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Clear Skin Guide: Accutane in St. Louis (Part I)

Accutane St. Louis
Accutane St. Louis

Dr. Feigenbaum and Dr. Gibstine are highly regarded specialists in acne treatment and acne prevention in St. Louis. Accutane plays a pivotal role as an essential medication for treating acne and preventing acne scars. Initially considered a last resort for severe cases of nodular acne or cystic acne, Accutane is now recommended by the American Academy of Dermatology for a broader range of acne conditions, including chronic or stubborn papules and pustules. This medication has shown remarkable results in preventing acne scarring and has become a valuable option for many patients. Accutane, also known as Isotretinoin or 13-cis-retinoic acid, is an oral retinoid medication related to Vitamin A. It offers tremendous benefits for acne patients when other treatments like topical or oral medications, photodynamic therapy, lasers, or chemical peels have been ineffective in providing a permanent cure for acne. Despite the controversies surrounding Accutane over the past two decades, it remains the only treatment known to effectively "cure" severe cystic acne and prevent acne scarring.

To effectively manage an acne breakout and prevent the formation of acne scars, it is crucial to consult with a board-certified dermatologist specializing in acne treatment, such as Dr. Feigenbaum and Dr. Gibstine at Mid-County Dermatology located at Missouri Baptist Medical Center in St. Louis. We take the time to understand your concerns, needs, and goals, creating personalized treatment plans that cater to specific skin types, tones, and conditions. The outcome is a clear, smooth, and beautiful complexion, helping you look and feel your absolute best. Don't wait any longer to address your acne concerns schedule your consultation with our dermatology team and take the first step towards achieving radiant and healthy skin.

What is Accutane?

Accutane, also known as isotretinoin, is an oral medication widely prescribed for acne treatment. It belongs to the retinoid class of drugs and is derived from vitamin A. The body easily processes and eliminates it. With its high potency, Accutane effectively clears various types of acne, including whiteheads, blackheads, cysts, and nodules. Acne is caused by sebum buildup, bacteria, and debris clogging the pores.

Accutane works by reducing sebum production and eliminating acne-causing bacteria. It is a life-changing medication that addresses moderate to severe acne unresponsive to other treatments like topical or oral antibiotics, tretinoin, and over-the-counter acne products. While it was previously considered a last resort, Accutane is now commonly prescribed to treat all types and severities of acne, preventing future breakouts and the formation of new acne scars.

How does Accutane work?

Accutane effectively treats acne by targeting its underlying causes. First, it can calm the activity of sebocytes, the oil-producing cells of the skin. Within 6 weeks, Accutane can reduce skin oil production by approximately 90%. Secondly, it decreases blackhead and whitehead formation by reducing hyperkeratinization (when skin cells don't exfoliate normally). While Accutane doesn't kill bacteria directly, by reducing oil production of the skin it directly lowers C. acnes (the bacteria that causes acne) colonization. This results in a significant reduction in C. acnes population and reduces acne inflammation, surpassing the effects of antibiotics.

What is the process for starting Accutane?

To initiate the treatment process, you will schedule a consultation with Drs. Feigenbaum and Gibstine at Mid-County Dermatology in St. Louis, MO. During the consultation, your current skin condition will be discussed, and a comprehensive assessment will determine if Accutane is the most suitable medication for you. Your complete medical history, including hormonal changes and family history of acne or skin issues, will be reviewed. While Accutane was traditionally used for severe acne, it is now prescribed for milder, chronic, or stubborn cases as well.

The complete Accutane course typically lasts for six months, and participation in the iPLEDGE program (discussed below) is necessary to obtain the medication from the pharmacy. During your consultation, we will carefully review your medical and surgical history, previous acne treatments, and medication history to evaluate your candidacy for Accutane. Depending on your history, blood tests may need to be ordered to check for liver abnormalities, hormonal irregularities, or anemia (low blood counts). Most healthy young adults do not require blood monitoring. Male patients can start treatment immediately once prescribed by one of our dermatologists. Female patients must have two negative pregnancy tests before starting treatment and are advised to use two forms of birth control or practice abstinence during the six-month period due to the risk of birth defects (this is the purpose of the iPledge program - to prevent unintended pregnancies while taking Accutane). The dosage of Accutane is based on weight, typically ranging from one to two milligrams per kilogram per day, taken once or twice daily with food (which helps with the absorption of the medication). Immediate improvement is often noticed within the first month, although a small subset of patients may experience a mild flare of their acne. The dosage is gradually increased over the six months to prevent new breakouts and ensure clear skin. Over 85% of patients respond positively to Accutane and remain free from acne after completing the course of medication.

For the 15% of patients who do not clear acne after six months of Accutane treatment, 50% see significant improvement after a second shorter course. A small number of patients (<5%) may require a low-maintenance dosage to keep their skin clear.

Women must have a monthly negative urine pregnancy test. Accutane is regulated by the iPLEDGE program, which requires documentation of this urine test and birth control methods (or claim of abstinence).

The cost of Accutane or its generic variants depends on the pharmacy. Usually, this medication is well covered by health insurance plans, but it is important to review your policy for details on specific benefits and eligibility.

If you think you would be a good candidate for Accutane, please call or text us at 314-994-0200 to schedule your consultation.

How long is a typical Accutane treatment course?

A typical Accutane course lasts for six months, but it can vary between four to seven months based on individual progress. In some cases, a second course of Accutane may be necessary, lasting an additional three to five months.

What is the timeframe for clearing acne with Accutane?

A complete course of Accutane usually lasts 24 weeks or approximately six months. Most patients notice improvement within 1-2 months, but it's important to continue the treatment as prescribed. After the 24-week period, about 85% of patients experience complete acne clearance. Some individuals may require an additional 3-5 months of treatment for optimal results. After completing the initial course, a follow-up appointment with one of our St. Louis dermatologists will determine the need for further treatment.

How long does it take for Accutane to start clearing acne?

Patients typically experience a noticeable improvement in their skin within the first month of starting Accutane. Throughout the six-month treatment period, the Accutane dosage is gradually increased (as needed) to prevent new breakouts. The maximum prescribed dosage is 2 milligrams per kilogram of body weight per day. A majority of patients (over 85%) respond positively to Accutane, achieving lasting clearance from acne after completing the six-month course. Generic versions of isotretinoin follow the same dosage calculations. In cases where patients do not achieve clearance after the initial treatment, a second course of Accutane leads to complete clearance for 50% of these individuals.

Who is eligible to take Accutane as a treatment for acne?

There are generally no specific age limitations for taking Accutane as an acne treatment. Accutane can be prescribed to both teenagers and adults, depending on the severity of their acne and their overall health condition. However, it is important to note that Accutane is typically reserved for individuals who have reached puberty and have persistent, severe acne that has not responded to other treatments. Prescribing Accutane is determined on a case-by-case basis by Dr. Feigenbaum, Dr. Gibstine, or Denise Apprill ANP-BC.

What is the Ipledge Program for Accutane?

The iPLEDGE Program, regulated by the U.S. Food and Drug Administration, was introduced in 2005 to ensure the safe use of Isotretinoin and prevent birth defects. It establishes a centralized system for physicians, pharmacists, and patients to manage the medication and minimize risks.

Women who are capable of becoming pregnant and participating in the iPLEDGE program for Isotretinoin therapy must have two negative pregnancy tests before starting the medication. They are also required to agree to use two forms of contraception or practice abstinence while taking Isotretinoin. Combination birth control pills, containing both estrogen and progesterone, are recommended as an effective method of pregnancy prevention during Accutane treatment. Monthly negative pregnancy urine tests are mandatory throughout the entire treatment duration. Women taking Accutane must have a negative pregnancy test every month.

What brands of Accutane (isotretinoin) are currently available?

The following brand names of Isotretinoin are available in the US: Zoretanin, Absorica, Amnesteem, Claravis, Myorisan, Sotret, and Zenatane. Take these medications with high-fat meals to ensure absorption and correct dosing. Absorica incorporates fats in its capsule for accurate dosing. Twice daily dosage may be beneficial for better absorption.

Will my insurance cover Accutane?

Possibly (and likely), but it is always best practice to check with your health insurance provider to see if they cover the cost of Accutane. It's important to consult your insurance policy to understand your benefits and eligibility before starting the treatment.


Accutane is a potent and proven treatment option for individuals grappling with severe and persistent acne. At Mid-County Dermatology, our experienced St. Louis dermatologists specialize in providing comprehensive acne solutions and prescribe Accutane regularly (for those who are candidates). If you're seeking effective acne treatment, we invite you to contact us and schedule a consultation.

With our unwavering commitment to patient care and expertise in acne treatment, Mid-County Dermatology is here to support you throughout your Accutane journey. We understand the impact of acne on your self-esteem and overall well-being, which is why we strive to deliver personalized care tailored to your specific needs.

This blog series continues with Part II, where we will delve into an essential aspect of Accutane treatment: the potential side effects and long-term prognosis. We believe in providing you with a complete understanding of the treatment process, ensuring you can make informed decisions about your acne treatment journey.

To schedule a consultation and explore Accutane as a treatment option, we encourage you to call or text us today. Our dedicated team of St. Louis dermatologists is eager to assist you in achieving clearer and healthier skin.

Remember, when searching for reputable St. Louis dermatologists and effective acne treatment in St. Louis, Mid-County Dermatology is your trusted partner.

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