Looking for Alternatives to Accutane? Here Are 3 Options

If you have severe acne, a healthcare professional may have recommended isotretinoin. Most people know it as Accutane, but it's also available under a number of other brand names, such as Claravis, Zenatane, and Absorica.

Like a lot of people, you may be concerned about the side effects of this medication. Or maybe you're looking for another option for a different reason. We'll go over the pros and cons of Accutane as well as some alternatives you can consider.

What is Accutane, and how does it work?

Accutane (isotretinoin) is a medication used to treat severe acne. It's a derivative of vitamin A. The FDA originally approved it as an acne treatment in 1982, and it's still commonly used today. It's especially helpful for people with severe, scarring acne or those who have acne that doesn't respond to other treatments.

Accutane treats acne in a number of ways:

• It lowers the production of oil on your skin.

• It slows the growth of new skin cells that can clog pores.

• It keeps acne-forming bacteria from growing.

And the Accutane success rate is high: About 85% of people get permanently clear skin after one course of treatment. So it's clearly very effective. Higher doses are more effective than lower doses but tend to cause more side effects.

Are Accutane side effects really that bad?

The concerns most people have about isotretinoin are related to the side effects. You've probably heard rumors that the medication can cause depression and suicidal thoughts.

Large studies of thousands of people have shown no association between taking isotretinoin and depression. In fact, treating bad acne seems to make depression better in most people. This is not to say that people taking isotretinoin don't get depression - it just means that isotretinoin is not likely to be the reason why. Even so, dermatologists who prescribe isotretinoin carefully screen and monitor for signs of depression to be safe.

Known side effects of isotretinoin can include:

• Birth defects (avoid isotretinoin if you're pregnant)

• Dry skin and eyes

• Chapped lips

• Hair thinning

• Dry nose/nosebleeds

• Trouble seeing at night

• Sensitivity to sunlight

• Increased cholesterol

• Back, muscle, and joint pain

• Liver problems

• High pressure in the brain

Is Accutane safe?

Side effects can happen with any medication, including Accutane. It doesn't necessarily have "more" side effects than other pills.

Whichever medication you take, you need to weigh the benefits of taking that medication against the risks. Knowing what can happen and what to expect is important, too. The good news is that isotretinoin has been around for a long time. A large study in 720 people found no serious long-term side effects after taking one or more courses.

If you're taking isotretinoin, your dermatologist or other healthcare professional will order periodic blood tests to make sure the medication isn't causing any serious problems. You'll also follow up regularly with your dermatologist and register with a national risk management program called I-Pledge. These measures may sound complicated, but if you can follow them, they'll make sure your Accutane treatment is safe.

What are some Accutane alternatives?

If you've looked into isotretinoin and decided you'd like to try something else first, below are some Accutane alternatives that you may want to talk about with your dermatologist.

1. Topical retinoids

Isotretinoin is a type of retinoid, but it's not the only one used to treat acne. Others include tretinoin (Retin-A), tazarotene (Tazorac), adapalene (Differin), and trifarotene (Aklief).

However, unlike isotretinoin, which you take as a pill, you apply these retinoids topically, meaning they're put directly onto your skin. They work by helping to unclog pores and regulate skin cell growth so your pores don't get clogged as often.

In addition, they have fewer side effects than isotretinoin. You may experience some temporary skin side effects while using retinoids, such as:

• Dryness

• Irritation

• Redness

• Peeling/flaking

But these symptoms are easy to manage or eliminate with proper use. Just like isotretinoin, you shouldn't use these medications if you're pregnant.

Isotretinoin tends to be more expensive than other types of retinoids. But in general, retinoids are pricier than other types of acne treatments, although insurance may cover them. Generic versions are usually more affordable than brand names, and Differin 0.1% is now available over the counter at a lower cost.

2. Antibacterial medications

These medications work mainly by killing the acne-causing bacteria in your pores. They're commonly used to treat acne. And, for some people, they could be a good alternative to Accutane.

Antibiotic treatment for acne

An antibiotic can be applied to your skin or taken by mouth as a pill. In terms of cost, generics are relatively cheaper, and your insurance may even cover them.

If you're dealing with more severe acne, this may not be the best option. Long-term use of antibiotics can cause bacteria to develop resistance, and the medication may become less effective over time.

And keep in mind that each antibiotic has its own possible side effects. This can range from stomach upset and sun sensitivity from the pills to skin irritation and dryness from the topical treatments.

Here are some of the most commonly prescribed antibiotics for acne:

• Tetracyclines, like minocycline (Dynacin) and doxycycline (Vibramycin), are the most commonly prescribed antibiotics for acne.

• Macrolides, like azithromycin (Zithromax) and erythromycin (Ery-Tab), are usually used as topicals for acne.

• Sulfonamides, like trimethoprim-sulfamethoxazole (Bactrim), is a second-choice antibiotic for acne. Your dermatologist may prescribe it if you're allergic or don't respond to topical antibiotics and tetracycline pills.

• Sulfones, like dapsone (Aczone), is a newer topical treatment for acne and tends to be a bit more expensive.

Benzoyl peroxide

Benzoyl peroxide is a topical medication that's available over the counter. You can find it in face washes, body washes, gels, and creams. It's usually pretty inexpensive.

If your acne is mild, it may do the trick on its own. But if your acne is moderate or severe (such as hard or pus-filled pimples or bumps), your healthcare professional will probably prescribe you another medication to use with it, like a topical retinoid or antibiotic. The combination works better than either alone.

Like other topical acne medications, you may have some minor skin redness, peeling, and irritation that will go away once you stop the medication.

One tip about using benzoyl peroxide: Make sure you rinse thoroughly after applying it because it can bleach your towels and clothes.

3. Hormonal treatments

If you're female, you may want to look into hormonal acne treatments. For teenagers and adult women, hormone changes around periods and menopause can cause acne.

These treatment options help control certain hormones in your body called androgens. These are "male" sex hormones, but they're found in women, too. But when their levels are too high, they can cause the skin to produce excess oil, which contributes to acne.

Birth control pills

Birth control pills can be used on their own or along with other treatments. Insurance usually covers them, and people without insurance can get them for free or at a low cost from places like Planned Parenthood. Some types that work well for acne are:

• Ethinyl estradiol/norgestimate (Ortho Tri-Cyclen)

• Ethinyl estradiol/norethindrone acetate/ferrous fumarate (Estrostep FE)

• Ethinyl estradiol/drospirenone (Yaz)

• Ethinyl estradiol/drospirenone/levomefolate (Beyaz)

Anti-androgen pills

Another treatment option for women is the medication spironolactone. It's a diuretic ("water pill") commonly used to treat high blood pressure, but its hormonal effects can help acne as well. It's available in a relatively inexpensive generic form.

It's not safe to take during pregnancy, and it may interact with some medications. Side effects can include headache, dizziness, and more frequent urination. Spironolactone requires a prescription. And you may have to get blood tests every now and then because it can affect potassium levels.

Anti-androgen cream

If you want to stick with topical treatments, an anti-androgen cream called Winlevi (clascoterone) is available to treat acne. It's the only acne cream that targets hormones that cause excess oil in acne.

Because it's newer, it may be more expensive. However, there are ways to save on Winlevi. If you're eligible, use the manufacturer's saving card to access Winlevi for as little as $20 per month.

How to get Accutane or its alternatives

If you want an Accutane alternative, or if you've just started struggling with acne, see a dermatologist or your primary care provider for help. At your visit, they'll ask you questions about your acne, such as how long you've had it and what your skin care routine is like. They'll also want to know if you have any medical problems or take any medications.

Depending on how severe your acne is, and what kind (blackheads versus whiteheads, for example), they can provide some recommendations. Together, you can come up with a plan to get your acne under control. Many of the more effective treatment options require a prescription, so be sure to check out GoodRx savings options if cost is an issue.

What about natural alternatives?

Products such as tea tree oil, barberry extract, and gluconolactone are promoted as natural treatments for acne. Unfortunately, they haven't been very well studied. As a result, the American Academy of Dermatology doesn't recommend them based on a lack of evidence. These treatments need more research to determine whether they are safe, effective, and/or reliable ways to help with acne.

Frequently asked questions