, so I had pretty bad acne as a teenager. And you know, my dermatologist, I don't know what his deal was, but he really never advocated for Accutane.
Um, my parents were scared of the side effects, so. We just kind of, you know, went with traditional therapies and kind of went through that and, you know, I would still be breaking out, um, even through med school and, you know, into residency. And then when I became a dermatology resident [00:28:00] and I was treating my patients with Accutane and just seeing like the phenomenal response, I'm like, Hey, I'm just gonna do it.
And I think it was the best thing I could ever do for my skin. Um, I finally stopped breaking out, improved scarring, and just stopped that whole cycle. And I wish I had done it a decade prior. Um, it would've saved a lot of. You know, just consuming thoughts about like, looking at yourself in the mirror, not being happy, just constantly dealing with painful cysts and nodules.
Um, you know, and just, it just made me really self-conscious. I really didn't like having acne, so I, I was really happy that I can move on to the next phase. Then, you know, I worked on the scarring that was residual and, you know, that really, you know, helped my confidence and how I viewed myself. So I'm a big proponent of Accutane, um, especially if I have suspicions of patients who are going to scar mm-hmm.
Mm-hmm. Have a strong family history. Um, I have a low threshold to put them on Accutane as long as it's, you know, appropriate for them. Mm-hmm. You know, I [00:29:00] always tell the, uh, their parents like, it's going to be. A lot cheaper for you.
Heather: Mm-hmm.
Dr. Zain: Um, it's covered by insurance, which is great, um, for Accutane. And then also it really helps with, you know, scars that, um, have already formed and also preventing future scars.
Um, it's very painful and expensive process to treat them.
Courtney: Mm-hmm. Yeah. And you know, I've worked with different providers and there are providers out there that really do use Accutane as like a true last resort. Mm-hmm. And. I understand sometimes that reasoning, I mean, you know, yeah.
You have a patient that comes in, they have a few bumps here and there. Yeah. You're not gonna jump to Accutane. Mm-hmm. But then, you know, like you mentioned sometimes like when they're on that fold, I think a lot of providers think that acne has to be like mm-hmm. Severe. Yeah. And sometimes you look at someone and they've got pretty moderate acne, but yeah.
Maybe doxy and of five months of tr, but. I feel sometimes it's a disservice to the patient. Yeah. When again, we don't know for sure that, you know, the doxy or the tread or the [00:30:00] whatever might work. I think sometimes, again, when you're looking at that risk of scarring, it's almost more beneficial just to, you know, take that risk benefit and put them on the Accutane.
Dr. Zain: Yeah. And I get, you know, parents being concerned about putting their. Children on medications. I get it. But it is a very well studied drug. It's been out for a long time and it's not like we're putting them on this medication, just kind of leaving them be. Mm-hmm. We're seeing them every month. Mm-hmm.
We're doing labs every month. We also have open communication. If they're having any issues, they're talking to us. Yeah. Um, and the vast majority of my patients. Have been extremely happy with their results. They are really grateful, um, for, you know, being given the opportunity to finally clear their skin once and for all.
And their parents usually thank me too. Yeah. Even the ones who were fighting with me in the beginning. Yeah. Um, but, you know, it takes some convincing, some patience. But most parents come around, um, after I really, you know, talk to them about the data, my own experience. I [00:31:00] think that always, you know, yeah.
Astounds 'em that, hey, like. Your doctor was on it. Yeah. Um, half my staff
Courtney: Yeah. Has
Dr. Zain: been on it like most of the time my medical assistants who are in the room with me have also been on it. Yeah. So it kind of gives a little bit more reassurance and I think that the trust factor, um, really plays a big role, like being a dermatologist and just kind of knowing.
How this medication can change lives.
Courtney: Mm-hmm. Yeah. And as you get older, you know, I just think about the col, it's so much harder when you're in college. Mm-hmm. I think to be on Accutane with the monthly visits, especially if you're out of state somewhere and you know, maybe you don't have a dermatologist where you are, I just, you know, I think about the later years in high school being a little bit easier and who doesn't wanna like go to college and have like that fresh start and like feel good and you know, do good.
Dr. Zain: Well, the other thing I think about is. You have parental support. Mm-hmm. Supervision while you're in school, at home mm-hmm. On your parents' roof. Mm-hmm. When you go off to college, I mean, there's other factors that are gonna be there. Mm-hmm. There's more stressors. You're a new environment, you know, you're like sleeping late, [00:32:00] um, you're like eating, not eating great.
Yeah, exactly. Yeah. And then also let's. Let's alcohol. Exactly. Yeah. It's in the room. It's out there. It's out there. And you know, it's just only like, you know, it's a reality. Mm-hmm. So I think that it's a lot easier to control some of those other factors while they're at home. Mm-hmm. Yeah. All right. Well I think that, you know, we've really.
Dove deep into Accutane and hopefully it clarifies some of the common misconceptions that we hear about it. It is a phenomenal medication, and I think for the appropriate patient it can be a lifesaver. It really can, and it really does change lives. Um, if you have questions about acne or if Accutane or isotretinoin is right for you.
See your board certified dermatologist, um, and the team and just see if, um, you know, it's a good option for you. It's not the right option for everyone. Mm-hmm. And we understand that. And then we respect that and we have other tools in our belt that we can use to help you with your acne. So hopefully you [00:33:00] guys enjoyed this episode.
Please follow us. Subscribe like, and until next time, skin side. Ow.
Heather: Ouch.