[Music] hey everyone it's Dr Joyce Park board certified dermatologist and I wanted to react to a series of acne and Accutane related videos for you today recently I did a reaction to an Accutane glow up where a patient very bravely posted her entire course on Accutane showing before and afters and believe me when I say that the glow up that transformation was mind-blowing it was really really awesome to see this patient's confidence increase and her skin was just looking really amazing so I thought this would be a great time to do a reaction to a couple of Accutane and acne related videos and then also impart and share some knowledge about acne and Accutane side effects who it's good for things to watch out for and what to expect when you're on it so let's get into it to start off with I wanted to briefly explain what Accutane is Accutane is oral vitamin A and it's given to patients for the treatment of severe nodulocystic acne it is not a treatment for for everyone and we don't just hand it out willy-nilly and the reason for that is there are a lot of side effects that can come along with taking Accutane orally the most common side effect I see is dry eyes dry lips dry mucocutaneous membranes meaning you could be prone to dry lining of your nose and you would get nosebleeds that is hands down everyone gets it I rarely have ever seen a patient that doesn't get that some patients can also experience worsening of their eczema they get dry itchy skin and then there's the kind of more rare side effects that can also be seen so definitely something we have to counsel about it can worsen your mood it can cause irritability if you have a history of depression or anxiety or other mood disorders Accutane can exacerbate that before I ever give Accutane to any patient with a history of mood disorders I would definitely make sure that they have a psychiatrist or psychologist who is ready and available to provide support to them throughout their entire Accutane Journey Accutane has also rarely been shown to cause bone pain it can affect your hair growth or accelerate right hair loss it can temporarily decrease ovarian reserve and impact female fertility for the time that you're on it it can also be and this is a huge one a teratogen so it can cause birth defects to a developing baby which is why if you are of child bearing potential and you want to take Accutane you actually have to sign paperwork and promise that you will not get pregnant in fact you have to take a monthly pregnancy test to prove that you're not pregnant before I can even release the medication to you it's very strict but for good reason because we cannot have people getting pregnant on this medication because of that risk to the babies something I always consider and talk to my patients about is Family Planning if you are of childbearing potential and you want to have a child soon like in the next couple of months to a year I would really say that Accutane is not the choice for you at least not right now and that's because a you cannot get pregnant while on Accutane because of the risk of birth defects and B there is a chance that Accutane can decrease female fertility while you're on it and even for a several months after you're done with the therapy so if you are thinking you want to start trying to have a kid soon definitely Accutane is not the choice for you Accutane can also cause headaches it can also impact and decrease your night vision it can also rarely cause these growths called pyogenic granulomas to appear they're these little vascular kind of painful bleeding growths you can also get paronychia which is inflammation around the fingernails Accutane can also cause a whole host of blood test abnormalities which is why we carefully screen you at Baseline and also again throughout your course using serial blood tests the most common lab abnormality it can cause is elevation of your triglycerides so we screen for that in a cholesterol panel it can also alter your liver function tests so we also screen for that and make sure to tell you not to take Tylenol and not to drink alcohol while you're on this medication because those can also impact your liver as a dermatologist just there are a lot of things that I think about before I even offer Accutane to a potential patient number one I think about what type of acne you have Accutane is typically reserved for severe nodulocystic acne because of all the side effects that it has I typically Reserve Accutane for severe recalcile transcystic acne meaning horrible scarring painful acne that has not really responded to anything else you could also have moderate acne that qualifies for Accutane if your moderate acne just has not gotten better has not gotten touched or influenced by any other medications like if you've already tried everything else in the book that we have and it's just not budging at all then Accutane might be something that we bring up for discussion if your acne is at high risk for leaving permanent scars that's another reason why I would be willing to offer Accutane to a patient because those scars are really hard to treat and can last a lifetime so then we really want to be proactive and stop the acne in its tracks before you have further scarring the other thing I always consider too is if you have hormonal acne hormonal acne is influenced by male androgens so testosterone and dihydrotestosterone levels that fluctuate throughout our cycle and hormonal acne typically appears at a certain point in the cycle either at ovulation or slightly before your period And it typically comes out along your jawline and your chin and they're these pesky painful inflamed cysts and I know it really well because I personally have it a lot of my patients have it and we do have a lot of great medications that do work specifically on the hormonal level to Target hormonal acne now some of my patients have gone on Accutane before because the hormonal treatments like spironolactone just don't get rid of their hormonal acne Accutane will improve hormonal acne but when you get off of it there's a chance that your hormonal acne may come back and it may come back to a lesser degree but it will probably still come back so you'll still need a little something to treat your hormonal acne whether that's oral spironolactone or topical spironolactone or birth control we can kind of player round with what medication fits your lifestyle and your family planning goals but just know that if you have hormonal acne Accutane is not going to deliver those long lasting effects that it might do for run-of-the-mill nodular cystic acne now that we've covered some of the basics of Accutane let's react to some of these videos so this first video that I'm going to react to is from user Daisy CBJ and this is the video that I reacted to on Tick Tock that went viral thank you foreign [Music] she's already starting to look a lot better with less actively draining cysts less nodules still with significant scarring and breakouts though but for only one month in [Music] foreign [Music] by June 6th oh my gosh her skin is looking good not as many active breakouts that I can see still with significant redness which is what we see a lot in Accutane patients but the scarring is already decreased and very few activists so this is a great result [Music] wow so she shared her full six month treatment and she looks amazing so typically Accutane is used for a I would say anywhere between a five to seven month course but that depends on this very of your acne as well as your weight so we dose it by weight as well as clinical response when you get to your gold dose which is usually a mathematical calculation we do based off of your weight in kilograms then we see have you been acne free for one month two months or three months and from there we decide whether we should continue whether we need to up the dose or whether we need to tweak it if you're experiencing side effects dosing Accutane is really an art form of course we have the standard mathematical formulas where we dose you know one to two milligrams per kilogram per day however it really depends on how your body responds and we can either increase the dose or decrease it if you have side effects we'll try to go down if the acne isn't responding you're just not really getting the results we had hoped for then we can go up but it really is an art and a balancing act so the one thing I wanted to say about this account as well is she had a really incredible transformation with just five to six months of treatment however seeing as how her acne was really really severe to begin with she is someone I would have been afraid of developing acne fulmanans so I feel like acne fulminance is not commonly understood in the social media space and it's not widely talked about acne fulminans is a skin condition where you get explosive painful draining nodular cystic acne after starting Accutane and this typically occurs in patients who have really severe acne to begin with and when this happens it really can be quite catastrophic because just imagine you're coming to the doctor's office you already have really severe acne and then you go on Accutane after reading about all of the side effects and then you start taking the medication and then you get explosive acne and sometimes this can be not just on the face people can get it on their backs on their chests it can be all over it's really quite devastating and I've had a handful of patients that this has happened to and this is something that dermatologists can recognize and we are trained to treat it so basically your body is mounting an inflammatory reaction to being on Accutane so what we typically need to do in that case is cut way down on the dose of Accutane meaning if you're starting at 40 milligrams according to your weight we scale you all the way down to like 10 milligrams a day and we keep you there for a while so you're not getting treated at the full gold dose but because you're having such a severe reaction we really cut way back down and then additionally we also put acne fullmanian's patients on prednisone a short oral taper of Prednisone I say short but the length of time really depends on how severe your acne fulminance is and how well you respond to the prednisone in terms of getting rid of your acne full name now there's not a specific way that we could screen for patients who will develop acne full minions but typically if I have a patient who has very very very severe nodulocystic acne maybe on multiple locations of the body that is someone that I would start at a very very very tiny baby dose on and then see how it goes before jumping in full force and giving them their full goal dose okay so I'm going to react to this second video it's a compilation of pictures during the treatment she looks amazing now I don't know how long she was on Accutane but she definitely experienced a pretty awesome and incredible transformation the reason I wanted to react to this video is one of her photos actually showed her having a nosebleed and I wanted to explain that a little bit more Accutane we know completely dries you out that's part of why it actually works for acne and for cysts it completely dries out your pores it dries out your skin because it works in that way patients on Accutane also experience dryness everywhere they get dry itchy rashes they get flaring of their eczema they can also get dry lips very dry chapped lips and they can also get drying inside of their noses and also very very dry eyes now I often have seen patients with dryness in all those areas I've talked about but one of the really annoying ones for my patients are nosebleeds so in order to combat that I typically recommend sleep thing with a humidifier especially during winter time and then using a Q-tip to apply a thin layer of Vaseline to coat the inside of your nose every day and it could even be twice a day for chapped lips I always recommend a thick layer of petrolatum either Vaseline or Aquaphor and keep that chapstick on you literally all day it will be your best friend because that side effect lasts the entire time that you're on Accutane for dry eyes I do recommend trying to cut down on contact lens use because I find that that could potentially irritate my patient's eyes and lead to more dryness I also recommend using refreshed tears and using that to re-wet their eyes constantly throughout the day okay moving on to the third video this says POV you're on Accutane for the third time [Music] thank you [Music] all right so I wanted to watch and react to this video because it is true some patients may need to take Accutane multiple times and I know that's not what people want to hear because it is a hard medication to take and you have to take it from multiple months at a time but research has shown that in patients who take Accutane about one-third don't have breakouts again about one-third still get occasional breakouts that they can handle with prescriptions non-acute and the last one third may have acne recurrence severe enough that they need another course of Accutane possibly even a third course and typically if your acne is really really severe to begin with you might be in that last bucket where you may need a second or third course so that is something that we look out for and we really try to stay on top of it the other thing I wanted to point out in this video is that she is taking her Accutane with spoonfuls of peanut butter and the reason for that is because we know that vitamin A is a fat soluble vitamin and so you want to take your Accutane with a fatty meal not too fatty because we know that it can also raise your triglycerides but you want to take it with enough fat with the right amount of fat to help have maximal absorption of the medication so it can really work things I typically recommend my patients take are fatty nuts fatty Meats fatty fish like tuna avocados and basically work that into your meal or take it with a spoonful of peanut butter and that will really help with absorption of the medication okay let's move on to the last video which I thought was interesting because this woman claimed that Accutane gave her a nose job POV if you're convinced Accutane gave you a nose job let's take a look foreign I would argue that her nose was really nice to begin with so there is no evidence and no scientific research backing the claim that Accutane can give you a nose job like make your nasal Bridge higher make your nose look smaller and more snatched no we know that Accutane works by shrinking pores so if you have a ton of oil glands and very visible pores on your nose to begin with those might look reduced after Accutane it certainly doesn't impact the shape of your nose and the formation of the cartilage Etc so nope that one is not true so I hope you enjoyed this brief primer on Accutane what it is what it does how it works who it's for who it's not for and reaction to some popular Accutane related videos on Tick Tock please leave any questions or comments below I am always super open to hearing what you have to say and also I really want to know what you want to see so I can make more videos for you don't forget to like and also hit subscribe for more skincare related content coming really soon until next time [Music]