For deep cysts, antibiotics may not be enough. Isotretinoin (brand names include: Absorica, Amnesteem, Claravis, Myorisan, Sotret) is a powerful medication available for scarring cystic acne or acne that doesn't respond to other treatments. Accutane was a common form of isotretinoin, but it was taken off the market in 2009, possibly due to controversy over mental health issues associated with the drug.
"We reserve isotretinoin for patients who have tried other medications and have not turned the corner," says Dr. Buka. He estimates about one out of every 20 patients needs this strong of a prescription. Most patients see improvement in their acne on one course of the prescription, after about four months, and then the acne stays away. Both dermatologists agree that this medication is very effective, but should be used with caution.
Because isotretinoin is associated with unpleased side effects from sun sensitivity to anxiety to severe birth defects, dermatologists carefully evaluate patients before writing a prescription. Doctors will also remain on alert for any unsettling symptoms and will likely do blood work once a month to make sure the med isn't hurting their patient's liver, says Dr. Buka.