Medications

Accutane

Question:

Both my children have been on Accutane on and off for the past seven years. My daughter is 25 and my son is 22. Needless to say I worry about long-term effects of Accutane.

Answer:

The use of Accutane for the treatment of acne is usually a dose- and time-limited therapy. Therefore, this minimizes the risks of long-term complications. If a person received a standard course, or even several standard courses of Accutane for acne, there are no long-term side-effects. During the course of therapy, blood is monitored to look for the more acute, short-term side effects which may require a dosage change or discontinuation of the medication. Even in patients that experience the short-term side effects such as an elevated triglyceride level, elevated liver enzymes, or a drop in the white blood cell count, these usually resolve upon discontinuation of the medication. -- Suzan Obagi, MD, director, The Cosmetic Surgery & Skin Center, University of Pittsburgh Medical Center.

Question:

As a dermatologist once put it, I have overactive sebum production. I don't want to use Accutane again. Any advice on affordable treatments to reduce the production of sebum?

Answer:

Accutane is for cystic acne not just oil control. Topical tretinoin (Retin-A) can help decrease oil. There is also a product Clinac O.C., which is available over the counter, that contains a polymer that absorbs oil. -- Karl R. Beutner, MD, director of the Human Papillomavirus (HPV) Clinic at the University of California, San Francisco Hospitals.

Question:

Everyone agrees that Accutane use increases the risk of birth defects. However, I have not seen good data on the risks of pregnancy following Accutane use. Does Accutane use increase the risk of birth defects or other problems AFTER taking it? How long should a woman wait to become pregnant after taking Accutane?

Answer:

Luckily, since there is good long-term follow-up on patients having received Accutane, there appears to be no long-term risk of birth defects. The recommended time course is to wait until one month after the last dose to begin to attempt to conceive a baby. -- Suzan Obagi, MD, director, The Cosmetic Surgery & Skin Center, University of Pittsburgh Medical Center.

Question:

Is there a safe (low to no side effects) prescription pill that gets rid of adult acne (not Accutane)? And how effective are pills over topical creams and vice versa?

Answer:

Depending on severity, there are treatments other than Accutane. Accutane is for cystic acne and many patients with adult acne do not have cystic acne. -- Karl Beutner, MD, director of the Human Papillomavirus (HPV) Clinic at the University of California, San Francisco Hospitals.

Other Medications

Question:

I have been using the contraceptive pill (Mircrogynon 30) for a few months now and haven't seen significant improvement in my acne. Is there a particular type/brand of the pill that reduces acne more than others?

Answer:

There is no prescription medication that has no side effects. However, there are low hormone-containing birth control pills as well as a diuretic pill (spironolactone) which work to even out the hormone levels which play a role in premenstrual acne. In the right patient (non-smoker, healthy) the risks are relatively low. -- Suzan Obagi, MD, director, The Cosmetic Surgery & Skin Center, University of Pittsburgh Medical Center.

Question:

Does the prescription Renova help adult acne even though it's marketed for wrinkles? My dermotoligist put me on it … I am 35 so am I killing two birds with one stone (adult acne and preventing wrinkles)?

Answer:

While Renova is FDA approved for the treatment of fine lines/sun damage, the active ingredient in it (tretinoin) treats acne as well. The only concern is that the Renova formulation is a much heavier base which moisturizes the skin much more than the other formulations of tretinoin. In some patients, this may flare acne. -- Suzan Obagi, MD, director, The Cosmetic Surgery & Skin Center, University of Pittsburgh Medical Center.

Question:

My son is 21 and is being treated for pustular cystic acne. He takes tetracycline ... and has been on it for two and a half years. Taking this medication for such a long time disturbs me as I believe he could develop a resistance when he's older. Please comment on this. Is there any complimentary therapy which would have some efficacy?

Answer:

This is not a simple question, but if he has been on it for that long without a response, I would suggest a change of therapy to either an alternative antibiotic or if he has cystic acne, he may be a candidate for Accutane. -- Karl Beutner, MD, director of the Human Papillomavirus (HPV) Clinic at the University of California, San Francisco Hospitals.

Question:

My dermatologist prescribed spironolactone to control my acne. It has worked wonderfully! I no longer have breakouts and my skin looks great. I've been using it for about 18 months now. My question is what are the long-term effects of this medicine?

Answer:

Spironolactone is relatively safe in low doses, long term. However, it should be used with caution in females planning to get pregnant within six months since it may feminize a male fetus (affects the male genitalia as it forms). Occasionally, some women experience an increase in breast size (which is why it is not used in males) and irregular periods. -- Suzan Obagi, MD, director, The Cosmetic Surgery & Skin Center, University of Pittsburgh Medical Center.

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The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have a question about your health, you should consult your personal physician. This event is meant for informational purposes only.

Published Feb. 23, 2004.