What is Accutane?

Isotretinoin, also known as its brand name of Accutane, is a commonly-prescribed medication used to treat severe acne and other skin conditions. 

Accutane was first developed to be used as a chemotherapy medication for the treatment of brain cancer, pancreatic cancer and more. It is still used in the treatment of these cancers to this day because of its ability to kill rapidly dividing cells. The effects of the medication are systemic and non-selective. In some cases, it is used to treat Harlequin type ichthyosis, a usually lethal skin deformation in which sufferers develop armor plated-like skin and usually die soon after birth. It is a retinoid, meaning it derives from vitamin A and is found in small quantities naturally in the body.

The way that Accutane works is not currently known, but research has revealed at least one way in which it may produce its effects. Accutane could promote the body's production of neutrophil-gelatinase-associated lipocalin (NGAL), which promotes the programmed cell death of certain sebaceous gland cells that normally produce sebum, an oily, waxy substance, that clogs pores and helps acne to form. As a result, sebaceous glands shrink, and less sebum is made. While this shrinking of the sebaceous glands only lasts while the medication is being taken, acne may not reappear even after cessation of Accutane.

Additionally, the increased production of NGAL may help to kill a type of microorganism that contributes to the development of acne, Propionibacterium acnes. Since it attacks acne on multiple levels, it is much more powerful than other acne medications, but these multiple mechanisms of action also increase the side effects that Accutane can have.

Interestingly, because Accutane was first developed as an anticancer agent, it has some effects that make it useful in combating certain forms of the disease such as brain or pancreatic cancer. Accutane has been shown to be able to kill quickly replicating cells quite easily. Accutane may have its anti-cancer effect from the fact that it diminishes the expression of certain genes that code for enzymes that are active in cancer cells. One of these proteins, telomerase, is responsible for adding DNA sequences to genes, essentially making cells immortal; this action helps to make cancer cells resistant to natural cell death.

Accutane is usually taken orally, in which case it is more effective, but the side effects can be more severe as well. It is also available as a topical formula, with fewer side effects, but correspondingly less efficacy against acne.

The molecular structure of isotretinoin resembles Vitamin A, and some of its side effects resemble an overdose of this vitamin, especially since Accutane is often initially given in high doses to clear up existing acne. Some Vitamin A derivatives are normally used by the body in order to control certain functions, including embryonic development, so a compound like Accutane that resembles them can sometimes inadvertently trigger unintended events. These side effects often include dry skin, itchiness, rashes, headaches, and eye irritation.

One of the more severe side effects of Accutane is the development of inflammatory bowel disease, which may be due to its similarity to Vitamin A, or the many effects it can have on the body. This usually manifests as either Chron's disease or ulcerative colitis, and the condition persists even after Accutane is no longer being taken. These diseases are characterized by abdominal pain, cramping, intestinal spasms, nausea, vomiting, and diarrhea, and may require treatment with antibiotics, steroids, or in some extreme cases, surgery.