Accutane (Isotretinoin) is an extremely effective medication in treating acne, and works by reducing oil (sebum) production in the skin (sebaceous glands), which is the root cause of acne. While it’s considered a game-changer for many dealing with persistent breakouts, Accutane isn’t something you should take without careful consideration. 

Before delving into the side effects and long term impacts of Accutane it is worth discussing why milder treatments should definitely be considered first and what exactly these treatments are. 

By starting with a gentler treatment, you, your doctor, and/or your dermatologist can assess whether your acne is responding well without resorting to stronger medications, which often carry higher risks. This approach is important because it avoids overmedicating those who simply don’t need accutane or those who over assess the severity of their action, and avoids complications or unnecessary dependency on harsher drugs. 

If the milder option proves ineffective, only then is it reasonable to move to stronger alternatives, ensuring treatment is both safe and effective.

So what exactly is the milder but effective treatment? 

It is a drug named Winlevi, and works by blocking something called the androgen receptor in the sebaceous glands. Acne is caused by hormones binding to the androgen receptor at the sebaceous glands, and ‘transcribes’ an effect, which downstream leads to the overproduction of sebum (oil) in these sebaceous glands. Winlevi blocks all hormones, indiscriminately from binding to the androgen receptor. Acne is much more multifactorial than men’s hair loss (androgenic alopecia) and the hormones responsible for this condition include testosterone + DHT (thus why it is more prevalent in boys/men), insulin + IGF-1 (insulin like growth factor 1), Corticotropin-releasing Hormone, and glucocorticoids (like cortisol the ‘stress’ hormone). It is not important to understand what these hormones are and what they do but they’ve all been shown to cause this overproduction of sebum after binding to the androgen receptor.

IGF-1 and Insulin has been shown in countless studies to upregulate modulates androgen receptor activation.

By blocking these hormones from binding to the androgen receptor after application, Winlevi helps prevent acne formation, and allows you to treat acne till a time in which hormone fluctuations have ceased like after puberty without causing any long term alterations to your hormone levels and skin glands.

Winlevi is the brand name for a compound named Clascoterone or CB-03-01, and is classified as a steroid antiandrogen, which is extremely well studied and has a good safety profile, whereas in contrast accutane has been associated with the following side effects (with the serious ones being rare but still present); Dry lips, Chapped lips, Dry, peeling or flaking skin, Dry nose, Nosebleeds, Dry eyes, Eye irritation, temporary hair loss or thinning (known as telogen effluvium),  Increased sensitivity to sunlight, muscle and joint pain, mood changes, depression, anxiety, and very loosely suicidal thoughts, as well as Birth defects if taken during preganancy.

One of the more concerning side effects is liver damage as Accutane is hepatotoxic, which is why youll need to conduct a liver test every 3 months if your prescribed Accutane in Australia and other countries.

Dermatologists in the United States and Australia often prescribe Accutane as the first-line treatment for acne, even for those who suffer from mild-acne. I believe that this practice is completely inappropriate, given the risks associated with Accutane. Winlevi should be considered as a first-line treatment for hormonal acne, as it is safer and has similar efficacy.