Accutane while in med school

[Kepsnys]

I have an acne for about 5 years and nothing helped me during this period, so I finally decided to take Accutane and finish this. First question: Has anyone been on Accutane while in med school and did it have negative effect for your brain and memory?
Accutane may have a lot of side effects, but the only thing I'm worried about is life-long side effects after I finish my course. I found some cases in google of life long side effects post accutane (joint pain, depression, muscle pain) so I'm bit worried now. My dermatologist told me that ussualy people get dry lips and skin, but she also had couple serious cases which she didn't want to tell me. So second question: Does anyone experience any side effects after the treatment? Now it's my 2nd week on accutane (40mg per day) and I have only dry lips, nothing more. Share with me your experience and knowledge. Thanks.

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[KHE]

Can't speak about medical school as I took it in high school about 30 years ago. The only side effects I had was dry lips. The only long term side effects is that the back of shoulders sometimes get a little dry in the winter and I have to put lotion on that area of my back once or twice a week during the winters.

So I can say is that while I know it has the potential for some side effects, as far as I'm concerned, whoever came up with that stuff should get the Nobel Prize in Medicine. Best drug ever.

 

[Marine to MD]

I took it in high school, which was about 14 years ago. I do not recall any cognitive issues personally. The medication worked wonders but I went from being a competitive, multi-sport athlete (track, basketball, baseball) to barely being able to run suicides at practice. It wiped me out physically and I was constantly fatigued. These signs showed up at roughly the end of month 1. Your derm isn't messing around with the dry lips either. Buy lip balm by the case, you're going to need it.

I was on a 6-month cycle of the medication. Within a few weeks of completing the course, I started regaining most of the physical/endurance ability I had lost. Overall, I do not believe that I have had any long-term side affects.

 

[Kepsnys]

I took it in high school, which was about 14 years ago. I do not recall any cognitive issues personally. The medication worked wonders but I went from being a competitive, multi-sport athlete (track, basketball, baseball) to barely being able to run suicides at practice. It wiped me out physically and I was constantly fatigued. These signs showed up at roughly the end of month 1. Your derm isn't messing around with the dry lips either. Buy lip balm by the case, you're going to need it.

I was on a 6-month cycle of the medication. Within a few weeks of completing the course, I started regaining most of the physical/endurance ability I had lost. Overall, I do not believe that I have had any long-term side affects.

Thank you. That's very informative for me. I also play basketball for my uni team, so I really don't want it to be affected for life long.

 

[Marine to MD]

You're welcome. Remember, this was just my personal experience so n=1. Just make sure and communicate any side effects with your doc.

 

[futuremdforme]

The side effect that I have heard of the most is depression, which can affect your performance in school. You could proactively set up monitoring sessions with a doctor to make sure this doesn't happen, or to address it if it does maybe?

 

[qw098]

Accutane Best Drug Ever.

 

[Baller MD]

Accutane worked for me while I was in my preclinical years. Had to stop early due to high LFTs. Also experienced dry skin/lips and headaches.

 

[Merely]

Most of the docs I spoke to said that accutane is not worth it unless you have serious acne that you are really itching to get rid of, since acne is cosmetic and not a serious medical condition theres no need to use such a serious drug for a minor cosmetic inconvenience. This is something I heard from multiple physicians (not derms) so don't think im giving advice as i just started the medical journey and know literally close to nothing about anything lol

 

[Stagg737]

I took it in high school for 6-9 months. The only side effects I experienced while I was on it were dry lips/skin (seriously, this can't be emphasized enough) and that I somehow got a sunburn in January. Other than that I don't think I had any long-term effects. Unless you're pregnant, chances are the side effects will be pretty minimal, but I'd still try several options before using accutane just because some of the possible risks are pretty extreme.

 

[Baller MD]

Most of the docs I spoke to said that accutane is not worth it unless you have serious acne that you are really itching to get rid of, since acne is cosmetic and not a serious medical condition theres no need to use such a serious drug for a minor cosmetic inconvenience. This is something I heard from multiple physicians (not derms) so don't think im giving advice as i just started the medical journey and know literally close to nothing about anything lol

Cystic acne can become quite painful. So yeah, the docs don't know ****. Better stick to derms when it comes to skin related issues.

 

[amichel]

Cystic acne can become quite painful. So yeah, the docs don't know ****. Better stick to derms when it comes to skin related issues.

Also even if not cystic it's more than a minor inconvenience for lots of people...

 

[fractalabysm]

The only side effects I had were dry lips and dry eye. I did avoid physical activity (running, weight lifting, etc.) during treatment and didn't suffer any joint pain or muscle aches. I'm now 1 year out and eyes still get dry occasionally. It did not affect my learning/memory one bit. The medication has never been shown to cause depression. More likely that people with severe acne have higher rates of depression/suicide at baseline.

 

[alethiologist]

People can share anecdotes all day long, but ultimately your reaction to Accutane won't necessarily be the same as anyone else's. The best advice is what someone else already said, have regular med check and monitoring sessions with your doctor and make an emergency plan with them just in case you experience any cognitive or mood issues.

 

[deleted500612]

Most of the docs I spoke to said that accutane is not worth it unless you have serious acne that you are really itching to get rid of, since acne is cosmetic and not a serious medical condition theres no need to use such a serious drug for a minor cosmetic inconvenience. This is something I heard from multiple physicians (not derms) so don't think im giving advice as i just started the medical journey and know literally close to nothing about anything lol

Simply because it is a "benign" condition that poses little health risk, doesn't mean it is merely a minor inconvenience. The psychological effects of severe acne can be quite profound, certainly enough to cause depression in and of itself, never mind as a side effect of treatment. I do not get acne personally, but I have struggled with another "benign" skin condition since around puberty, so I can appreciate the impact that such cosmetic conditions can have psychologically despite not being a big deal from a medical perspective. It is a bit naive to write off conditions like this as a minor inconvenience, and I feel like a lot of people who have not personally experienced it have trouble grasping the profound impact it can have on a person socially and psychologically. I do agree with you that getting the odd zit here or there is not a huge deal, and extremely common, but severe cystic acne is a whole different ball game.

 

[Polonium-210]

I was on Accurane in middle school. This past June was my one year anniversary of being devoid of a colon/rectum secondary to refractory UC. No history of IBD on either side of the family. No history of any GI issues. Accutane was hit pretty hard over lawsuits and millions were given out. I was not involved in any of that though. Did Accutane instigate IBD in me? Maybe, maybe not. I had horrible case of cystic acne. But if I knew definitively it did result in UC for me and possessed a magic time machine, in a heartbeat I would tell my teenage self to deal with it. I can't speak about Accutane while in medical school but I can speak about having no colon while in medical school. That lack of **** sucks.

 

[username456789]

Most of the docs I spoke to said that accutane is not worth it unless you have serious acne that you are really itching to get rid of, since acne is cosmetic and not a serious medical condition theres no need to use such a serious drug for a minor cosmetic inconvenience. This is something I heard from multiple physicians (not derms) so don't think im giving advice as i just started the medical journey and know literally close to nothing about anything lol

Those doctors you've talked to have no idea what they're talking about.

They're the same idiots who tell their patients that their "atypical/dysplastic nevus" is a skin cancer or a precancer. They are so far out of their league it's not funny.

 

[username456789]

I was on Accurane in middle school. This past June was my one year anniversary of being devoid of a colon/rectum secondary to refractory UC. No history of IBD on either side of the family. No history of any GI issues. Accutane was hit pretty hard over lawsuits and millions were given out. I was not involved in any of that though. Did Accutane instigate IBD in me? Maybe, maybe not. I had horrible case of cystic acne. But if I knew definitively it did result in UC for me and possessed a magic time machine, in a heartbeat I would tell my teenage self to deal with it. I can't speak about Accutane while in medical school but I can speak about having no colon while in medical school. That lack of **** sucks.

Sorry to hear about your circumstances. Most of the studies that have come out lately have clearly pointed to a lack of association (and even a negative association, in some cases) between taking isotretinoin and getting diagnosed with IBD.

The conventional wisdom, however, is that people with inflammatory acne almost certainly are at higher risk for other inflammatory systemic conditions, such as inflammatory bowel disease.

 

[username456789]

People can share anecdotes all day long, but ultimately your reaction to Accutane won't necessarily be the same as anyone else's. The best advice is what someone else already said, have regular med check and monitoring sessions with your doctor and make an emergency plan with them just in case you experience any cognitive or mood issues.

This isn't even up for discussion, iPledge mandates that he/she see the prescribing doctor every 30-40 days and that they discuss/screen for these things.

I tell my patients that 100% of them will get dry cracked lips +/- nosebleeds. This is actually how you know they're taking roughly the correct dose. If they come in and they deny those symptoms, you're doing it wrong.

 

[Merely]

I've heard of people getting really serious side effects from accutane that led to lawsuits, is that very uncommon?

 

[sunflower18]

We learned pretty extensively about Accutane as a teratogen in embryology... Yikes. Accutane and pregnancy DO NOT mix well, unfortunately. So keep that in mind too! iPledge has some pretty strict birth control requirements -- I think as a woman, you need to take two pregnancy tests 30 days apart before you can even get the initial Accutane prescription.

 

[anonym00seOP]

.

 

[PharmlyDoc]

Why would you want to be on a REMS medication in medical school? In my opinion the side effects outweigh the benefits based purely on pharmaceutical knowledge. Talk to your dermatologist about using topical medications such as tazorac and clindamycin/benzoyl peroxide combo. I would avoid taking antibiotics PO. And have a good attitude. Everyone else is going to be so busy they'll see right through your acne.

 

[meupatdoes]

I went on it during medical school. I had very minor side effects (dry skin, etc.). It was not bad at all. However, that was my experience.

My 0.02 is that I wanted to treat my acne. It was painful and scarring. If I didn't go on accutane now, when would I? Our lives are not going to get less stressful. You can't put off life forever.

 

[Rekt]

Do it.
I had severe acne and nothing else worked. Took in high school a few years ago. I ended up doing an 8-10month course. I only had to do the first few months of serial LFTs and didn't have any changes. I've had almost zero return of any acne. As for side effects, I only had dry lips (they would literally bleed sometimes). You'll quickly figure out any chap stick other than Burt's Bees is terrible.

 

[Futurephys]

I just stopped it this week but I'm still in high school... I only got really bad dry lips and skin and some bowel issues but nothing like memory problems.


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[Snoopy2006]

Another fantastic example of why SDN was never intended for medical advice.

Go see a dermatologist and have an open discussion about how the acne affects your life, your treatment goals, and the pros and the cons of topicals, PO antibiotics, and Accutane. If you're highly anxious, feel free to get a second opinion - from a professional who routinely prescribes Accutane and can give you a n=200 sample size rather than n=1.

 

[Slack3r]

I made the mistake of playing around with fairly high doses of Vitamin A (retinol) as a late teenager, since I thought Accutane was too dangerous. I'm sure the high doses of Vitamin A (and eventually other vitamins) have messed with me, but I'm still glad I never went on Accutane. I'm sorry but there are WAY too many scary stories on the internet about it. Plus, I've come to think that its sebum-ridding effect dramatically ages the skin, never mind hair-loss/thinning. I'm glad to hear that many on here don't seem to have suffered too bad from it, despite the IBD case.

FWIW, I had fairly sever superficial acne and not the cystic/deep kind.

You heard it here first, folks. Medical advice from the premeds.

 

[username456789]

You heard it here first, folks. Medical advice from the premeds.

A premed who, by his own description of his acne, had no business even considering being on isotretinoin in the first place.

FWIW I have prescribed isotretinoin to >75 patients over the past 4 years and have yet to have one negative outcome or one person who regretted doing it. Most are ecstatic by their last visit.

100% of people will get dry, cracked lips. If you don't, you're in too low a dose. Several will get arthralgias. Recent studies suggest a LOWER risk of IBD while on the drug, not higher.

 

[Merely]

A premed who, by his own description of his acne, had no business even considering being on isotretinoin in the first place.

FWIW I have prescribed isotretinoin to >75 patients over the past 4 years and have yet to have one negative outcome or one person who regretted doing it. Most are ecstatic by their last visit.

100% of people will get dry, cracked lips. If you don't, you're in too low a dose. Several will get arthralgias. Recent studies suggest a LOWER risk of IBD while on the drug, not higher.

Do you put people on accutane anytime normal like doxy doesnt work or whats the protocol?

 

[username456789]

So isotretinoin is only for cystic acne?
.

Generally, yes.

Yes, their acne may be gone, but in the future they might look terribly aged, have joint issues, hair loss, etc. These are very private matters, especially the bolded, do you really think patients are going to come back to tell you about it?
.

Absolutely I think and know patients will come back to me, patients discuss side effects of medications with me all the time. Thankfully, the things you're coming up with are non issues with isotretinoin (although occasionally acitretin [not used for acne] gives women a reversible telegenic effluvium), but none of this is "very private", it's precisely the kind of things that patients see dermatologists die in the first place.

Your entire post is very weird, steeped in misinformation, and reads like a little kid who was given the opportunity to choose between "anti-vaccine" or "anti-isotretinoin" in his third rate high school debate club.

 

[username456789]

Do you put people on accutane anytime normal like doxy doesnt work or whats the protocol?

If a patient with inflammatory and/or cystic acne has failed triple therapy (topical retinoid + benzoyl peroxide wash + doxycycline [or minocyclone]), in most cases the next and last step would be isotretinoin. Many people at this point choose this path. A few shy away from it. Unfortunately, there is little available to help the latter group.

 

[username456789]

Except side effects don't always occur while one is taking the drug. You mean to tell me that despite all of this talk about patient non-compliance, you actually have patients check in with you years down the road regarding possible side effects? Not buying it...

I think your psychiatrist needs to adjust your meds.

 

[username456789]

Why?

Because.

Why do we not give morphine for hangnails?

 

[username456789]

How long do you keep patients on mino? Is it common for a derm to prescribe 50mg daily for roughly a year?

3-6 months usually at 100 bid.

 

[username456789]

Awful analogy.

Nope. Spot on.

Morphine is not indicated for wittle boo boos. Isotretinoin is not indicated for mild/moderate comedonal acne.

 

[medic86]

Right, you've already gotten that point across. What makes moderate comedonal acne exempt?

Also, morphine for wittle boo boos won't do much harm to the patient, whereas accutane on extremely mild superficial acne (now the analogy somewhat makes sense) can cause serious harm.

lol.

 

[username456789]

Right, you've already gotten that point across. What makes moderate comedonal acne exempt?

The fact that I can improve it with many other less expensive, less time intensive medications that don't require monthly visits, monthly pregnancy tests (for women), iPledge online headaches, several sets of lab draws, and scheduling nightmares.

Oh, and also because it's not particularly effective against comedonal acne.

 

[username456789]

Can you go into this a bit more for me? I have even heard of individuals with comedonal acne and ending up with cystic/scarring acne. Why might this happen?

People can start with one thing which can progress into another thing. If someone with unremarkable comedonal acne is under my care and they develop cystic/scarring acne, the circumstances have now changed and isotretinoin (or at least doxy) enters the conversation.

I often give patients low strength tretinoin for after their isotretinoin course, as they may often have persistence of some comedonal acne despite significant improvement in the inflammatory/cystic component.

 

[username456789]

Have any of your patients developed seborrheic dermatitis or rosacea during or immediately after a course of accutane?

Nope. Occasionally people will get a little mild retinoid dermatitis, which resolves pretty quickly either with triamcinolone during treatment or simply by cessation after they complete the treatment.

Isotretinoin does not cause rosacea. It's actually a treatment for serious/certain types of rosacea.

It also doesn't cause colitis/inflammatory bowel disease. The conventional wisdom and current thought is that people predisposed to inflammatory acne are much more likely to be predisposed to inflammatory bowel disease.

 

[Giovanotto]

It also doesn't cause colitis/inflammatory bowel disease. The conventional wisdom and current thought is that people predisposed to inflammatory acne are much more likely to be predisposed to inflammatory bowel disease.

Excusing side effects for predispositions, I mean "conventional wisdom," can be said for nearly every side effect accutane might cause. Hairloss? You were predisposed. IBD? Predisposed. Let's assume for a second that everyone with said side effects really is predisposed and isotreit only "triggered" these issues, why is that any better? I would rather NOT trigger IBD, hairloss, or depression in anyone, especially prematurely. SMH at derms prescribing accutane to pre and early teens.

It would be nice for a change to have dermatologists transfer their acne patients who don't improve with the host of treatments available today to psychologists and other mental health professionals. Do you ever see this happening? Is this a possibly emerging field/coop?

 

[username456789]

SMH at derms prescribing accutane to pre and early teens.

It would be nice for a change to have dermatologists transfer their acne patients who don't improve with the host of treatments available today to psychologists and other mental health professionals. Do you ever see this happening? Is this a possibly emerging field/coop?

SMH at preteens/teens coming into this thread and acting as if they half understand what they're arguing against.

You can start your learning by clicking and reading these recent studies.

http://www.ncbi.nlm.nih.gov/m/pubmed/25207875/?i=4&from=isotretinoin inflammatory bowel

http://www.ncbi.nlm.nih.gov/m/pubmed/26545085/?i=1&from=isotretinoin inflammatory bowel

Commentary:
http://www.ncbi.nlm.nih.gov/m/pubmed/24698863/?i=7&from=isotretinoin inflammatory bowel

When I say people are predisposed, I am not even suggesting the medication triggers anything. It's that it is the progression of events that would have occurred regardless. People with severe inflammatory acne have other elevated systemic inflammatory markers and are more likely to manifest IBD as well, isotretinoin or not (they may actually be LESS likely to do so if they get isotretinoin). They also have much higher rates of depression (for obvious reasons). Unfortunately, lawyers make a living off of people like you who don't understand science, the scientific method, or the difference between a case report and a meta-analysis and make all their decisions based on emotion.

As for your question about psych, it may become more of a thing in the future, but even from a practical standpoint this would be difficult, at least in my state/region where psych resources are scarce and costly (and many of these kids have bad insurance).

I am not arguing that acne doesn't affect quality of life. Quite the opposite. Many many centers are working hard to demonstrate this using objective measures (since this value-driven approach is the new reality in medicine) in order to continue to have insurance companies cover acne medications/services.

 

[username456789]

On an unrelated note, I will add that I never force the medication on anyone. I actually hate starting someone on it because of the scheduling headaches (it basically adds a few appointments to the end of my day when I could otherwise go home on time). People come to me begging for the medication as there are few offices in the area who prescribe it. I try to avoid it until it's clear that it is the best and o my treatment for their acne.

We have extensive discussions, the parents/patients read and acknowledge all the pros/cons outlined in the iPledge packet, and we go from there. Obviously if someone had a clear family history (or personal history) of IBD or depression, we proceed much more cautiously.

 

[occams_razor]

Do it.
I had severe acne and nothing else worked. Took in high school a few years ago. I ended up doing an 8-10month course. I only had to do the first few months of serial LFTs and didn't have any changes. I've had almost zero return of any acne. As for side effects, I only had dry lips (they would literally bleed sometimes). You'll quickly figure out any chap stick other than Burt's Bees is terrible.

This was my experience as well. I had horrible acne since middle school and nothing worked for me. I did 2 courses of accutane and it completely cleared up my skin. My last course was 6 years ago and I have no lingering side effects (the only side effect I experienced on it was having very dry lips). I also no longer have acne!


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