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Accutane Side Effects – Birth Defects, Depression, and More

side effects of accutane

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Accutane is a brand name for Isotretinoin, a drug used as a last line of defense in the treatment of severe acne. It’s a Vitamin-A derivative which usually comes in gel capsules.
The drug Accutane works by reducing inflammation and acne bacteria. At the same time, it also shrinks oil glands and prevents clogging of the skin’s oil glands. In some cases, Accutane side effects are possible. Therefore, heavy considerations needs to take place before use.

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It shrinks the oil glands by 35%-58%. Therefore, the amount of oil produced in the oil glands decreases by about 80%. As a result, the reduction in oil effectively limits the number of bacteria that is able to live on the skin.
Other brand names for Isotretinoin include:

  • Roaccutane
  • Absorica
  • Claravis
  • Zenatane
  • Amnesteem
  • Myorisan
  • Sotret

Side Effects of Accutane

Many physicians and skin specialists are hesitant to prescribe the drug. This is because the Accutane side effects are quite severe. First of all, one needs to know the risks associated with the treatment. Then, one has to weigh them carefully against the possible gains. In fact, the manufacturer even states this in the product leaflet! First, consider that most teenage acne clears by itself towards the end of puberty. Second, one must be aware of possibility of Accutane relapse.
Roche is manufacturer of the drug. They list the Accutane side effects in the product leaflet that’s included with the drug:

  • Psychiatric disorders
  • Allergic reactions
  • Lymphadenopathy (changes in size of the lymph nodes)
  • Fatigue
  • Weight loss
  • Birth defects
  • Spontaneous abortion
  • Premature birth
  • Skin conditions
  • Nail abnormalities
  • Allergic reactions
  • Intracranial hypertension (Pseudo Tumor Cerebri)
  • Headaches
  • Seizures
  • Paresthesia (burning, tingling or numb sensations of the skin with no physical cause)
  • Insomnia
  • Unstable emotions
  • Ulceration of the esophagus
  • Ileitis (inflammation of the ileum)
  • Pancreatitis (inflammation of the pancreas)
  • Glomerulonephritis (inflammation of the kidneys)
  • Hematuria (the presence of blood in urine)
  • Changes in levels of cholesterol and lipids
  • Hematological disorders (disorders of the blood system)
  • Tinnitus and other forms of hearing impairment
  • Medical hepatitis (hepatotoxicity)
  • Inflammation and bleeding of the gums
  • Inflammatory bowel disease
  • Increased or decreased bone mineral density
  • Stunted growth
  • Tendonitis (inflammation of tendons)
  • Joint pain
  • Myalgia (muscle pain)
  • Rapid breakdown of muscle tissue (especially with heavy exercise)
  • Back pain
  • Visual impairment
  • Irregular menses (periods)
  • Cardiovascular conditions
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Psychiatric Disorders Associated with Accutane

The mechanism by which Accutane causes psychiatric disorders are unknown. Additionally, the manufacturer lists the behavioral effects as:

  • Suicide
  • Suicidal ideation
  • Suicide attempts
  • Depression
  • Feelings of helplessness or worthlessness
  • Loss of interest or pleasure in activities
  • Changes in appetite and body weight
  • Fatigue
  • Irritability
  • Restlessness
  • Change in sleeping patterns
  • Psychosis
  • Aggressive and violent behaviors
  • Acting on dangerous impulses

In certain cases, simply stopping use won’t resolve these symptoms. Furthermore, one will need future treatments by a mental health professional.
A 2016 paper in the Journal of the American Academy of Dermatology suggests that everybody on Accutane treatment be screened for depression; “Regardless of whether depression in these patients is rooted in the underlying acne or its treatment, the prevalence and serious nature of depression, suicide, and suicidal ideation demand attention.”.

Allergic Reactions can be Caused by Accutane

First, the allergic Accutane side effects include vasculitis. It is an inflammation of the blood vessels. Then, there is systemic hypersensitivity. That is an overreaction by the body’s immune system. Finally, there is edema. It’s the swelling of parts of the body or the entire body.

Birth Defects

People have observed some Accutane-induced birth defects or congenital disabilities as part of the side effects. They include abnormalities of the skull, face, ears, eyes. There is also damage in the cardiovascular system, CNS as well as thyroid glands. In some cases, IQ lowered to below 85 points.

The risks are so serious that they only give the drug to certain patients. They are the ones who have registered with the iPLEDGE program. It includes counseling, the use of two methods of contraception, and pregnancy testing. Also, they have to successfully answer educational questions about the drug. Both male and female patients have to register. Furthermore, they have to comply with the program. This way, they can keep their prescription active.

Skin Conditions

This is the most common type of Accutane side effects. Patients are especially susceptible to sunburn. Therefore, they need to apply sunscreen on all parts of the skin exposed to direct sunlight. And this is for the entire duration of treatment with Accutane.

The skin becomes very fragile and may easily break or tear. As a result, one cannot wax any part of the body. Some patients find that their soles of palms peel and they are prone to infection. Scarring is usually permanent. They advise the patients to take particular care in the prevention of any scars.

Up to 33% of all patients experience bleeding of the fingertips.

The skin also dries out considerably and is very susceptible to scarring. This is especially the mouth and nose. As a result, it can cause frequent nosebleeds. In severe cases, the skin forms painful crusts. Hives may develop as welts or red bumps on the skin, and certain patients develop eczema. They advise the patients to use a good quality body cream and lip balm for the duration of the treatment.

Initially, within the first month’s use of the drug, acne worsens for around 30% of patients.

Alopecia is a particular type of hair loss. It may occur in some cases. Sometimes, this is a persistent condition. It continues after stopping the use of the drug. The opposite may occur, with spontaneous growth of dark hairs (hirsutism).

Skin pigmentation abnormalities may occur, where pigment levels increase or decrease.

Intracranial Hypertension (Pseudo Tumor Cerebri)

Early indicators of the condition include:

  • Papilledema (increased pressure inside the brain which causes swelling of the optic nerve)
  • Nausea and vomiting
  • Headaches
  • Disruptions in visual fields

Change in Levels of Cholesterol and Lipids

During clinical trials, 25% of patients experienced an increase in triglycerides. In addition, 15% experience a decrease. Finally, 7% experienced an increase in the bad kind of cholesterol. Patients who are obese, have diabetes, have a lipid metabolism disorder or have a high level of alcohol intake are especially at risk. Therefore, it requires regular screenings.

Hematological Disorders

These disorders of the blood system include

  • Changes in blood sugar
  • Neutropenia (insufficient levels of a type of white blood cell)
  • Thrombocytopenia (insufficient blood platelets)
  • Anemia (insufficient red blood cells, which starves the body of oxygen)
  • Agranulocytosis (a severely lowered white blood cell count)

Medical Hepatitis (Hepatotoxicity)

15% of patients experienced elevated levels of liver enzymes during clinical trials.

Inflammatory Bowel Disease

Patients with a prior history of this condition are at risk. Furthermore, in some cases, the symptoms persisted after discontinuing use of the drug. Accutane side effects include:

  • Severe diarrhea
  • Abdominal pain
  • Rectal bleeding

Increased or Decreased Bone Mineral Density

These changes include hyperostosis. It is a hardening of ligaments where they attach to the spine. Also, there is premature epiphyseal closure. It is the stunted growth of the skeleton before adulthood.

In rare cases, patients experience arthritis and calcium deposits in soft tissue.

Visual Impairment

Some patients encounter a clouding of the cornea as one of the Accutane side effects. This is the transparent layer on the outside of the eye. Certain patients suffered from diminished night vision. Moreover, in some cases, the onset was sudden. In fact, the manufacturer warns patients to take extra care when driving at night.

Cataracts may form. Dry eyes and conjunctivitis (pink eye) can occur. in addition, the inflammation of the eyelids and corneas are common. As a result, wearing contact lenses during treatment with Accutane is inadvisable. Many patients develop photophobia, an abnormal sensitivity to light.

In rare cases, patients develop color blindness. Optic neuritis (inflammation that causes damage to the optic nerve) may occur. Consequently, it can result in permanent damage to vision.

Cardiovascular Conditions

Here patients report tachycardia (increased heart rate), palpitations and vascular thrombotic diseases. This involves the formation of blood clots which obstruct blood flow. Furthermore, in severe cases have resulted in strokes, as Accutane side effects.

Sources
  1. Oliveira JM, Sobreira G, Velosa J, Telles Correia D, Filipe P. Association of Isotretinoin With Depression and Suicide: A Review of Current Literature. J Cutan Med Surg. 2018.
  2. Melnik BC. Apoptosis May Explain the Pharmacological Mode of Action and Adverse Effects of Isotretinoin, Including Teratogenicity. Acta Derm Venereol. 2017 Feb 8;97(2):173-181. https://www.medicaljournals.se/acta/content/abstract/10.2340/00015555-2535
  3. Wooltorton E. Accutane (isotretinoin) and psychiatric adverse effects. CMAJ. 2003. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC139322/
Sharon Levy

About Author

Sharon Levy, MD, MPH

After successful graduation from Boston University, MA, Sharon gained a Master’s degree in Public Health. Since then, Sharon devoted herself entirely to the medical niche. Sharon Levy is also a certified addiction recovery coach.

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