Using Accutane to Treat Rosacea
A powerful medication sometimes used to treat severe acne can also be an effective rosacea treatment for people with more advanced skin disease. But isotretinoin, commonly known as Accutane, is controversial because it can cause devastating side effects. In fact, the effects of Accutane can be so toxic to a fetus that women have to sign a pledge not to get pregnant while using the drug.
Accutane is an oral drug approved by the U.S. Food and Drug Administration (FDA) for use in people with severe cystic acne when other treatments haven't helped. This kind of acne often leaves physical and emotional scars. Accutane is a manmade form of vitamin A and is usually taken once or twice a day for four to five months. It has been shown to dramatically and sometimes permanently clear the skin of many people with this type of acne by reducing the size of oil glands and the amount of oil in the skin, inhibiting the growth of acne bacteria and fighting inflammation, and keeping the pores from becoming blocked.
To treat rosacea, low-dose Accutane is sometimes used in more advanced cases when other rosacea treatments haven't worked. Research has shown that accutane reduces the size and number of enlarged oil glands and might be able to fight off acne-like bumps and pimples in rosacea patients. Accutane has been especially effective in slowing down skin changes on the nose (rhinophyma), especially in younger people with less advanced disease. Sometimes, however, the problems return after the drug is stopped.
Side Effects of Accutane
The maker of brand name Accutane stopped selling the drug in the United States in 2009. The company cited the cost of lawsuits over potential side effects and declining market share after generic versions (isotretinoin) hit the market in 2002. Isotretinoin is now marketed under brand names Amnesteem, Claravis, and Sotret. Still, the medication is commonly referred to as Accutane.
One of the most serious side effects of Accutane is damage to unborn babies. When it's taken during pregnancy, there is a high risk of miscarriage, preterm labor, death of the baby soon after birth, and very serious physical and mental defects.
The FDA has set up a program called iPLEDGE to make sure pregnant women don't take Accutane and women don't get pregnant while on the drug. All patients, even men and women who can't have children, need to be registered in the program and learn about the risks of accutane before getting a prescription. Women who are of childbearing age must promise to use two forms of birth control a month before starting treatment, during their treatment, and for a month after treatment ends, or they have to pledge not to have sex with a man during that same time period. Read more about the iPledge program.
Other Effects of Accutane
Besides birth defects, there's a long list of other side effects of Accutane, ranging from mild to serious. Side effects are dose-related, meaning the higher the dose, the more serious the side effects tend to be. At very low doses, there may be no side effects of accutane at all. Some common ones include chapped lips; dry, itchy skin; nosebleeds; eye irritation and dryness; and joint and muscle pain.
More severe side effects of Accutane include chest and abdominal pain, vision problems, and severe headache. The drug has also been linked to inflammatory bowel disease and to severe depression, including reports of suicide, but it hasn't been proven as a direct cause.
If your dermatologist puts you on Accutane, you'll be closely monitored for side effects. People are usually given regular blood tests to make sure their triglyceride (a blood fat) levels don't rise too high.
If you have rosacea that isn't responding to the standard treatments â€” avoiding known triggers, taking proper medication, and using rosacea-friendly skin care â€” talk to your doctor about whether the potential benefits of accutane outweigh the possible risks.
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