Accutane – Also Known As Oratane, Roaccutane, Isotretinoin


Best Taken:AM or PM with foodCaution: Mood changes, pregnancy warning & othersBest for: Cystic or recalcitrant acne

Powerful tablet 

Mode of action: Multiple, see belowScience Score: *****


What is the science behind Accutane / Oratane?

Retinoids are one of the most powerful molecules in dermatology. This family of drugs can be applied as a cream (Tretinoin, Differin/  Adapalene, Zorac) or taken orally. The most well known oral medication is Accutane (in the US, disc.), Oratane (in Australia). The generic name is isotretinoin. In the context of acne, retinoids work by- 

  1. Decreasing inflammation that leads to red pimples, pustules, papules & cysts.
  2. Decreasing bacteria counts responsible for pus, namely decreasing the numbers of bacteria named C.acnes.
  3. Reducing excessive oil production, also known as sebum.
  4. Reducing abnormal shedding of skin cells that can lead to blackheads & skin congestion. 

Will my acne purge if I am on Accutane / Oratane?

Skin purging is frequently seen with oral isotretinoin as well as topical retinoids. Think of it as the medication pushing acne from within, much like a slow internal squeeze! Purging typically lasts 2-4 weeks, however in some cases can last up to or even longer than 6 months ! There are several ways your dermatologist can reduce this purge. This includes-

  • Starting you on a very low dose of isotretinoin, say 5 to 10 mg for the first few weeks or months.
  • Starting you with an anti inflammatory during or even before the course of Oratane / Accutane
  • Using a pre-treatment peel prior to escalation. Frequently used peels pre or during treatment include salicylic acid or retinoic acid 1-3%
  • Manual extraction of acne cysts, whitehead & blackheads
  • Laser assisted cyst extraction for submarine comedones (probably the best solution)
  • Reducing your dose of isotretinoin if you have a significant flare
  • Direct injection of cysts with very dilute anti-inflammatories

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Will one course of Oratane/Roaccutane cure my acne?

One course of oral isotretinoin also known as Roaccutane/Accutane/Oratane will place 60-70% of patients in remission. This means 30-40+% may require a second course. A course can be defined by a total cumulative dose based upon body weight; 120 to 150 mg/kg total dose.  Additionally another benchmark is to be acne free for 8 to 12 weeks before cessation. Your goal post will depend on what journal papers your dermatologists read, or believe. There are predictive values that may place you in the 30-40% of patients that may require a further course of isotretinoin. This includes-

  • A family history of severe acne
  • Clinical findings including truncal acne/bacne, or severe cystic acne
  • Hormonal changes including PCOS
  • An incomplete previous course of medication
  • Acne at an early age (<12-13 year old)
  • Timing of intake (with food, better outcomes)
  • BMI, smoking & other comorbidities may be related (conflicting literature)
  • Ethnicities (relapse dependent on studied ethnicities)
  • Rare derm conditions including FGF-1 gene mutations, RAR resistance 

Davin’s ProTip on the use of Accutane

This drug is the most controversial medication for the treatment of acne. Side effects are almost universally seen, however in the vast majority of cases they can be sorted out with adequate action early in the course of treatment. Skin side effects such as dry lips, dry skin, sunburn can be mitigated with adequate care. Liver, blood count & cholesterol levels can be checked with regular screening. The most important side effect, namely mood changes can not be detected on a blood test. This is especailly important when treating teenages. Most dermatologists are mindful of this side effect. The decision to go on this powerful medication requires careful consideration. Most dermos view this as the last resort treatment for acne. 

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