Dermbusters: Elizabeth Swanson, MD

Join Dr Nick Brownstone in this episode of Dermbusters, where he chats with Dr Elizabeth Swanson to address some common misperceptions surrounding the use of Accutane that they often hear from both colleagues and patients. 

Are monthly labs for Accutane needed for safety? 

No. Dr Swanson notes that she has been in practice for over 12 years, and when she was in training, providers did do labs every month for patients taking Accutane, including a liver function test, a lipid panel, and sometimes a CBC. Since she’s been practicing, the guidelines for Accutane have recommended less and less monitoring over time. 

She references an article published in JAMA Dermatology that recommended testing only for alanine aminotransferase (ALT) and triglycerides at baseline and again at 2 months or after peak dose is reached. Dr Swanson comments that testing only twice for 2 things is great news for patients. 

Dr Brownstone asks Dr Swanson how she counsels patients when they want additional labs performed to ensure the medication isn’t causing side effects. She remarks that her patients never request that, and she generally finds they are very pleased to only need minimal blood draws for monitoring. 

Does Accutane increase the risk of suicidal behavior or depression? 

Dr Swanson notes that this is a very controversial topic. When she addresses this with her patients and their families, she explains that there were some initial concerns about suicidal behavior and depression in patients with Accutane, but because of these concerns, it has been extensively studied in tens of thousands of patients. Those studies found that most patients actually notice an improvement in their mood due to clearer skin and improved self-esteem and confidence. 

As a pediatric dermatologist, Dr Swanson prescribes Accutane daily; she reassures her patients and their families that in her years of practice, she has had only 6 patients who exhibited signs of depression and had to stop the medication. She concludes by noting that while these side effects do occur rarely, the studies support patients seeing an improvement in their mood.