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SEVERE RECALCITRANT NODULAR ACNE

Treating Deep, Painful Nodules When Standard Acne Therapies Haven't Worked

Severe Acne
Severe Acne
Severe Acne
Severe Acne
Severe Acne
Severe Acne

Severe recalcitrant nodular acne is a serious subset of acne vulgaris defined by two critical characteristics: the presence of multiple large, painful nodules, which are solid, deep lesions measuring 5 millimeters or greater in diameter, and resistance to standard acne treatments. Unlike the surface-level blemishes associated with milder acne, nodules form deep within the skin when inflammation penetrates through the follicle wall into the surrounding dermis and subcutaneous tissue. Lesions can persist for weeks or months at a time, commonly appearing on the face, chest, jaw, and back, and are frequently accompanied by significant pain and tenderness.1,2,3

Severe nodular acne develops through the same four connected processes seen in all forms of acne: increased oil (sebum) production, often driven by hormonal changes; improper shedding of dead skin cells, which can clog pores (hair follicles); growth of bacteria (C. acnes) within clogged pores; and an inflammatory response, leading to redness, swelling, and pimples. In more severe cases, pressure and bacteria build up inside a clogged pore to the point that the pore wall breaks open. When this happens, its contents spill into the deeper layers of the skin. This leads to a strong inflammatory response that damages collagen and other structural components responsible for keeping skin smooth and intact. Because this damage occurs deep below the surface, severe nodular acne carries a high risk of permanent scarring.1,2,3
The physical and emotional toll of severe recalcitrant nodular acne is profound and far-reaching. Permanent scarring, including icepick, boxcar, rolling, and hypertrophic scars, is among the most distressing consequences, as it leaves lasting visible reminders of the disease long after active lesions have resolved. The pain and visibility of active nodules have been shown to affect patients' willingness to participate in social, academic, and professional settings. Critically, the quality-of-life impairment seen in severe nodular acne is comparable to that reported in chronic conditions such as asthma, psoriasis, and diabetes, underscoring that this is not simply a cosmetic concern, but a serious medical condition with wide-reaching consequences that extend well beyond the skin.3,4,5

POTENTIAL TREATMENT

Accutane® is used to treat a type of severe acne (nodular acne) that has not been helped by other treatments, including antibiotics.

Accutane can harm your unborn baby, including birth defects (deformed babies), loss of a baby before birth (miscarriage), death of the baby, and early (premature) births. Patients who are pregnant or who plan to become pregnant must not take Accutane. Accutane can cause serious mental health problems, including depression, psychosis, and suicide.

Please see the Medication Guide and full Prescribing Information here for Boxed Warning, Contraindications, other important Warnings and Precautions, Drug Interactions, Use in Specific Populations, and other Adverse Reactions.

Important Safety Information
References:
  1. Vasam, M., Korutla, S., & Bohara, R. A. (2023). Acne vulgaris: A review of the pathophysiology, treatment, and recent nanotechnology based advances. Biochemistry and Biophysics Reports, 36, 101578.
    https://doi.org/10.1016/j.bbrep.2023.101578
  2. Sutaria, Amita, et al. “Acne Vulgaris.” National Library of Medicine, StatPearls Publishing.
    https://www.ncbi.nlm.nih.gov/books/NBK459173/
  3. Fife D. (2011). Practical evaluation and management of atrophic acne scars: tips for the general dermatologist. Journal of Clinical and Aesthetic Dermatology, 4(8), 50–57
  4. Reynolds, R. V., Yeung, H., Cheng, C. E., Cook-Bolden, F., Desai, S. R., Druby, K. M., Freeman, E. E., Keri, J. E., Stein Gold, L. F., Tan, J. K. L., Tollefson, M. M., Weiss, J. S., Wu, P. A., Zaenglein, A. L., Han, J. M., & Barbieri, J. S. (2024). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 90(5), 1006.e1–1006.e30.
    https://doi.org/10.1016/j.jaad.2023.12.017
  5. Cresce, N. D., Davis, S. A., Huang, W. W., & Feldman, S. R. (2014). The quality of life impact of acne and rosacea compared to other major medical conditions. Journal of Drugs in Dermatology: JDD, 13(6), 692–697
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Important Safety Information for Accutane® (isotretinoin)

What is the most important information I should know about Accutane?

Accutane is used to treat a type of severe acne (nodular acne) that has not been helped by other treatments, including antibiotics.

Accutane can harm your unborn baby, including birth defects (deformed babies), loss of a baby before birth (miscarriage), death of the baby, and early (premature) births. Patients who are pregnant or who plan to become pregnant must not take Accutane.

Patient must not get pregnant:

  • for 1 month before starting Accutane
  • while taking Accutane
  • for 1 month after stopping Accutane

If you get pregnant while taking Accutane, stop taking it right away and call your healthcare provider.

Accutane is only for patients who can understand and agree to follow all the instructions in the iPLEDGE® REMS. Patients taking Accutane must register in the iPLEDGE® Pregnancy Registry at 1-866-495-0654 or www.ipledgeprogram.com. See your healthcare provider for further information.

Accutane can cause serious mental health problems, including:

  • depression.
  • psychosis. (seeing or hearing things that are not real)
  • suicide. Some patients taking Accutane have had thoughts about hurting themselves or suicide. Consult your healthcare provider if you have such thoughts.

Stop Accutane and call your doctor right away if you or a family member notices that you have any of the following signs and symptoms of depression or psychosis:

  • start to feel sad or have crying spells
  • lose interest in activities you once enjoyed
  • sleep too much or have trouble sleeping
  • become more irritable, angry, or aggressive than usual (for example, temper outbursts, thoughts of violence)
  • have a change in your appetite or body weight
  • have trouble concentrating
  • withdraw from your friends or family
  • feel like you have no energy
  • have feelings of worthlessness or guilt
  • start having thoughts about hurting yourself or taking your own life (suicidal thoughts)
  • start acting on dangerous impulses
  • start seeing or hearing things that are not real

After stopping Accutane, you may also need follow-up mental health care if you had any of these symptoms.

Who should not take Accutane?

Do not take Accutane if you are pregnant, plan to become pregnant, or become pregnant during Accutane treatment. Accutane causes life-threatening birth defects. See “What is the most important information I should know about Accutane?”

Do not take Accutane if you are allergic to anything in it. See the end of the Medication Guide for a complete list of ingredients in Accutane.

What should I tell my doctor before taking Accutane?

Tell your doctor if you or a family member has any of the following health conditions:

  • mental problems
  • asthma
  • liver disease
  • diabetes
  • heart disease
  • bone loss (osteoporosis) or weak bones
  • an eating problem called anorexia nervosa (where people eat too little)
  • food or medicine allergies

Tell your doctor if you are pregnant or breastfeeding. Accutane must not be used by women who are pregnant or breastfeeding.

Tell your doctor about all of the medicines you take including prescription and non-prescription medicines, vitamins and herbal supplements. Accutane and certain other medicines can interact with each other, sometimes causing serious side effects. Especially tell your doctor if you take:

  • Vitamin A supplements. Vitamin A in high doses has many of the same side effects as Accutane. Taking both together may increase your chance of getting side effects.
  • Tetracycline antibiotics. Tetracycline antibiotics taken with Accutane can increase the chances of getting increased pressure in the brain.
  • Progestin-only birth control pills (mini-pills). They may not work while you take Accutane. Ask your doctor or pharmacist if you are not sure what type you are using.
  • Dilantin (phenytoin). This medicine taken with Accutane may weaken your bones.
  • Corticosteroid medicines. These medicines taken with Accutane may weaken your bones.
  • St. John’s Wort. This herbal supplement may make birth control pills work less effectively.

These medicines should not be used with Accutane unless your doctor tells you it is okay.

Know the medicines you take. Keep a list of them to show to your doctor and pharmacist. Do not take any new medicine without talking with your doctor.

What should I avoid while taking Accutane?

  • Do not get pregnant while taking Accutane and for one month after stopping Accutane. See “What is the most important information I should know about Accutane?”
  • Do not breast feed while taking Accutane and for one month after stopping Accutane. We do not know if Accutane can pass through your milk and harm the baby.
  • Do not give blood while you take Accutane and for one month after stopping Accutane. If someone who is pregnant gets your donated blood, their baby may be exposed to Accutane and may be born with birth defects.
  • Do not take other medicines or herbal products with Accutane unless you talk to your doctor. See “What should I tell my doctor before taking Accutane?”
  • Do not drive at night until you know if Accutane has affected your vision. Accutane may decrease your ability to see in the dark.
  • Do not have cosmetic procedures to smooth your skin, including waxing, dermabrasion, or laser procedures, while you are using Accutane and for at least 6 months after you stop. Accutane can increase your chance of scarring from these procedures. Check with your doctor for advice about when you can have cosmetic procedures.
  • Avoid sunlight and ultraviolet lights as much as possible. Tanning machines use ultraviolet lights. Accutane may make your skin more sensitive to light.
  • Do not share Accutane with other people. It can cause birth defects and other serious health problems.

What are the possible side effects of Accutane?

  • Accutane can harm your unborn baby, including birth defects (deformed babies), loss of a baby before birth (miscarriage), death of the baby, and early (premature) births.
  • Accutane can cause serious mental health problems.
  • Serious brain problems. Accutane can increase the pressure in your brain. This can lead to permanent loss of eyesight and, in rare cases, death. Stop taking Accutane and call your healthcare provider right away if you get any of these signs of increased brain pressure: bad headache, blurred vision, dizziness, nausea or vomiting, seizures (convulsions), stroke.
  • Skin problems. Skin rash can occur in patients taking Accutane. In some patients a rash can be serious. Stop using Accutane and call your healthcare provider immediately if you develop: conjunctivitis (red or inflamed eyes, like “pink eye”), rash with a fever, blisters on legs, arms or face and/or sores in your mouth, throat, nose, eyes, skin begins to peel.
  • Stomach area (abdomen) problems. Certain symptoms may mean your internal organs are being damaged, such as the liver, pancreas, bowel (intestines), and esophagus (connection between mouth and stomach). If your organs are damaged, they may not get better even after you stop taking Accutane. Stop Accutane and call your healthcare provider if you get: severe stomach, chest or bowel pain, trouble swallowing or painful swallowing, new or worsening heartburn, diarrhea, rectal bleeding, yellowing of your skin or eyes, dark urine.
  • Bone or muscle problems. Accutane may affect your bones, muscles, and ligaments and cause pain in your joints and muscles. Tell your healthcare provider if you plan hard physical activity during treatment or get back or joint pain or broken bones. Stop Accutane and call your healthcare provider immediately if you have muscle weakness. Muscle weakness with or without pain can be a sign of serious muscle damage. Accutane may stop long bone growth in teenagers who are still growing.
  • Hearing problems. Stop using Accutane and call your healthcare provider if your hearing gets worse or if you have ringing in your ears. Your hearing loss may be permanent.
  • Vision problems. Accutane may affect your ability to see in the dark. Stop taking Accutane and call your healthcare provider right away if you have problems with your vision or dryness of the eyes that is painful or constant. If you wear contact lenses, you may have trouble wearing them during and after you stop treatment with Accutane.
  • Lipid (fats and cholesterol in blood) problems. Accutane can raise the level of fats and cholesterol in your blood. This can be a serious problem. Return to your doctor for blood tests to check your lipids and to get any needed treatment. These problems usually go away when Accutane treatment is finished.
  • Serious allergic reactions. Stop taking Accutane and get emergency care right away if you develop hives, a swollen face or mouth, or have trouble breathing. Stop taking Accutane and call your healthcare provider if you get a fever, rash, or red patches or bruises on your legs.
  • Blood sugar problems. Accutane may cause blood sugar problems including diabetes. Tell your healthcare professional if you are very thirsty or urinate a lot.
  • Decreased red or white blood cells. Call your healthcare professional if you have trouble breathing, faint, or feel weak.

The common, less serious side effects of Accutane include:

  • Dry skin
  • Chapped lips
  • Dry eyes
  • Dry nose that may lead to nosebleeds

These are not all of the possible side effects of Accutane. Call your healthcare professional for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or JG Pharma, Inc. at 1-844-325-3350.

Click here to see the full Prescribing Information for Boxed Warning, Contraindications, other Important Warnings and Precautions, Drug Interactions, Use in Specific Populations, and other Adverse Reactions.