Isotretinoin patients should not be overly worried about IBS
People with acne-prone skin can understand the challenge of eliminating their acne.
Trialling medications and treatments with a long list of potential side effects can be gruelling for people wanting the safest and most effective option.
For many patients, especially those who have not responded to other treatments, isotretinoin can be life-changing for clearing stubborn acne and improving quality of life.
But like all medications, isotretinoin comes with potential side effects, and one area of concern that has sparked debate over the years is its possible link to inflammatory bowel disease (IBD).
What is isotretinoin?
Isotretinoin capsules (e.g. Accutane, Oratane or Roaccutane) have long been an effective treatment to address all known causes of cystic acne.
Isotretinoin is a type of retinoid that is a derivative of Vitamin A.
It works by making the oil gland less friendly to the bacteria that contribute to acne and can produce long-term remission in up to 85% of people with severe cystic acne.
Isotretinoin has many benefits to the skin, including:
- Unblocking pores
- Preventing further blockages
- Reducing oil production
- Soothing redness and inflammation.
Although very effective at treating acne, isotretinoin can cause side effects.
Side Effects of Isotretinoin
Common side effects of the oral medication include dry skin, eyes and lips, which may cause the skin to appear scaley or irritated.
In the first few weeks of treatment, isotretinoin tends to cause very dry skin, but using a moisturiser regularly helps to relieve this dryness.
Other common side effects include flare-ups, sun sensitivity and joint aches.
It is often said things get worse before they get better, and this is the case for isotretinoin.
Less common side effects include tiredness, joint aches and pains, but they can occur.
Generally, these side effects are dependent on the number of capsules a person takes each day.
Many side effects of isotretinoin are left unproven such as depression or suicidal ideation.
If experiencing rare side effects such as hair loss, mood change, severe headaches associated with nausea, vomiting and vision changes people are encouraged to consult their doctor or dermatologist immediately.
Understanding Precautions to take when taking Isotretinoin as a Woman
It is important to know the risks of isotretinoin if you are a woman and of child-bearing age (when your period starts).
It is recommended very effective contraceptive measures are used while taking isotretinoin as it can cause birth defects.
As a result of these risks, it is recommended birth control is used for:
- At least one month before starting isotretinoin treatment
- During the entire isotretinoin treatment
- For at least one month after stopping the isotretinoin treatment.
A negative pregnancy test is also usually required before starting isotretinoin.
If you become concerned you have become pregnant while taking isotretinoin, it is best to contact your doctor or dermatologist immediately.
Side Effects: The Relationship Between IBS and Isotretinoin
Over the past two decades, there have been reports and studies suggesting a possible connection between isotretinoin use and the development of IBD.
These reports have led to concerns among patients and healthcare providers alike.
However, the relationship between isotretinoin and IBD is not straightforward, and the scientific community is working to clarify if this link is real or coincidental.
What is IBS?
IBS is a chronic condition that affects your digestive system.
It is characterised by symptoms, such as:
- Adnominal pain
- Bloating and swelling in the stomach
- Excessive wind
- Changes in bowel movements.
The direct cause of IBS is unknown and is thought to be a combination of gut sensitivity and abnormalities and is potentially caused by stress and diet.
However, isotretinoin is not a confirmed cause of IBS.
Other Types of Irritable Bowel Disease
There are other types of irritable bowel disease (IBD) that have been thought to be connected to taking oral isotretinoin, and not yet confirmed.
These other types of IBD are:
- Crohn’s Disease: A chronic IBD that causes inflammation of the digestive tract, most commonly affecting the small intestine and beginning of the large intestine.
- Ulcerative Colitis: A chronic IBD that causes inflammation and ulcers in the lining of the colon and rectum.
New Research
Research suggests patients should not be overly concerned when prescribed oral isotretinoin.
The American Academy of Dermatology reviewed previous analyses to clarify the IBD connection with taking oral isotretinoin.
The review considered 9 previously published case studies.
It looked at the risk of IBS and the two sub-types of IBD—Crohn’s disease and ulcerative colitis.
The review considered the risk of new cases of IBD in isotretinoin patients compared to the cases of IBD in placebo patients.
The 9 studies reviewed involved more than 10.5 million patients.
But what does the evidence say? Let’s break it down.
The Results
It was found patients who take isotretinoin for more than one year are at higher risk of developing IBD.
Crohn’s disease risk decreased with isotretinoin, but ulcerative colitis risk remained unchanged.
However, for shorter treatments, there was minimal risk.
The risk of IBD from isotretinoin was not a major concern for many people, but extended use should be monitored.
Limitations
Dermatologists say that extended research on the link between isotretinoin and IBS, as well as other related IBD, is unlikely to exist.
They recommend that dermatologists and patients continue conversations about the IBD risk with isotretinoin and tailor their treatment place to other factors like family history or diet.
Practical Advice for Patients
If you’re considering isotretinoin or are already taking it, here are some practical steps to ensure you’re making informed decisions about your treatment:
- Discuss Your Medical History: Be open with your dermatologist about any personal or family history of IBD or other gastrointestinal conditions. This information will help tailor your treatment plan with your dermatologist.
- Monitor for Symptoms: While on isotretinoin, pay attention to any new or unusual symptoms, such as persistent abdominal pain, changes in bowel habits, or unexplained weight loss.
- Follow Your Treatment Plan: Stick to the prescribed dosage and duration of treatment. Avoid extending your course of isotretinoin without medical advice, as longer use may carry additional risks.
- Stay Informed: If you’re concerned about the potential side effects of isotretinoin, don’t hesitate to ask your dermatologist for more information. A good dermatologist will take the time to address your concerns and provide evidence-based advice.
Dermatologist Advice
Dermatologists don’t want you to be deterred from seeking the right treatment because of fear of potential side effects.
By working closely with your dermatologist and staying informed, you can make the best choice for your health and well-being.
Isotretinoin is a safe and highly effective option for managing severe acne.
Conclusion
Finding the right treatment for your acne can be challenging, especially with the side effects and common concerns of oral medications.
New research tells that long-term isotretinoin use may increase the risk of developing IBD, especially after one year of treatment; however, the slight rise in risk is still small and might not be a serious limiting factor for most people with acne taking isotretinoin.
Most patients can now feel relieved that they do not need to worry about IBS is unlikely to concern them while taking isotretinoin.
Reference: Ahmed A, Liaquat A, Raza S, Koza E, Ma M, Haq M, et al. Association of inflammatory bowel disease incidence with isotretinoin usage: A metaanalysis and systematic review. Journal of the American Academy of Dermatology. 2024 Nov;91(5):949–51. doi:10.1016/j.jaad.2024.06.068
