Though every teenager occasionally sports a couple of zits, 30 percent of teens suffer from moderate to severe acne, a skin condition that is not only painful but also demeaning to self-esteem. Isotretinoin, more commonly known by the brand name Accutane, helps to clear the most stubborn acne, providing a solution to millions of people hoping for clear skin.
As a Vitamin A derivative, Isotretinoin has been on the market since 1982 and is often used as a last resort to treat moderate to severe acne. However, it has been at the center of significant controversies due to its potentially harmful side effects. The most worrisome risks of Isotretinoin arise from taking the medication while pregnant, including miscarriage, death of the fetus, premature birth or severe birth defects. According to a study conducted by the Institute for Family Studies in 2019, 38.4 percent of high-schoolers reported ever having sexual intercourse. The study’s findings demonstrate the tangibility and danger of a teen becoming pregnant while on Accutane and suffering life-threatening consequences.
Other serious potential consequences include liver failure, depression, self-harm or even suicide. Extremely common symptoms that are harmless yet uncomfortable include excessive dryness of the skin, mouth, eyes, nose and lips. Yet despite these potential risks, Isotretinoin remains on the market today with five different brands available: Zenatane, Absorica, Myorisan, Claravis and Amnesteem. The specific brand Accutane was discontinued in 2009 after studies displayed a correlation between Accutane consumption and Irritable Bowel Syndrome, although it still remains the most commonly used name to refer to the medication. Specifically at Redwood, many students struggle with severe acne and among them, a few take Isotretinoin.
Senior Sadie Hershfield-Cohen took Isotretinoin from August 2019 to March 2020. The typical timeline for treatment is four to six months, as that is usually the point that the patient has reached their target dosage. However, Hershfield-Cohen was on it for eight months. After six years with painful hormonal acne, she felt relieved to have finally found a solution.
“I had acne for so long, since middle school. I wanted to be happy with my skin. [Acne is] not only mentally draining, [but] it’s physically draining. It really hurts,” Hershfield-Cohen said.
Because of the potential dangers and discomforts of Isotretinoin, it is commonly used as a last resort option after other treatments, like topical creams and less invasive oral medications, have failed. After being prescribed many ineffective topical creams by her dermatologist, Hershfield-Cohen was willing to endure any side effects that came with taking Isotretinoin.
“[My skin] was flaking, my nose hurt so bad [and I had to use] Aquaphor 24/7,” Hershfield-Cohen said. “It was honestly painful … my lips would crack … [Isotretinoin is] harsh and a lot to take care of.”
In addition to Hershfield-Cohen, freshman Skylar Bramlette was willing to risk any uncomfortable side-effects that come with Isotretinoin in order to clear her skin. She is currently scheduled to finish the medication in December and has been on it for seven months. Unlike Hershfield-Cohen, who had only tried topical treatments prior to Isotretinoin, Bramlette had also tried several oral medications, including Seysara, Spironolactone and birth control, only finding short-term improvement in her skin. Bramlette’s acne is genetic. Her father had suffered from severe acne as a teenager, leading him to take Isotretinoin as well. Bramlette had originally wanted to begin the medication in eighth grade while struggling with low self-esteem stemming fromher acne.
It took a year for Bramlette to get her father’s permission to begin Isotretinoin, as he was concerned that she would struggle with the same side-effects as he did, which included hair loss, heightened sun sensitivity and painfully dry lips. Luckily, so far, she has only experienced one extremely common and benign side-effect; chapped lips.
Along with uncomfortable symptoms, patients on Isotretinoin must receive regular blood tests in order to measure the effect of the medication on their liver, which can potentially be harmful as it has shown to increase the serum levels of liver enzymes. Because of this, Isotreitinion patients are advised not to consume alcohol as it also raises serum levels. Furthermore, regardless of whether they are sexually active, patients with child-bearing capacity must take monthly pregnancy tests and register with iPledge, a restricted distribution program that is approved by the U.S. Food and Drug Administration that aims to eliminate pregnancy while on Isotretinoin. iPledge requires that the patient take monthly surveys affirming that methods of birth control are being implemented in order to receive medication.
Bramlette and Hershfield-Cohen both took a pledge of abstinence, yet still had to take monthly pregnancy tests to verify that they were not pregnant and fill out the monthly iPledge surveys.
“It feels like [iPledge] doesn't trust you,” Bramlette said. “At the same time, going through an abortion can be really painful or if you don’t get one, your kid will have deformities,”
Lida Shams, Redwood parent and a former dermatology assistant at the Acne Institute in Vienna, Austria, has helped treat many patients with acne and believes the thoroughness of the iPledge system is proportional to the gravity of being pregnant while on Isotretinoin.
“There’s a whole process and I completely agree with that because the consequences to getting pregnant and being on [Isotretinoin], even with a single dose, are catastrophic,” Shams said. “It’s sad, the birth defects and all the trauma that you go through.”
Shams worked at the Acne Institute in 1995, a time when Isotretinoin had only been on the market for 12 years and was only being prescribed as secondary medication in low doses in conjunction with an antibiotic.
“We had patients with really bad, deep-scar acne. [Many] patients … were really suffering and for them, it was a life-saver because they felt confident again. They were able to see that there’s a way out,” Shams said.
Only 10 to 29 percent of patients taking Isotretinoin experience more severe side-effects like depression, anxiety, muscle and joint pain, hair loss and irregular blood tests, and Bramlette and Hershfield-Cohen are both examples of patients who only experienced skin dryness. Despite the potential risks, many are driven to a point of frustration with their acne and ultimately feel grateful for a medication like Isotretinoin.
“It changed my life,” Hershfield-Cohen said. “I’m a lot happier.”