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Treatment of acne normally begins with topical medications (e.g. adapalene,  benzoyl peroxide), and if is not effective than is followed by oral antibiotics and finally Accutane (isotretinoin) therapy. Doctors purposely avoids immediate prescription of isotretinoin (Accutane) medications because of it's numerous adverse effects that is same case can lead to chronicle depression and suicide.
Health Canada has been monitoring Accutane. From 1983 when the drug arrived on the Canadian market until 1997, Health Canada received eight reports of depression and other psychiatric reactions associated with the use of Accutane.
In the last three years, those numbers have more than doubled. Since 1998 there have been 20 reports of psychiatric side effects including delirium, suicidal tendencies, and one suicide. Many researchers believe the numbers may be significantly higher because adverse drug reactions are under-reported.


A story in the Ottawa Citizen made Daines wonder if there was a link between Accutane and her daughter's overdose.

UPDATE on Accutane:
There have been some important changes in Health Canada's position on Accutane since this story first aired on Marketplace.

Patients must now sign a consent form in Canada before they receive Accutane.

Health Canada has updated its Web site information on the drug.



Mild acne

Moderate acne

Severe acne

Topical therapy Salicylic acid (Keralyt)

Azelaic acid (Azelex)

Tretinoin (Retin-A)

Adapalene (Differin)

Benzoyl peroxide


Oral contraceptives



Doxycycline (Vibramycin)

Minocycline (Minocin)

Isotretinoin (Accutane)

Below is a list of commonly used medications. They are divided into topical medications and oral medications.

Drugs Used to Treat Acne and its side affects



Side Effects


Topical Acne Products - Antibacterial

Clindamycin This antibiotics is available in lotions, solutions, gels, and disposable pads, and is typically applied twice daily. Diarrhea (rarely)
Erythromycin This antibiotics is available in lotions, solutions, gels, and disposable pads Well tolerated
Benzoyl peroxide Benzoyl peroxide if often used to treat mild to moderate acne, and can produce a response in as few as five days. It is available in several strengths, some of which are only available by prescription. Benzoyl peroxide is available in soaps, lotions, washes, gels, and creams. Gel formulations are typically the most potent. Care should be taken when applying products containing benzoyl peroxide to avoid bleaching hair, sheets, towels and clothing. A common side effect of benzoyl peroxide is dryness and irritation of the skin. To help avoid this side effect, start with a lower potency formulation (2.5%) and increase the strength (5% to 10%) as needed for acne control.
  • Dry skin
  • Possible bleaching of clothing and hair
Especially effective when combined with erythromycin or clindamycin

Unclogs pores  - Topically

Tretinoin Tretinoin is a topical retinoid available in various strengths and forms (creams, gels, solutions, a microsphere gel, and liquid polymer). It works by preventing the formation of microcomedones and has anti- inflammatory actions. For mild acne, weaker strengths are typically used first and increased as needed for moderately severe forms of acne. A "flare" of acne may occur after starting tretinoin, but clears after about 8 to 12 weeks of therapy. Tretinoin works well for moderate to severe acne when combined with benzoyl peroxide, topical antibiotics, and oral antibiotics. Tretinoin can cause skin irritation, redness, and peeling which are usually noticed within the first week of use but can be minimized by slowly increasing application frequency. The doctor may recommend you use it every other day and, over a period of time, increase to a maximum of twice daily. Tretinoin can also increase sensitivity to sun, wind and cold.
  • Irritated skin
  • Sensitization of skin to sunlight
Apparent worsening of acne when tretinoin is started, sometimes requiring 3 to 4 weeks before any improvement occurs

Requires use of protective clothing and sunscreen during sun exposure

Tazarotene Tazarotene is a topical retinoid, available as a gel or cream, and used to treat mild to moderate acne. Although it is effective for acne, it can cause skin irritation, itching, burning, and redness (similar to tretinoin). It is recommended that patients avoid other medications or cosmetic products that have strong drying effects as these could further irritate the skin.
  • Irritated skin
  • Sensitization of skin to sunlight
Apparent worsening of acne when tazarotene is started, sometimes requiring 3 to 4 weeks before any improvement occurs

Requires use of protective clothing and sunscreen should be worn during sun exposure

Adapalene Adapalene is a topical retinoid available as a gel, cream or solution and is used to treat mild to moderate acne. Adapalene is typically used as an alternative to tretinoin in patients who cannot tolerate tretinoin. It can also be used in combination with topical and oral antibiotics. Improvement is generally seen by 12 weeks of therapy. Some patients may notice redness of the skin and peeling. It is recommended that patients avoid contact with mucus membranes, including the eyes, mouth, and nostrils. Patients should also try to avoid UV ray exposure through sunlight and tanning because drying of skin, scaling, redness, burning, and itching may occur after exposure. Some redness, burning, and increased sun sensitivity As effective as tretinoin but less irritating

Requires use of protective clothing and sunscreen during sun exposure

Azelaic acid Azelaic Acid is a cream used in the treatment of mild to moderate acne. It has antibacterial effects and may help with skin inflammation. Azelaic acid is generally well tolerated with a low incidence of temporary side effects such as skin redness, itching, and burning. Darker complexions may develop hypopigmentation during treatment. Azelaic acid should be applied to clean, dry skin. May lighten skin Minimally irritating.
May be used by itself or with tretinoin .Should be used cautiously in people with darker skin because of skin-lightening effects

Anti bacteria - Oral

Tetracycline Tetracycline is the most commonly prescribed antibiotic for treating acne. It may cause sun sensitivity
and predispose a woman to vaginal yeast infections.
Inexpensive and safe, but must be taken on an empty stomach

Should wear protective clothing and sunscreen during sun exposure

Doxycycline Doxycycline is commonly used in people whose acne does not respond to tetracycline. Possible sensitization of skin to sunlight Should wear protective clothing and sunscreen during sun exposure
Minocycline Minocycline is commonly used in people whose acne does not respond to tetracycline.
  • Headache
  • Dizziness
  • Skin discoloration
Most effective antibiotic
Erythromycin Erythromycin is most effective when combined with other acne medications (such as benzoyl peroxide). The combination also helps decrease the risk of the bacteria becoming resistant to the antibiotic.
  • Stomach upset
  • Can cause occasional skin irritation and stinging
Frequently, development of bacterial resistance to erythromycin

Unclogs pores - Oral

Spironolactone Spironolactone also decreases androgen hormone levels and thus decreases production of sebum. If oral contraceptive therapy is not effective, spironolactone can be added for additional benefit. Some side effects associated with spironolactone include: dizziness, breast tenderness, and painful menstruation in women. It is recommended to get blood pressure and potassium levels checked periodically while on this medication.
Isotretinoin Isotretinoin (Accutane) is used to treat severe, cystic acne that has not improved with other therapies. Some dermatologists use isotretinoin in mild to moderate acne that has not responded well to 6 months of standard therapies. Treatment with this drug usually continues until there is a 70% reduction in the number of cysts, and usually this can be seen in 15 to 20 weeks. A 6-month course of isotretinoin is sufficient for most patients. While extremely effective for treating acne, isotretinoin is associated with some potentially bothersome side effects including extreme drying of the mouth, nose, and eyes (approximately 90% of patients taking isotretinoin experience these side effects); inflammation and peeling of facial skin, joint aches, muscle stiffness, and sun sensitivity. Isotretinoin can also cause birth defects if used during pregnancy, so contraception (some type of effective birth control) is required in females taking isotretinoin. Contraception should begin one month before starting isotretinoin and continued for three months after stopping isotretinoin. Isotretinoin now has a mandatory registry that was put in place by the FDA, which is known as IPLEDGE. IPLEDGE was primarily put in place to prevent unwanted or potentially dangerous adverse effects.
  • Possible harm to a developing fetus
  • Possible effect on blood cells, the liver, and fat (triglyceride and cholesterol) levels
  • Dry eyes, chapped lips, and drying of the mucous membranes
  • Pain or stiffness of large joints and lower back with high dosages
  • Associated with depression, suicidal thoughts, attempted suicide, and (rarely) completed suicide
For sexually active women, requires a pregnancy test before they start isotretinoin and at monthly intervals while they are taking the drug plus use of two forms of contraception or sexual abstinence, beginning 1 month before they start the drug and continuing while they take it and for 1 month after they stop taking it

Requires blood tests to check whether the drug is affecting blood cells, the liver, or fat levels

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