Accutane and Gut Problems: The Latest Research

Recent research in JAMA Dermatology stated that isotretinoin (Accutane) does not cause inflammatory bowel disease (IBD). This finding contradicts the conclusions of earliest studies, which suggested that the drug could cause gut problems.

Recent Study Shows No Connection Between Accutane and IBD

The study, published in September, compared 1,078 patients who had been diagnosed with IBD. Of those patients, 576 had taken isotretinoin and 502 had not, or had only done so after the IBD diagnosis. The study concluded that patients who had taken the drug were 66% less likely to develop IBD. Out of those who had taken isotretinoin, 0.9% developed IBD, compared to 2.6% of the control group.

Unlike much of the earliest research into Accutane and IBD, this study was highly controlled. It took into account race, gender, systemic antibiotic use, and systemic tetracycline use –  a class of antibiotics often prescribed to acne sufferers. Some data suggests a possible relationship between tetracyclines and IBD, which only complicates the matter.

The Recent Results are Supported by Previous Research

These conclusions back up another JAMA Dermatology study that also refuted a connection between the drug and the disease. That study compared 2,200 women who had been diagnosed with IBD against 43,000 without the disease. After a statistical comparison, scientists found that among those in the IBD group, 0.46% had used the drug compared to 0.44% in the control group. In other words, there was no difference.

Both of these studies’ results are in line with a critical literature review published in The American Journal of Gastroenterology in 2009. Researchers from the University of North Carolina reviewed over a dozen case studies and found that there isn’t enough evidence to support the idea that isotretinoin causes IBD.

In fact, many of the later studies conclude that acne itself is linked to higher rates of gut problems, something I’ve written several times here. And that the earlier studies linking isotretinoin to gut problems simply reflect the fact that acne patients have higher rates of gut problems than people without acne.

Early Research and Lawsuits

One of the first reports that suggested a link between Crohn’s disease and Accutane was one of Roche’s internal documents, titled Internal Causality Assessment. It noted that of 104 Accutane users who experienced colitis symptoms, including Crohn’s disease, 33 were probably linked to the drug.

Early research and lawsuits reflect the connection between acne and gut problems

Subsequently, there were quite a few case studies between the mid-1980s and the late 2000s that suggested a link between Accutane and Crohn’s disease. And several researchers came to the conclusion that the drug can cause IBD.

These results caused a serious stir when the company that developed Accutane, Roche Holding AG, was ordered to pay six Accutane users a total of $56 million. According to the plaintiffs, the drug had caused them to develop IBD. As a result of the illness, one patient had to undergo six surgeries and have his colon removed. He was awarded $25 million in damages.

Roche stopped manufacturing Accutane in 2009, though it is still available in generic forms.

Conclusion

Despite the controversy and the millions of dollars that have been awarded to patients who used Accutane, there is still no evidence to support the idea that Accutane causes any form of IBD, such as Crohn’s disease.

If anything, the most recent JAMA Dermatology study caused scientists to come to the opposite conclusion. They acknowledged that the statistical variance may be due to the small study size, but added, “the anti-inflammatory and immune-modulating effects of isotretinoin may be worth exploring.”

Don’t know how to get over acne? Let me help.

Feel like you’ve tried everything but acne still won’t budge? Read this page to understand why you get acne and what you can do to get over it.

Learn more

About Me

Hi, I am Acne Einstein(a.k.a. Seppo Puusa). I'm a bit of a science nerd who is also passionate about health. I enjoy digging through medical journals for acne treatment gems I can share here. You can read more about my journey through acne and how I eventually ended up creating this.

18 thoughts on “Accutane and Gut Problems: The Latest Research

  1. Thank you for this Seppo. Amazing stuff as always, now I have to ask you one simple question before I elaborate on the details of why I’m asking, a new trend that is catching on…would you ever use Accutane in a low dosage 10mg/week as a maintenance procedure to keep your oil levels and pores in check for a very extended period of time provided as long as you get your chemistry levels checked?

    • Sorry about my late reply. Would I consider using low dose Accutane as maintenance therapy for a long time? Hmm.. good question. I’ve glanced over some studies on low dose isotretinoin treatment, but I haven’t really paid attention to them. My impression is that low dose regimen is reasonably effective and causes far fewer side effects.

      I guess it really depends on how long I would need to take it. In my current situation I probably wouldn’t take it. The little acne I still get doesn’t really bother me. So even if the risk is minimal, I also feel that the upside is also very limited. But if I had more serious acne then I would certainly consider it. In fact, I would probably take it.

      • When I was on Accutane my skin has never looked better. Not only did I not have any zits but my pores were not in a constant state of dilation with an overproduction of oil like they are now, littered in black heads and clogged pores. The problem that I have now, in addition to the black heads, constant greasiness, dilated pores, is even when I stick to the most flawless routines both topically and orally I will still always end up getting a few zits every few weeks. I have a very light skinned Asian skin tone so even the smallest, minute zit will leave me a hyper pigmented, red pink scar that takes one month of aggressive exfoliating to get rid of. Taking 1 step forward with blemish-free skin for two weeks and then a new pimple that pops up and leaves a hyperpigmented scar that sets me 4 steps back. I don’t think it’s possible for me to ever have good skin if I don’t try this Accutane route low dose. My oil levels just seem way too high and even when I curb my diet and use the best topicals I can’t ever seem to get my skin where I want it to be. At the present moment I’m having to blot my skin at least 3-4 times a day to keep shine away, and that’s without wearing sunscreen, moisturizer, etc.

        Not to mention, having acne control my diet is not the funnest thing. I would like to be able to go out and have fun with my friends, maybe drink a little, eat some foods that are not completely unprocessed, and not be in massive paranoia the next day about having zits.

        As you know though, the fear mongering about Accutane is incredibly intense. This chronic skin problem has been affecting my life on a level that I find completely unacceptable, but the horror stories of overgrowth in bone, liver damage, bowel inflammatory disease and whatever else, is something I always think about before jumping on this Accutane low dosage program.

        • Understand where you are coming from. I don’t think it makes sense to let ‘acne diet’ control your life too much. I mean, at some point you reach the point where the cure isn’t any better than the problem.

          In your case I would talk to a doctor about trying low dose Accutane. Sounds like your skin is far more sensitive than normal and it’s probably not possible to do much with diet/lifestyle.

  2. I have the SAME question in mind too. Appearantly it’s more common in Asia countries than in USA, for example. My doctor doesn’t even recommend it comparing to the regular 6 months course. Anyway, I am going to take 10mg/day next Monday… So it’s good to know at least I don’t need to worry about gut problems, well not as much at least…

  3. hi 🙂 I’ve been taking 10mg dose of isotretionoin for amost a year now! I works fine and the only side effect used to be the chopped lips, I say ‘used to be’ because I recently switched taking one pills every two days instead of the regular regimen one pill a day. so… it is even bettern now and the oil is under control. I’m going to meet my skin doctor in a month or so and will see how to continue although a longer term low dose regimen even is said to be more effective as recommended by my doctor too. I’m going to ask him if I could follow this pattern but take the 10mg pills only few days a week or even less! that would be a relief to me too… it has helped so much already – by building my confidence and reduced overall stress too that I had due to worries about my skin when in public and in general 🙂

    • How long do you think you will be on this program though? That’s the thing that scares me the most. I don’t mind popping one pill every few days or every week if it keeps my oil levels in check for the rest of my life but the fear comes from not knowing what the long terms effects are.

  4. Andrew, good question – I have yet to consult with my doctor regarding this problem. However I don’t see it as being very dangerous to take a 10mg pill a week – it is vitamin A in high concentration after all although in a slightly different form than ‘normal’ vitamin A pills you would take as supplements. The major concern with accutance is said to be the overload of vitamin A in the liver but it is a potential risk mostly for those who take greater amounts (above 10mg) and daily! – but 10mg a week would be fine I think for a longer period too. One way to find it out is to have such a regimen for a few months and then make a blood (+urine) test which will show you how the liver would react and if there would be an above the average level of vitamin A. I must note here that I don’t know about the long term risk for women though – it is said abnormal levels might affect babies and cause abnormalities. For a guy it might be safer for this reason but yet to see how it goes. I read about several accounts when people took low dose for +2 years without any problems or people who were on the drug for one year then had a break and continued it again for another year to see amazing results when not taking it after that – their acne never came back. It will vary person to person though, we are all different and as Seppo pointed it out too acne had several core causes and it depends on the overall factors whether you get pimples or not. In my case I always had one type of acne, the white pus filled ones, pretty much concentrated on the lower part of my face and nose, mostly around my mouth. I did notice certain foods aggravated it and so did the weather (humid/hot/dry) and my state and stress levels, this latter one is very important. Accutane definitely helped me, my face is clear now with few occasional fast drying pimples that don’t bother me at all 🙂 and… it boosted my confidence too, ending the constant thinking of acne on my face. I also changed my diet but have not omitted sugary foods in entirety, rather keeping a healthy balance between ‘organic’ and the fast food type meals. I inherited being more stressful than the average from my parents’ side but I learned how to deal with it and a lower dose of the drug xanax helped in it too but I realise it could be addictive so I handle it well and carefully. I see this as an extra that will help me frogetting being overy stressful about things… and I see this is reflected in my skintone as well – I don’t usually get that rosacea-like reddening anymore that connected to being stressed.

  5. Seppo,

    Quick questions. Have you always had gut problems even prior to taking Accutane? Do you think that the Accutane in any way affected your intestinal health? I know the studies don’t suggest a link, but has it ever crossed your mind that Accutane is the reason that you still have gut issues?

    • I don’t remember. My gut symptoms are relatively mild, and before this I would have dismissed them as normal – I mean, who doesn’t get some constipation. I do remember experiencing constipation quite often when I was younger. So most likely these issues were there already before Accutane but I just didn’t think they were a problem.

  6. Hi Seppo,

    I’m 95% sure i’m starting a full dose 50 mg a day of accutane in about a month (i am 115 pounds). i USED to have bad acne- but got it to be pretty manageable through diet/exercise/ cutting out foods/ drinking green tea/ taking fish oil/ and i credit so much of my acne success in the past to your website, along with thelovevitamin and paleoforwomen. This year i moved from florida to new york for university and i don’t know if it is the weather/stress of school/ change in lifestyle, but my acne really came back bad despite all of my efforts. it honestly feels out of control/ my hair and skin are super oily and they have NOT been this way for about 2 years. the acne is extremely upsetting. I’m hopeful that accutane will help. would you say that the majority of people have long term remission? I’m seriously praying. i’m an extremely healthy person and I want to do accutane the right way. what do you reccommend me take as suppliments while taking accutane? i’ve heard some people taking Vitamin E. should i take probiotics while on accutane? my gut health is pretty great right now and I don’t want accutane to have a negative effect. Thank you!

    • Sorry to hear that your acne came roaring back.

      Most people who take Accutane will never see acne again. I think it’s something like 80%. But the risk of relapse is much higher in some ‘high risk’ groups, such as adult women with hormonal issues.

      Before you decide to take Accutane, please take a look at gut issues as a potential trigger. I think quite many people have gut issues without even realizing it. It was certainly like that for me.

      I don’t think you need to take any supplements while on Accutane.

  7. ALSO- i notice that the ingredients of the capsules of isotretinoin contain SOY—- my worst acne enemy. i have mistakenly in the past taken vitamin D softgels in the past that had soybean oil and i broke out in cysts the next day. I was kinda set on accutane but soy is such a no-no for me. because it is “ACCUTANE” would i not break out….?? i’m really bummed that soybean oil is in the capsules.. what do you think?

    • I’m sorry but I can’t say. Maybe you can ask your doctor if it’s available in different capsules? Or if it’s powder, you could take it out of the capsules.

Leave a Comment