Accutane is to the holistic acne treatment folk what Monsanto is the organic folk: pure unadulterated evil that can do no good. The drug is universally demonized in the natural health community, and hot on the heels are lawyers eager to scare people into signing up for a class action law suits.
It is said that truth is the first casualty in every war. It’s certainly true in the war the natural health folk and lawyers have declared on Accutane. In the midst of all the fear-mongering, nobody presents rational, balanced and science-based discussion of the risks and benefits of Accutane. So I took it upon myself do just that.
I knew I had to write this post when a reader posted the following comment on another post where I talked about a study showing new side effects from Accutane.
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Here’s the comment she posted.
Hi! i read your acne history and noticed that you have taken accutane. I have a couple of questions on my mind and hopefully you have time to answer, i’d really appreciate it because I too have taken accutane and now i’m kinda scared of having done damage to my body. How old were you when you took accutane and how old are you now? Have you been healthy since taking it? based on your knowledge, do you think that accutane can cause any kind of long term damage or premature aging?( there are so many people on the internet speculating that) and don’t all medications cause at least some oxidative stress? and have you run into any studies about if accutane inhibits cellular proliferation even after discontinuation of treatment? and does accutane really destroy water holding molecules in the body?
I’m going to answer all the questions she asked, but before that I want to put all the Accutane injury stories and fear-mongering into perspective.
Are Accutane injury stories the result of a logical fallacy?
If you’ve researched Accutane you’ve no doubt read stories of people claiming to be injured by Accutane. I suggest you take them with a grain of salt. Here’s why.
We humans have a strong need to make sense and feel in control of our lives. We absolutely abhor the notion we are not in control. So when something bad happens, we demand to know how and why it happened. We need to know the cause and who to blame. We demand to be in control, even if it’s only illusionary.
But nature is inherently random. When a predator kills a prey, there’s no grand design or intention involved. The predator was hungry and the prey was in the wrong place in the wrong time. Virus infecting a person is not driven by a grand design, it merely exploits an opportunity.
People born with genetic abnormalities do so because of randomness inherent in multiplication of genes. Those mutations drive the evolution of all life on earth. Some mutations are beneficial, the vast majority are not. It sucks to be born with harmful mutations, but since life itself depends on mutations, the process goes on. Nature is a cruel mistress, indifferent to the plights of any individual.
This inherent randomness in life doesn’t play well with our need to understand and be in control. Interesting side note: pretty much the entire alternative medicine field is built on peddling the illusion that we have more control over our health than we actually do.
We frequently torture logic and reason while trying to make sense of the world. One of the most common logical fallacies we commit is the post hoc, ergo propter hoc (Latin: “after this, therefore because of this”) fallacy. When B happens after A, we assume that A causes B – simply because it happened after A.
The entire vaccines cause autism fallacy is based on this loopy logic. Parents start to notice the first signs of autism at around 18 to 24 months, which is just a few months after some vaccinations. Aided by ‘education’ from the university of Google, some parents mistakenly conclude that the vaccine caused autism. I say mistakenly because studies have clearly shown no connection between vaccines and autism. Furthermore, studies have shown signs of autism already much earlier, even in the womb. These signs are just too subtle for parents to notice.
My point is that just because some people noticed some health problems following Accutane treatment doesn’t mean Accutane caused those problems. Millions of people experience unexplained health problems every day. Millions of people take Accutane every year. Purely by coincidence there are going to be people who experience unexplained health problems shortly after taking Accutane.
I want to make it clear that I’m NOT saying this explains every story out there. I’m sure some people have really been injured by the drug. But just because someone claims to be injured by Accutane doesn’t mean he or she is right.
Putting side effects into perspective
Accutane is a powerful drug that causes side effects, in some cases severe ones.
Because of the potential for harm, there’s an ongoing effort to better understand and minimize the side effects. In 2013 alone 53 scientific papers were published that talked about the adverse effects of isotretinoin (the generic name for Accutane).
By all reliable accounts severe side effects are very rare.
Dr. Marius Rademaker reviewed patient records of 1743 people treated with Accutane. About 81% of the patients reported side effects. However, the vast majority of these were mild (70.1%) or moderate (9.8%). Only 3 patients (0.17%) reported severe side effects, 2 of which were birth control pill failures. Side effects were dose-dependent, so those who got a lower dose reported fewer and milder side effects.
Accutane and gastrointestinal damage
Many people claim Accutane causes intestinal damage, some people apparently had to have their colons surgically removed after treatment. Dr. Raed O. Alhusayen and colleagues compared the rates of inflammatory bowel disease (IBD) between people treated with Accutane, topical acne medications, and general population. Their analysis included data from 46,992 people treated with Accutane, 184,825 people treated with topical acne medications and 1,526,946 untreated individuals.
They showed that Accutane did not increase the risk of IBD. Among people diagnosed with IBD, taking Accutane did not increase the risk of hospitalization (due to aggravation of IBD). In other words, this massive study showed no connection between IBD and Accutane. The study did show a possible connection between IBD and acne itself. I’ve covered the link between gut problems and acne extensively in other posts.
Does Accutane cause depression and suicides?
Some people claim Accutane causes depression and increases the risk of suicides. That data on this point is not as clear as for IBD. While most studies show treatment with Accutane does not cause depression or suicides, we can’t yet rule out the possibility.
Regardless, the possible increase in risk seems small. A Swedish study showed 1 additional suicide attempt for every 2300 new 6-month Accutane treatments, that’s 0.04%.
Man boobs, blindness, and kidney injury: reports of serious problems
Rare as they may be, serious side effects can and do occur. Here are a few case studies published in the recent years. A 17-year old girl developed an acute kidney injury after Accutane treatment. Fortunately, her kidney function recovered in 5 weeks after stopping the treatment.
Another case report talks of a 19-year old woman who started bleeding on her left eye and consequently lost vision on that eye. I don’t have access to the full-text of that case report and can’t say whether her vision recovered or not.
Yet another report talks about a 20-year old male who developed gynecomastia (man boobs) after taking Accutane.
Update: Sexual dysfunction as grossly under reported side effect?
I’ve recently learned that erectile dysfunction, vaginal dryness and other sexual side effects may be grossly under reported. None of the reviews I read made any mention of these. However, Mexican researchers published a paper in 2005 that showed 6 out of 20 men suffered erection problems as a result of taking Accutane. Whereas only 2 out of 35 people taking minocycline (control group) reported erection problems. Accutane increase the risk of erectile problems by whopping 600%.
If true, these are very alarming results! It’s nothing short of an outrage that in 9 years nobody has followed this up with another study. Because this is the only study looking at this, it’s impossible to say how common these side effects are. What I can say is that you can find hundreds of men who complain about this online.
In the Mexican study the symptoms faded over time and all the men were able to have and sustain normal erection. But not everyone may be so lucky. There are reports of men complaining that the problems have persisted for years.
Life permanently ruined by Accutane
Just to make it clear that Accutane does sometimes cause extremely severe and permanent side effects, I’m going to share with you one such experience. This was sent to me by a reader and I’ll keep it anonymous.
“I suffered from acne since i was a teenager. At first it was quite mild but later became severe to the point where i had multiple cysts on my back and face. Topical treatments didn’t work so when i became 18 and was about to go to college my doc decided that accutane would be the solution so i started my 1st accutane course. This is where the first side effects manifested. During the first days of my course i experienced a terrible acne breakout which left many scars. It was so serious that i decided to stop the treatment after only 15 days. This was the only side effect i got but acne didn’t clear up as 15 days was not long enough to clear my serious acne.
The nightmare starts
4 years later and as my acne didn’t get any better i decided to give accutane a 2nd try.This time no initial breakout occurred and i thought that everything would be fine and my acne nightmare would finally come to an end.I was so wrong.During my 2 month treatment i experienced some serious side effects which i though would go away after treatment stopped.
Vision ruined by retinal detachment
My first side effect was that i started not being able to see at night with my left eye.I though it was because of the night vision impairment that accutane is well known to cause. Later during the course i noticed that my daytime vision in my left eye also deteriorated so i decided to visit an ophthalmologist. I was devastated when he told me that in my left eye the retina had been detached! This meant that my vision deterioration was not due to the cause i though it was previously. I had a surgery immediately the next day after the diagnose in order not to lose any more vision. My vision acuity in my left eye never returned to normal levels. Not only did accutane cause a permanent impairment in my vision but i was surprised when i found out that my myopia increased by 2 diopters in both eyes!
Unfortunately this was not the only side effect i experienced. I noticed during my course that my libido dropped significantly. Also the sexual sensation on my genitals pretty much disappeared. Again i though that such side effect would be temporary as it was not even stated in the drug leaflet! 6 years have passed since then and my libido hasn’t come back. Not only that but it has actually gotten worse. Moreover i have developed erectile dysfunction and anorgasmia because of the fact that i can no longer get sexually aroused.
Aggression and rage
Another permanent side effect that experienced was extreme aggression and constant rage. I managed to get rid of this side effect by taking antipsychotics for a while.
The drug has permanently affected my life resulting in a severe degradation of my quality of life. The permanent side effects make it difficult for me to develop relationships with the opposite sex. In general i enjoy life a lot less and the psychological negative impact of the side effects has been furthermore disabling.”
Side effects like these are rare, but I wanted to share with you this story just so you understand they can and do happen occasionally.
Medicine is always a risk vs. benefit calculation
There are no 100% safe medications. Anything that has a potential to do good also has the potential to do harm. Think about it, in order to have a positive effect a medication has to affect the biochemistry in your body. And there’s no way to exactly predict what happens when you mess up with the biochemistry.
Think of the biochemistry in the body as a huge tangle of yarn. Your goal is to move a specific end of a yarn by pulling at another yarn at the opposite side. Do you think it’s possible to move just one piece of yarn? Of course not. The moment you pull at one yarn you are going to move several other yarns. That’s not unlikely how the biochemistry in your body works.
This applies equally to natural (herbs and supplements) and prescription drugs.
All medication is inevitably a decision to balance risks and benefits.
From what I’ve read, it seems that Accutane is about 85% effective against acne. That is, 85% of the patients get very good results. Is that enough to justify the severe but rare side effects? That I can’t answer for you. I can only report the facts, but the ultimate decision rests on you.
Scaring people is easy, informing less so
Scaring people is very easy. Just about every day some scientifically illiterate food blogger spreads unfounded fears of common foods. Fear is a powerful emotion and once that seed is planted, it’s difficult to get out. Studies show facts linked to fear are remembered much better than other facts.
Stories that evoke fear and anger are also great for social media. They get shared like candy. By contrast science-based and balanced discussion is bland, easily forgotten, and left unshared.
So had I been social media savvy, I would have titled this post something like this: “Accutane robs sight from 19-year old, sweet girl – also causes man boobs and kidney damage”. Technically I would have been correct. With an alarming headline like that, this post would have been shared widely in the social media and alternative medicine sites.
It’s easy to twist facts to support your bias when you can forget pesky things like truth and balance.
But I don’t think such a post would have helped you. I don’t think Accutane is the right choice for most people, and I think there are better ways to get over acne. But regardless of what I think about Accutane, you have the right to decide what’s the right choice for you. And you need honest, unbiased information to do that.
My point is that all the fear-laden blog posts and Accutane injury reports tell more about the nature of humans than about Accutane itself. They represent the 0.2% of cases as if they are what happens to the majority.
With the self-righteous navel-gazing out of the way, let’s go through the questions.
Accutane questions answered
I too have taken accutane and now i’m kinda scared of having done damage to my body
Well, is there something wrong with you? Have you been diagnosed with something? If not, you might want to read this: Cyberchondria: How the Internet Is Making Us Paranoid About Health.
How old were you when you took accutane and how old are you now? Have you been healthy since taking it?
If I recall correctly, I was around 18 or 19 when I took it. I’m 36 now. As far as I can tell, it hasn’t caused any long-term health problems for me. While on Accutane, I got the usual side effects; very dry skin, dry eyes, chapped lips, etc. Nothing that would have troubled me too much.
based on your knowledge, do you think that accutane can cause any kind of long term damage
Yes, it’s possible. As I discussed above, Accutane can cause severe side effects. Fortunately, these are very rare and usually go away once you stop taking the drug. But it’s possible for Accutane to cause long-term side effects.
or premature aging?( there are so many people on the internet speculating that)
Most people who take Accutane get dry skin, but I’m not sure I would call that premature aging. You also have to keep in mind that acne itself can cause long-term scarring and skin damage.
The choice is not between skin damage from Accutane and perfect skin. The choice is between possible skin damage from Accutane and the very real possibility of scarring from acne.
and don’t all medications cause at least some oxidative stress?
have you run into any studies about if accutane inhibits cellular proliferation even after discontinuation of treatment?
The fact that Accutane is a permanent cure for many people is proof that it reduces cellular proliferation even after the treatment ends. One reason people get acne is because the sebum and keratin producing cells proliferate (multiply) too rapidly.
Your question implies that inhibiting cellular proliferation is a bad thing. In some cases it is bad, but there are also cases where you need to inhibit it. Cancer is a good example. Cancer is a form of uncontrolled cell proliferation.
and does accutane really destroy water holding molecules in the body?
Sometimes Accutane fear-mongering goes beyond silly. This is one such example. If this were true, then people taking Accutane would die of dehydration. With millions of prescriptions filled, I think someone would have noticed
The ability to make an informed decisions requires access to all the pertinent facts. The crunchy holistic health folk would have you believe that taking by Accutane you are poisoning yourself. This is nothing short of blatant fear-mongering and distortion of facts.
Accutane is a powerful drug and nearly everyone who takes it experiences some side effects. For the vast majority these amount to nothing more than dry skin and chapped lips. But there are unlucky few, and we are talking about 1 in 1,000 to 1 in 10,000, who experience something worse. However, even most of the severe side effects resolve once the drug is stopped. The really few unlucky ones can suffer severe, permanent damage from Accutane.
All medication means balancing risks against benefits, and you have to decide if the benefits of Accutane are worth taking the risks.
- Adverse effects of isotretinoin: A retrospective review of 1743 patients started on isotretinoin.
- Isotretinoin Use and the Risk of Inflammatory Bowel Disease: A Population-Based Cohort Study
- Isotretinoin and affective disorders: Thirty years later.
- Association between isotretinoin and mood changes: Myth or reality? An updated overview.
- Acute kidney injury following isotretinoin treatment.
- Premacular hemorrhage due to isotretinoin use.
- Gynecomastia: a rare complication of isoretinoin?
- Isotretinoin and intestinal damage.
- Ocular adverse effects of systemic treatment with isotretinoin.
- Erectile dysfunction during isotretinoin therapy.
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