Accutane & Crohn's

Isotretinoin is a prescription drug used to treat the most severe form of acne. While it can be a true lifesaver for those with nodular acne, the medication is suspected of being linked to inflammatory bowel diseases, including Crohn’s disease. Numerous studies have examined the potential association between isotretinoin and Crohn’s disease, and no clear-cut connection has been established. However, many researchers advise individuals to be cautious when taking isotretinoin, especially if they have other health conditions.

About isotretinoin

Isotretinoin is prescribed to people who have severe acne nodules, or cysts that are deeply embedded under the skin. As they fill with pus, they turn into large and painful bumps. The nodules may also leave scars.

Some people only need over-the-counter products containing salicylic acid or benzoyl peroxide to keep acne nodules at bay. Others might require something stronger, such as prescription antibiotics, to clear up cystic acne outbreaks. However, these treatments may not be enough to help those with severe nodular acne. In these cases, isotretinoin might be recommended.

Due to its potential side effects, the U.S. Food and Drug Administration (FDA) doesn’t recommend the medication to people who:

  • are pregnant or breast-feeding
  • are pregnant or planning on becoming pregnant in the near future
  • have mental health conditions, such as depression or bipolar disorder
  • have diabetes
  • have liver disease
  • have asthma

The most well-known brand of isotretinoin was Accutane. However, Accutane was discontinued in 2009. Since then, other brand names have emerged, including Claravis, Amnesteem, and Absorbica.

About Crohn’s disease

Crohn’s disease is a type of inflammatory bowel disease (IBD). It causes inflammation throughout the intestinal tract, most notably in the colon and small intestine. The Crohn’s and Colitis Foundation of America estimates that 700,000 Americans have Crohn’s disease. Of those, most are diagnosed with the condition during early adulthood.

The effects of Crohn’s disease may extend between the esophagus and the anus, causing symptoms such as:

  • abdominal pain and cramps
  • constipation
  • frequent diarrhea
  • rectal bleeding
  • excessive fatigue
  • fever or night sweats
  • weight loss (usually associated with a loss of appetite)

Acne is another common symptom seen in people with Crohn’s disease. However, this side effect is related to taking steroids that help treat the condition. The disease itself doesn’t cause acne. Steroid therapy can also make preexisting acne problems worse.

The exact cause of Crohn’s disease isn’t known. There’s also no cure for this chronic condition. Treatments are used to help keep symptoms at bay and to prevent permanent tissue damage from the persistent inflammation.

The potential connection between isotretinoin and Crohn’s disease

The FDA hasn’t formally linked isotretinoin to Crohn’s disease. However, the agency does warn individuals against potential “stomach area problems” that may develop while taking the drug. The FDA suggests that certain symptoms can occur as a result of internal organ damage. These might include:

  • severe abdominal pain
  • yellowing of the skin and whites of the eyes (jaundice)
  • rectal bleeding
  • dark urine
  • heartburn
  • difficulty swallowing

The above symptoms can also be related to IBD, but it isn’t clear whether this includes Crohn’s disease. In fact, according to a 2010 study conducted by The American Journal of Gastroenterology, there seems to be higher incidence of ulcerative colitis (UC) among people who take isotretinoin. UC is another form of IBD that only affects the colon. The study found that UC was most prominent in individuals who took isotretinoin for two months or longer.

However, other studies directly contradict the evidence that supports links between the acne medication and IBD. In 2016, the European Journal of Gastroenterology & Hepatology looked at the incidence of IBD among people who took isotretinoin and those who didn’t take the drug. The study found that the rate of IBD was the same between both groups. This led researchers to conclude that isotretinoin doesn’t increase the risk for IBD, including Crohn’s disease.

The link between isotretinoin and Crohn’s remains controversial and inconclusive. Some of the reasons for conflicting results include:

  • disparities in case studies
  • differences in the severity of acne
  • variations in how individuals respond to different doses
  • the use of antibiotics and other prior acne treatments often aren’t considered in studies
  • the symptoms of Crohn’s disease aren’t well-documented before studies are performed

There’s also research suggesting that some people experience symptoms of Crohn’s disease before taking isotretinoin. It is unclear whether or not the medication would still have any effect on these symptoms.

The takeaway

Isotretinoin is an extremely powerful medication. While it can help clear up severe forms of acne, there are major concerns about the possibility of serious side effects. In some cases, these side effects can linger long after you stop taking the drug.

In the case of Crohn’s disease and other forms of IBD, you should consider your risk factors before taking this medication. If you have a personal or family history of inflammatory conditions, your doctor may advise against using isotretinoin. There’s not enough evidence to prove the ingredient causes Crohn’s disease, but the risks might outweigh the benefits of acne treatment. Your doctor can ultimately help you make this decision.

You asked, we answered

  • What are the other risks involved with taking isotretinoin?
  • The side effect profile of isotretinoin is quite extensive. Reports of adverse reactions can be broken down into two categories: side effects involving the skin and those involving internal organs. The most common dermatological manifestations are dryness of the skin, lips, and mouth. Patients may also experience ocular symptoms such as eye dryness, pain, or redness. Side effects involving internal organs include muscle pain, abdominal pain, asthma exacerbation, and rarely, confusion and dizziness, among others. The most serious risk is teratogenicity, which refers to the potential for malformation of an embryo if a woman taking the isotretinoin is or becomes pregnant.

    - University of Illinois-Chicago, College of Medicine