Abbey Marshall | Managing Editor
Acne is a teenage nightmare: an undesirable side effect of puberty. Students attempt to combat their oily skin in a variety of ways, but when all else fails, some are turning to cure it at its source.
Accutane was an oral drug approved by the Federal Drug Administration in 1982, originally marketed as a chemotherapy. The intended use shifted once it was discovered to clear the skin of severe nodular cystic acne, however, severe side effects came alongside the drug. In 1984, the FDA required a “black box” warning for Accutane, citing the risk for fetal deformation. After decades of medical reports and studies analyzing the links between Accutane and severe side effects, as well as lawsuits, Accutane was discontinued in 2009. Generic brands of the medication, such as Isotretinoin, are still available.
Common side effects of Isotretinoin include dry skin, itching, rash, nosebleeds, dry mouth, peeling skin, inflammation, dry eyes, joint pain, dizziness, nervousness, and many more. In addition to these more common, primarily topical side effects, more severe conditions include depression, irritability, changes in weight, loss of interest in activities, and fetal deformities for females who become pregnant.
“I had really bad acne on my chest and back,” Schmidt said. “I wouldn’t wear swimsuits. I would always wear shirts all the way up to my neck. I wouldn’t want to show it.”
Low self-esteem of patients with nodular cystic acne is a common driving force for seeking out Isotretinoin, said Dr. Elizabeth Muennich of Dermatology and Skin Care.
“Severe nodular cystic acne can be very disabling,” Muennich said. “It is an independent risk factor for suicide. People have killed themselves over their skin. You can see that patients who are oftentimes broken out, they’re clinically depressed. It’s a very affecting disease. They don’t want to go to school, they don’t want to go out with their friends.”
Muennich said the process of getting on Isotretinoin is grueling and only a select few are eligible for the drug.
“First, you have to fail all other conventional topical therapies,” Muennich said. “You also have to fail oral tetracycline or the oral antibiotics. Sometimes it’s a couple year process before we say, ‘Okay, there’s nothing else we can do for you. You need Accutane or Isotretinoin.’”
In addition to the extensive process, the drug comes at a steep cost, Muennich said.
“It’s not cheap,” Muennich said. “You have to come to the dermatologist every month, you have to pay for bloodwork every month. The pills themselves are expensive. They can be around $500 a month…You can see the bills just add up.”
Severe side effects are an ominous danger for those considering Isotretinoin. Schmidt said the fear of these is what scares people off, however, she only experienced minor effects.
“There’s a lot of side effects with Accutane, so normally people don’t want to be on it because you could get depression,” Schmidt said. “The only symptoms I had was I had really dry lips, my skin was really dry, and I had a lot of nosebleeds.”
This common dryness of the skin, nose, etcetera is due to the drug turning off the oil gland at the site. As a result, the acne is not just treated, it’s cured.
“This is something I can cure,” Muennich said. “In medicine, when we treat things, we tend to be palliative. There aren’t very many cures in medicines, but Accutane is considered a cure.”
Depleting the body of vitamin A, however, poses a risk to those who are sexually active.
“You can’t have a baby grow without vitamin A,” Muennich said. “Vitamin A is a core vitamin…There’s a fundamental risk, so we just avoid it.”
To combat the potential risk of birth defects, the FDA requires women taking Isotretinoin to take part in the iPledge program in which they pledge to not become pregnant. In addition, females must be on two forms of birth control and take monthly pregnancy and blood tests.
Mental health is also a concern of those starting the drug. Since the development of Accutane in the ‘80s, medical analysts have drawn links between Accutane and depression. Muennich said, however, there might be more to the story than that.
“There’s a history of the whole suicide and Accutane risk, but now that they’ve fared it out that acne itself has an independent risk factor for suicide, they’re realizing this is more than just the Accutane,” Muennich said.
Many patients with depression are already seeing psychiatrists prior to going on Isotretinoin. Muennich said she works closely with their psychiatrists to make sure the patient is as happy and healthy as they can be.
“In terms of the mental health side effects, I do have some patients who are seeing psychiatrists for depression,” Muennich said. “I get a letter from their psychiatrists saying it’s okay to treat, and 100 percent of the time, they say, ‘Go ahead and treat’, because if I clear up their skin and make them a happier person on the exterior, they’re going to feel better on the interior…Our skin is what we project. If we have beautiful skin, we’re more confident and sometimes we’re happier.”
After the six month course is completed, the results are well worth it, said Schmidt.
“It was very worth it,” Schmidt said. “It’s a confidence thing. When you don’t have acne, you feel more confident about yourself. It really does help with your self esteem. Once it got all cleared up, I felt more confident about myself.”
Originally published in The Chronicle on March 11, 2016.