Isotretinoin (Accutane):concerns about BG/ diabetes management?

Parenting a D-Child Teen
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Our son’s dermatologist would like to have him use a 5-month course of isotretinoin (Accutane) for treatment of acne. He told us that, given the seriousness of the drug, he would expect to see the boy every 4 weeks to check potential side effects.

I am wondering if anyone has feedback on possible issues or concerns with respect to BG and diabetes management. The research we have done does raise some concerns. But the only other alternative (a very long treatment of systemic antibiotics) appears worse to us.

Any thoughts?

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Accutane protocol is much easier for a boy.
No issues with BG.
Antibiotics should be about 3 months.
I would try the antibiotics first.
I would also question if your son is a bit on the young side for the Accutane. Maybe by a couple years.

Duration of Accutane is only a best guess in the beginning. It may be adjusted during treatment.

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I’ve done both – Accutane twice or three times several years apart as well as more than a decade of both topical and oral antibiotics. For me, the Accutane just didn’t work. Accutane has pretty nasty side effects – although mainly what your son will notice is the horribly dry skin – but I am not sure how it would affect blood sugar.
I did find one case report tying Accutane to autoimmunity – but it’s just a case report:

The antibiotics made me queasy for years and some disrupt gut function… which I think could make diabetes management harder. And I started developing an irritation reaction to the topical creams, which made my skin burn, look red, and shiny, on top of having breakouts still. In the end I basically decided to quit everything in my mid-20s and just rough it out and my skin eventually calmed down – really improving dramatically after pregnancy.

Both treatments kind of suck. However my impression is that male acne really tends to clear up after the teen years, but that acne can cause serious scarring in just a few years, so it’s possible the Accutane would be more of a silver bullet for your son. For women I think it’s more common for acne to continue through to adulthood and the Accutane would need to be readministered, which sort of defeats the purpose.

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Eric and I have both used Accutane in our teens. Eric took two courses of it, I took one. We both had serious, and lasting, side effects which were not revealed to us at the time we initiated treatment. EH wasn’t diabetic at the time.

Both of us feel like we had a decrease in our night vision that has been lasting.

Also there was a substantial issue with dryness - both of us had really dry mouths among other things, which was very painful if you happen to have braces at the time (which I did) (Instructions on using chopstick regularly and hydrating with fluids might’ve helped but no one mentioned it.) And the dryness for me has continued on.

Eric was so exhausted while taking it that he routinely fell asleep right after school/sports practice, woke up for dinner, ate, did homework and went back to sleep. He views it as difficult to continue normal life.

He was exercising 5 days a week back then and he started having a ton of back pain. The doctor he had at the time suggested that due to the Accutane, he wasn’t having his muscles heal properly. So they started him on a course of steroids. He still has substantial back issues on and off.

I found taking it with food is necessary and very unpleasant if you forget. Make sure to eat.

I personally believe Accutane triggered an issue with depression which I have struggled on and off with since taking it.

We both tried antibiotics before Accutane and found them to be ineffective. Although if they worked, that would’ve been nice.

Despite all of these things, we could see how Accutane could be a useful medication. Eric says specifically: I don’t want to scare them off.

I will also throw in that since I stopped eating gluten, my skin improved massively. I didn’t put it together until friends began to ask what I was doing differently for my skin - they thought I was taking a course of Accutane again, but I wasn’t. Just eating fruits, vegetables and meat. It might be worth considering an elimination diet to see if the acne is triggered by food. Cheaper and easier than Accutane in my experience. (I’m sure some people here will say is BS, but again, this is just personal experience.)

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Thank you so much for the informative post. I would hope no one would say BS, the only time I find case reports bothersome is when the person says, it worked for me, and so it is the only way.

Your case report does none of these things, and so I commend you, and if anyone wants to call BS on TO’s case report, talk to me first! :slight_smile:

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This medication has a significant label. Not to imply that it “should” or “should not” be taken, however it deserves proper consideration and consultation with a competent doctor. Specifically in regards to the comment as mentioned above, as of 2005, this is a specific FDA Alert on the drug. After 2005, it would arguably be medical malpractice for a prescribing physician NOT to thoroughly discuss this (and other aspects) with the intended patient (and/or their parents if the patient is a minor).

FDA ALERT [7/2005]: Suicidal Thoughts or Actions: In addition to the strengthened risk management program, FDA continues to assess reports of suicide or suicide attempts associated with the use of isotretinoin. All patients treated with isotretinoin should be observed closely for symptoms of depression or suicidal thoughts, such as sad mood, irritability, acting on dangerous impulses, anger, loss of pleasure or interest in social or sports activities, sleeping too much or too little, changes in weight or appetite, school or work performance going down, or trouble concentrating, or for mood disturbance, psychosis, or aggression. Patients should stop isotretinoin and they or their caregiver should contact their healthcare professional right away if the patient has any of the previously mentioned symptoms. Discontinuation of treatment may be insufficient and further evaluation may be necessary. [Action taken 8/12/2005 Labeling revision]

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Agreed – I think this has been known for a while as a potential side effect. The thing with Accutane is, though, that since it’s had such a heightened level of scrutiny and so many decades of use I suspect rare side effects are actually picked up with it, whereas they may fly under the radar with other medicines. Not to say those side effects aren’t real – just that maybe there are similarly bad side effects with other drugs that none of us know about because the FDA reporting system isn’t very good post marketing. And certainly other acne treatments aren’t likely to come with such black box types of warnings.

I do think dermatologists should be much more judicious in prescribing Accutane – other less used medications such as spironolactone, for instance, might be more helpful for some cases. But I am guessing it’s just such a tempting medicine for dermatologists because it really does seem like magic for many people. Incredibly intractable cases clear up in a snap. And I for one see severe acne as significantly life impairing, especially in the teen years. So I do think it’s appropriate for many people.

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I am a bit concerned about the depression side effect. It spooks me that it does not stop when you stop treatment.

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I never took it myself, never had that bad of a need—- but I remember in high school and junior high kids walking around looking like their lips were about to disintegrate because this stuff dried them out so bad… gnarley… I mean these guys looked like they had leprosy— I think I’d have preferred the severe acne if I were them

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What topical skin options have you tried? Does he use low pH cleansers and glycolic and salicylic acid toners/exfoliators, and topical clindamycin? My skin was good as a teen and young adult, in part thanks to estrogen-containing hormonal birth control, but in my 30s, it went haywire, largely due to hormones. Those types of products, especially the acids, made such a difference and now my skin is back to mostly under control. I also know a lot of folks who use Retin A/treninoin, which has its own side effects (dry skin, heightened sun sensitivity), which was going to be my next plan if the stuff I’d tried hadn’t worked. I’m so averse to systemic medication if at all possible, although if you’ve already tried all those things, I certainly would understand giving them a try.

I’ve definitely heard and seen this from/in other people, as well as with dairy for some, and then for others, neither has an effect. It seems like there’s not a universal answer, but that acne is one of many ways food sensitivities show up and are discovered.

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All but the topical antibiotic: his doctor recommended antibacterial soap instead, which he uses.

He is also using topical tretinoin. Every 6 months we have upped the level of chemicals used :slight_smile:

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You would think that…until you can’t lean against something because your back is so broken out it’s painful. And having permanent scarring isn’t fun, especially if it can be eradicated. And it is, for most people, a temporary dryness issue.

@Michel about the depression thing…I do think many people use Accutane and don’t become lifelong depression sufferers. Eric, for instance. Also, depression strongly runs in my family, so checking in with family history might be wise.

I took it in 1996, there were barely any warnings other than pregnancy complications and taking it on an empty stomach.

I remember the day in 2000 when the concerns about Accutane hit the morning news programs (I didn’t have TV). My dad phoned me and I drove across town to his house to watch Good Morning America report about suicide and depression linked to Accutane. I finally felt like I wasn’t just crazy.

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The topical antibiotic definitely helped knocked down my cystic acne—I might ask for it unless your doc has a reason for avoiding. Unlike all the all the other things (including, I imagine antibacterial soap, which can be harsh), it doesn’t also dry the skin, which is nice, just kills the bacteria. Might be a useful tool regardless of what you do with the Accutane, and definitely seems worth trying before trying any systemic antibiotics.

I think considering personal and family history is definitely smart when drugs have these types of side effects. If someone has a tendency at all toward being depressed/moody and/or a significant family history of depression/psychiatric difficulties, that’s very different than someone who is temperamentally very stable and lacks a family history. The latter person might still have mood side effects, but I bet it’s both less likely and less likely to persist if they do occur and the med is stopped. I would exercise a lot more caution with someone who seems at greater baseline risk.

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This made me think too, about level of activity and mood in general. @cardamom might know, but I’m under the impression that physical activity can act in an anti-depressant manner. Maybe all the exercise will help! (I was by default a non-sporty person.)

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That’s a great tip, and I can’t think of any downside. We will definitely follow up on that.

I had no idea, thanks so much! I just found this excellent 2013 review article that explores exercise as a treatment for depression:

The article’s summary is striking:

In summary, exercise appears to be an effective treatment for depression, improving depressive symptoms to a comparable extent as pharmacotherapy and psychotherapy. Observational studies suggest that active people are less likely to be depressed, and interventional studies suggest that exercise is beneficial in reducing depression. It appears that even modest levels of exercise are associated with improvements in depression, and while most studies to date have focused on aerobic exercise, several studies also have found evidence that resistance training also may be effective.

I can’t help thinking that, given all the possible emotional side-effects of diabetes, this should be better known among the DOC.

[EDIT] I am finding a series of research papers on exercise in depression in PWDs, all of them so far indicating significant benefits. This seems so valuable to me that I will start a thread on this topic, once i have done a bit more research.

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Brilliant! I was thinking that something like that might belong in @Eric’s exercise wiki area!

I’ve read that exercise is basically equally effective for certain people with depression as RX medication. I will also add that I believe that depression is a real medical condition just like diabetes or cancer, and that it also sometimes requires medication and medical intervention to recover from. I can never believe how often people I’ve come across poo-poo depression or insinuate that it’s a choice.

Also, as great as exercising can be for depression, it’s really hard to get off the couch when you’re depressed!

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I’ve had depression since I was about 17 even as an athlete… it’s well controlled now with meds but took years to figure it out. For me, it’s very chemical. Tried to get off them many times since I worked through all the self criticism thought processes years ago but it’s just how my brain chemistry is. You can reduce risks, but it’s still just statistics.

I still get painful cystic acne sometimes and nothing really works. Never tried accutane but had friends that did. Doc/parents wouldn’t let me but I wanted to try. Mines never been awful but I haven’t had completely clear skin since I was about 10.

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Exercise can be effective for both depression and anxiety, but like meds, it works more for some and not others, and even when it works, it may work in that it takes the edge off, not in that it solves the problem. Also, like with meds, it can cause side effects (injury etc) and can be overdone, so it must be implemented in a reasonable way for the individual. That said, I absolutely recommend physical activity/exercise as part of comprehensive mental health treatment, and that is increasingly recognized and recommended within clinical psychology/psychiatry. It can definitely make a difference.

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I usually recommend starting with the smallest possible step, like, I will put on my exercise clothes. If that’s all I do, ok, that’s something. If you get that far, you get to feel good. Then same thing with walking outside. Then walking around the block. Whatever point you stop at, ok. Try one more the next day. If you don’t even get to step one, your steps are too big, make them even smaller, no matter how silly that might seem.

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Are you in the mental health field?