The truth about isotretinoin
Drug much safer for acne patients than previously thought
Dermatologists need to become more confident in prescribing isotretinon (Accutane, Roche) to their acne patients. After 35 years on the market, isotretinoin has been found to be safer and safer, not more and more dangerous, says Guy Webster, M.D., Ph.D., clinical professor of dermatology at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.
“A doctor can now look in the eye of a patient and their parent, and state that Accutane is a pretty safe drug, with the exception of pregnancy,” he says.
Psychiatric changes – truth or fact?
Since its introduction, isotretinon has been sporadically reported to cause psychiatric changes. For example, in 2002, many news outlets reported that a 15-year-old Florida boy flew his plane into a building under the influence of isotretinoin.
“It turns out, though, that the teenager never took any pills,” Dr. Webster says. “They were still sitting in his medicine chest.”
The reality is that patients who use isotretinon have a comparable psychiatric visit profile to those without isotretinon, and isotretinon patients are not prescribed more psychiatric medications, according to Dr. Webster. He spoke with Dermatology Times prior to his presentation “Perspectives on Acne” at the 16th Annual Caribbean Dermatology Symposium in Aruba.
“Questionnaire studies and interview studies seem to show that, as a group, Accutane patients are no more or less crazy than a group of same-age teenagers,” Dr. Webster says. “This indicates that the vast, vast majority of patients will have no difficulty on the drug.”
This does not mean, however, that there might not be a small subset of patients who are adversely affected by isotretinon, but it is too small a group to make a dent in the statistical average.
“Hence, I tell patients that if they think their mood is changing, ‘Talk to your parents or talk to me,’” Dr. Webster says. “’We will get you through your ordeal and treat your acne, too.’”
But patient visits cannot last a mere minute or two. “You have to talk in-depth to these patients at every visit,” he says.