Treatment for Severe Nodular or Cystic Acne
Adapted by Tracee Cornforth
People with severe nodular or cystic acne should be treated by a dermatologist. For patients with severe inflammatory acne that does not improve with other medications isotretinoin (Accutane), a retinoid, may be needed. Isotretinoin is an oral drug and is usually taken once or twice a day for 16 to 20 weeks. It is believed to markedly reduce the size of the oil glands so that much less oil is produced. As a result, the growth of P. acnes is decreased. Isotretinoin also reduces cell shedding and the stickiness of cells in the follicles, which helps prevent the development of comedones.
Advantages of Isotretinoin
Isotretinoin is a very effective medication that can help prevent extensive scarring in patients. After 16 to 20 weeks of treatment with isotretinoin, acne completely or almost completely goes away in most patients (up to 90 percent). For some people, however, the acne will come back, and they will need additional treatment with isotretinoin.
Disadvantages of Isotretinoin
Patients should carefully consider the several disadvantages of isotretinoin. The drug is not only expensive but is also linked to some adverse effects that can be severe. Possible side effects include inflammation of the lip and mucous membrane of the eye; dry mouth, nose, or skin; itching; nosebleeds; muscle aches; photosensitivity; and, rarely, decreased night vision. Other more serious side effects include increased blood cholesterol, lipid, and triglyceride levels and abnormal liver enzymes. To make sure isotretinoin is stopped if these side effects occur, the doctor usually monitors a patient's complete blood count, blood chemistries, cholesterol, triglycerides, and liver enzymes before therapy is started and periodically during treatment. All of these side effects usually go away after the medication is stopped. Patients who experience side effects while using isotretinoin should tell their doctor. The doctor may be able to reduce the dose of the drug so that the side effects are decreased or stopped.
The most serious potential adverse effect of isotretinoin is that it is teratogenic: it can cause birth defects in the developing fetus of pregnant women who take the drug. Therefore, it is crucial that women of childbearing age are not pregnant and do not get pregnant while taking isotretinoin. Women must use an appropriate birth control method for 1 month before therapy begins, during the entire course of therapy, and for 1 full month after therapy stops. Women should talk to their doctor about when it is safe to get pregnant after therapy with isotretinoin has stopped.
Reprinted from The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
