Accutane is a “vitamin A derivative” pill that shrinks oil glands. It is a very effective treatment of most types of acne, but not all. It is usually a five month course, the dose determined by weight. There are rare risks associated with the medicine, and therefore I monitor patients on a monthly basis with close follow up during the course. I watch bloodwork for changes in white blood cell count, liver function, cholesterol and triglyceride. Girls must be on birth control and pregnancy tests are performed monthly as well. Other side effects I watch for are headaches, dizziness, achy muscles and joints, lower back pain, change in vision; the possibility the medicine causes depression and even suicide is controversial. Data most recently do not support this concern. Nonetheless I watch closely for changes in mood while a patient is on the medicine. Most patients have at least some improvement on the medicine—sometimes acne clears completely and permanently. However, because of other rare side effects like hypersensitivity reaction, it is very important to follow up every month for assessment.