The Accutane Talk

Doctor Talking with Teens and Parents

So your teen wants to take Accutane.  It may be time for… the Accutane talk.

In this post we’re going to discuss the talk.  Not about the birds and the bees but rather about a topic that can trigger similar angst in a parent; whether your teenager should take Accutane.  The Accutane talk is one of life’s most uncomfortable realities for many parents who generally want to avoid discussing it and for teenagers who feel shy to express their desire to take it.  After all, teens generally sense that their parent may not be comfortable with Accutane so they are often hesitant to broach the subject.

A similar scenario plays out over and over again.  A parent and a teen come for an initial consultation.  The teenager is feeling very self conscious about his or her acne breakouts.  They often have tried various other therapies without much improvement.

The teenager is growing frustrated and eager to make the breakouts stop.  Typically one or more friends have taken Accutane with great results.  The teen has researched Accutane and has learned about many of the possible side effects which do not sway the strong desire to take it.

The parent on the other hand, has also researched Accutane and may have heard stories from another parent or a family member and is concerned over some of the information that turns up.  The parent may relate hearing about various side effects, whether proven or not, such as the possibility of mood changes and depression or side effects on the liver or whether Accutane will affect fertility in the future or stunt the teen’s growth, among others.

The teenager on the other hand is typically more concerned over his or her appearance and the strong desire to achieve clear skin.  To many teens, Accutane is seen as the holy grail and nothing else will satisfy them.

So here we are in the middle of two diametrically opposed interests.  The teens want Accutane at all cost to heal their breakouts and eliminate the emotional consequences of acne whereas the parents are more concerned about safety and they don’t want to make a decision that might be harmful to their children.

What I tell my patients about Accutane

In my practice I typically explain it in just that way.  I tell the teenager that the parent loves them and is just trying to prevent any harm to their child and that one day they may find themselves in the same position with their own children.  And to the parent I explain how acne is affecting the teen’s quality of life and that in addition to the possible side effects associated with taking Accutane there are also potential side effects of withholding treatment on the teen’s psychological well being.

Usually the discussion goes on for quite some time.  We spend time discussing the pros and cons, risks and benefits and potential side effects of Accutane in detail.  We review the accuracy of some of the information that the parent or teen may have heard or read about and note that some of the information they may have encountered in their research may not be as clear cut as they may have initially thought.

We also talk about other treatment options and review the possibility of trying a different treatment before turning to Accutane and whether or not an alternative to Accutane would have a real chance of working for the teen’s type of acne.

For some parent/teen duos, the decision is an easy one and is sometimes made even before arriving for their first consultation, especially if the parent has had a prior experience with Accutane.  For example, sometimes the parents may have taken Accutane themselves in the past and feel comfortable with using it for their child.  Or perhaps the teen’s sibling or other family member took Accutane with a good result.

This removes some of the apprehension for the parent when making the decision to use Accutane for their child.  Also, some parents become motivated to use Accutane for their teenager if the parent becomes aware that the teen is experiencing significant emotional effects of their acne, such as low self-esteem or low self-confidence.

Some teens with significant acne may feel uncomfortable going to school hoping to prevent their peers from noticing their breakouts.  Some may develop even more concerning mental health effects.  Once these significant psychological effects of acne begin to occur, the need to provide effective treatment becomes more urgent, making the decision to use Accutane less difficult for the parent.

Sometimes it’s the teenagers themselves who resist treatment with Accutane even though the parents approve.   This can occur if the teen is coping well with his or her breakouts and prefers to avoid taking medication in general.  Also, some teens are influenced by friends who may have taken Accutane and expressed cautious feelings about the overall process.

For example, some teens become very focused on the dryness of the skin and lips that typically accompanies treatment with Accutane which for some can become a roadblock to further consideration. It should be noted, however, that use of an appropriate moisturizing regimen can alleviate much of the drying effect.

Each parent and teenager harbors their own individual feelings and perceptions about the use of Accutane.  Ultimately the most important consideration is to ensure that all involved are comfortable with the treatment before moving forward.

What patients typically decide about Accutane

The talk usually concludes with one of a few possible outcomes.  The first is a decision to move forward with Accutane treatment.  This decision is often made by parents seeking the most effective option for their child and feel comfortable with the risks and benefits of Accutane treatment.  The parents conclude that the benefits of preventing both emotional and physical scars from acne outweigh the risks of the medication.

The second possible outcome is the decision to forgo Accutane treatment.  In this case, if the acne is very significant, the parents are made aware that there is a strong likelihood that an alternate treatment may not be effective.

It should be noted that, even for teens whose acne is severe, it is quite common for a parent to begin the initial consultation by proclaiming that they are absolutely opposed to Accutane treatment and will not even consider it as a treatment possibility for their child.  Their conviction is steadfast and they will not allow further discussion.  The interesting thing, however, is what happens next.

In this scenario, when Accutane is completely over-ruled by the parent, even for a teen who has severe acne that will not likely improve without Accutane, an alternate treatment plan is designed in an attempt to offer the best results as possible.  As expected, results are usually underwhelming.  As the teen’s acne continues unabated and may even worsen, both teen and parent become more frustrated and begin to realize that Accutane may deserve further consideration.

Not uncommonly, after experiencing the lack of results with an alternative treatment, the parent who initially refused to even consider Accutane for their child returns to the office, now with a strong intention to initiate Accutane treatment as soon as possible.  And the most interesting thing of all is that once treatment with Accutane is concluded and the teenager has responded well, the parent often proclaims that they wish they would have started with Accutane from the very beginning.

This interesting transformation from being adamantly opposed to Accutane at first to then becoming an Accutane evangelist occurs fairly often.

The third possible outcome is a hybrid between the first and second.  The decision to use or not use Accutane is less clear for the parent and teen.   Depending on the severity of the teen’s acne and the degree that it is affecting his or her quality of life, the parent/teen duo may decide to start with a less aggressive treatment plan with the understanding that if it is not effective, Accutane will be considered as the next step.

This usually is satisfactory to both parent and teen as it gives the parent a chance to start with a treatment that is perceived as more conservative before making the decision to use Accutane.  The teen also usually understands that if the less aggressive treatment does not work, Accutane will then be considered.  For the teenager who was hoping for Accutane from the very start, the delay in treatment is not always well received.

However, the delay in treatment is not usually a very lengthy one.  Also, depending on the teen’s type and severity of acne, an alternate treatment may actually provide enough improvement that the teen may be satisfied and Accutane can be deferred.

Admittedly these scenarios are oversimplified for the purpose of illustration.  Each parent/teen duo has unique circumstances that may require very different treatment considerations.

In conclusion, the Accutane Talk is an important ritual that helps all parties come to a comfortable decision about the role of Accutane in a teenager’s treatment plan.  The goal is to achieve a level of comfort to satisfy both teen and parent that makes the process as positive and productive as possible.

The Advanced Acne Institute is a unique dermatology practice located in Miami, Florida specializing only in the treatment of acne.   We focus solely on providing the most effective treatments to help our patients achieve clear skin.  We are pleased to share our insights and perspectives in acne treatment as an educational service, however this information is provided strictly for educational purposes only and should not be considered medical advice and is not a substitute for seeking the advice and treatment by an appropriate medical professional.