Your reputation. It’s all you got, right? And if it’s a bad one, then, well, good luck. It’s hard to come back to change people’s minds or to rebuild how they think of you. Some things in dermatology carry a bad taste too. For example, mention Accutane at a dinner party and suddenly everyone gives you the side eye and has their story or saw someone on social media that said it’s poison. From claims that it causes depression to feats about infertility, few acne medications have accumulated quite as many myths as isotretinoin.
Isotretinoin, more commonly known as the branded name Accutane (which is no longer available), is a vitamin A derived pill approved in the US to treat cystic acne in patients 12 years and older who have not responded to other treatments, such as antibiotics or topical therapies. To dermatologists, isotretinoin is the holy grail of acne treatments. It is truly our only disease modifying agent and works by shrinking the oil gland, reduces bacteria, normalizes skin shedding and calms inflammation. Yes, we are biased, but isotretinoin is one of the best medications we have in dermatology. And no, when we recommend it, we are not failing to address the root cause or pushing it for some other agenda.
Of course, isotretinoin has risks but so does untreated acne. The problem is that social media has spread misinformation about those possible risks and even listed some risks that are completely unfounded. But before you let social media or your cousin’s friend’s experience make the decision for you, let’s separate fact from fiction. Below I highlight four of my top isotretinoin myths that patients ask about.
Myth 1: Isotretinoin causes depression and suicide. No study has shown that isotretinoin causes depression. In fact, studies have shown just the opposite. Acne can often cause depression or anxiety. Studies have shown that after taking isotretinoin and having improvement in their acne, patients also have reported improvement in their depression and anxiety symptoms. One thing to consider is also the patient population. Teenagers, most often affected by acne, also have higher rates of anxiety and depression, which may skew results. Nonetheless, screening for mood changes before and throughout treatment remains important.
Myth 2: Isotretinoin Causes Infertility. Isotretinoin is known to be teratogenic, meaning it causes birth defects, but it has not been shown to cause infertility. Pregnancy prevention is essential during treatment and for one month after completing therapy. Isotretinoin is absolutely contraindicated during pregnancy, but that is not the same as saying it permanently prevents someone from having children.
Myth 3. Isotretinoin is only for teenagers with the worst acne imaginable. While having severe or cystic acne is part of the FDA indication, in clinical practice isotretinoin has a broader application. Patients with acne that leaves scarring are also good candidates. Adults with severe acne may also benefit from isotretinoin. If you tend to flare when you go off antibiotics and topicals don’t control your acne, isotretinoin may also be a good fit.
Myth 4: Isotretinoin causes Crohn’s Disease and Ulcerative Colitis. Research has not shown that isotretinoin causes inflammatory bowel disease (IBD). While it’s true that there have been reports of patients developing IBD while on isotretinoin, there haven’t been any studies to confirm that isotretinoin is actually the cause.
Trotter’s Take: Isotretinoin is a powerful medication to treat acne, but it’s not without risks. The key is to separate fact from fiction and work with your dermatology provider to make an informed decision that is right for you and your skin.
Want to get a clearer picture of isotretinoin and the myths surrounding it? Then check out my podcast with Dr. Josh Grosshandler as we debunk the isotretinoin myths landing on your feed.
