We approach acne differently.
Acne is usually influenced by genetic factors - mostly commonly and most significantly genetics and hormones. Despite this being the case many patients have excellent improvement with small changes in lifestyle. Sometimes this is through stress management, diet or supplements, sometimes with topical medications. We always recommend starting with the lowest risk options first but also recognize that everyone's capacity to commit to lifestyle changes is different, and ultimately you know your body best.
For acne that is disruptive to patients' lives and self esteem, and has not responded to initial therapies - we are happy to offer isotretinoin.
How is isotretinoin different at Performance Health?
Sarrah, the founder of Performance Health has had two rounds of isotretinoin herself for PCOS related acne. She found this medication to be life changing and supports its use in patients who are good candidates and willing to accept the risks.
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​Anyone who has taken isotretinoin can attest to the logistical nightmare it can be trying to get the correct testing, repeat pregnancy tests, repeated attestations and online quizzes. One fumble by your dermatologist's office can result in headaches with trying to get your medication - not at Performance Health.
In addition to being a concierge practice, where our provider handles the majority of tasks herself, our office offers flexible appointment times - including nights, weekends and holidays. This way you can have access to your monthly visit or labs without needing to take PTO or miss school
Our office specializes in circumventing insurance when possible because unfortunately - it usually results in a better and less expensive process for many outpatient treatments. Not utilizing insurance allows there to be no issue with prior authorization or surprise bills for labs. This path is affordable, usually less than $275 per month including medications from the pharmacy.
If patients would like to use their insurance for the medication itself and for the labs - they are absolutely welcome to. In these instances the usual membership fee applies - which can be found here. This fee includes your monthly visit, and depending on the membership includes in office lab draws and expanded office hours. ​
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Risks, benefits and expectations with isotretinoin
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Most treatment courses last about 5–6 months. Acne often improves gradually during treatment, and some patients experience a temporary flare early in therapy. The goal is long-term control of acne, reduction of scarring risk, and improvement in skin health and quality of life.
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Because isotretinoin is a powerful medication, it requires careful monitoring. In the United States it is prescribed through the iPLEDGE program, which is designed to prevent pregnancy exposure because isotretinoin can cause severe birth defects. Patients who can become pregnant must complete monthly pregnancy testing and counseling while on the medication. These requirements apply regardless of where the medication is prescribed.
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Common side effects are:
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Dryness everywhere - most patients experience dry lips, dry skin, and sometimes dry eyes or mild nosebleeds. These effects are expected and typically manageable with moisturizers, lip balm, and hydration.
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Sun sensitivity - patients must avoid the sun
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Fragile skin - so patients must avoid aggressive skin treatments like tattoos, microneedling or chemical peels for the entire duration of therapy and 6 months after stopping.
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Less common side effects include:
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Muscle or joint aches
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Changes in cholesterol or liver enzymes
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Headaches
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Possible mental health issues even though this is not supported by recent research
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Permanent changes in vision
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We encourage all patients to independently look up not only the side effects of isotretinoin on the FDA website, but also in places like Reddit, so that you can get a good idea of what others' experiences have been like and discuss this with your provider before starting therapy.
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Periodic lab monitoring is required:
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Monthly pregnancy tests in all female patients (which can now be done from home)
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Monthly or every other month labs to check blood
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There has historically been concern about mood changes with isotretinoin. Current evidence does not show a clear causal relationship, but mood symptoms should always be reported so they can be evaluated appropriately.
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Ready to try isotretinoin that sucks a little bit less? Book Here