By: Melissa Cugliari
Many North Americans struggle with acne, regardless of age. Conventional treatment generally involves seeking the medical advice of a dermatologist; usually the first line of treatment includes topical agents: prescription anti-bacterial or retinol creams. For females, if a hormonal cause is suspected, treatment may include the birth control pill. And in some cases, treatment can include oral antibiotics or accutane.
Accutane, also known as Isotretinoin, is a commonly prescribed oral medication used to treat severe recalcitrant acne. This medication is a vitamin A derivative, and works by reducing sebum production. Sebum is a secretion from the oil glands and, when balanced, contributes to a strong skin barrier; a strong skin barrier is key in the prevention of acne and other skin afflictions. When sebum production is out of balance, however, pores become blocked and breakouts can arise. By modulating sebum production, accutane keeps pores clear and acne causing bacteria cannot grow. It is also thought that this medication decreases inflammation of the skin.
Over the course of treatment, which usually lasts several months, individuals on accutane often see a major reduction in breakouts. For those that do not, sometimes a second round of treatment will be recommended. Although Accutane may clear acne, it comes with a whole host of potential and severe side effects which make it a less than desirable solution.
Each patient prescribed this medication should be monitored for changes to mental health, as one of the rarer but severe potential side effects is change to mood and suicidality. Because Accutane is likely to cause severe birth defects and/or miscarriage, it is also required that all females receive a pregnancy test prior to use and are using adequate birth control while on Accutane, This medication is also likely to cause dry skin, eyes, nose and throat, and may increase sensitivity to the sun and possibly cause changes to vision. It may also increase risk of common cold and contribute to hair loss. These are a few of the potential side effects of this medication.
Having experienced severe acne on/off during my teenage and early adult years, I understand how emotionally debilitating this condition can be and how tempting a medication like Accutane may sound. That being said, turning to an oral medication that can compromise mental health and your skin is not the answer in my opinion. It is my belief that using any skincare (topical or oral) that has the potential to cause birth defects or miscarriage should be absolutely avoided, even if you are not a female and not pregnant or trying to conceive.
This medication also does not address the root cause of why the acne is presenting in the first place, which to me means that acne clearance may only be temporary and the deeper problem will be suppressed, only to emerge as acne or in other ways later.
The skin is our largest organ and is constantly providing us with messages about our internal health and the strength of its barrier. When skin afflictions present, it is important to address internal health through nutrition, optimal hydration, and the avoidance of inflammatory foods and lifestyle factors like stress management and sleep. Addressing products used topically on the skin is integral as well. Often we are using harsh, irritating ingredients or facial treatments that strip the skin barrier, impacting pH and debilitating the microbial balance needed to keep harmful acne-causing bacteria at bay. It is always recommended that skin care is simplified and only gentle, mostly natural ingredients are used.
Sometimes though, this is not enough. In my practice, additional testing is often pursued, including hormonal testing for both men and women, testing for nutrient deficiencies, and digestive function. This can help us identify the root cause of why the skin is presenting as it is, and we can treat using targeted and evidence-based natural therapies, instead of using a band-aid solution that ignores what may be going on underneath.
Although seeking and treating the root cause of skin concerns may take longer, when these root problems are addressed, the body will be in a position to heal itself and the skin barrier can repair itself. While we balance internally and simplify skincare, gentle but effective topical treatments like cosmetic acupuncture and LED light therapy can be used to assist the skin in the healing process.The result is sustained clear complexion without the use of harsh, potentially harmful oral medications.
It is important to note that each of us must make a decision that suits us best in any given moment, and for some of us, that means using Accutane. There is no shame in this. If this applies to you, my recommendation is to seek alternative care with a registered Naturopathic Doctor who can help you support your system while on this medication so that you achieve an optimal result, and also address your skin from the inside as well.