Introduction
Whilst Accutane has been found to be a potent treatment for severe cystic acne, some patients find the cosmetic effects aren’t just skin deep. The so called ‘Accutane nose job’ is the observation that following treatment the retinoid, their nose is noticeably smaller than before the treatment. Despite the abundance of anecdotal evidence available on social media, there’s relatively little evidence in the clinical literature to substantiate this curious side effect.
Accutane triggers cell death
Despite being in use for over four decades, the reason for Isotretinoin’s efficacy in permanently resolving acne is still relatively mysterious. At the very least it’s understood that Accutane shrinks the oily sebaceous glands on the surface skin. [1] The surface of the nose is particularly abundant in these oily glands, which has led some to conclude that the ‘Accutane nose job’ is another consequence of this process of sebocyte cell death (apoptosis).
Whilst the shrinking of sebaceous glands may well contribute to changes in the appearance of the skin texture, there is a more probable cause for this occasionally desirable side effect. Those who’ve been treated with Accutane will appreciate that its effects aren’t limited to the skin, often suffering side effects related to vision, metabolic health, and not least – bones and joints. As it turns out, the same process of cell death (apoptosis) that occurs within the sebaceous glands can also take place in the cartilage structures that compose the joints in places such as the knees, shoulders, wrist etc.
Retinoic Acid breaks down cartilage
Most of the cells that make up these cartilage structures are called Chrondrocytes. They ensure that joints are both strong and also flexible. Without getting into too much detail, Accutane can influence the survival of Chondrocytes by disrupting a key growth signalling pathway called Wnt/β-Catenin. [2][3] β-Catenin is protein that plays a number of vital roles in the body, but in particular it governs the growth and development of tissues by influencing the process of stem cell proliferation.
Micrograph of hyaline cartilage, showing chondrocytes in an extracellular matrix, Robert M. Hunt, Public domain, via Wikimedia Commons
Stem cells are the unique cells that have the ability to self-renew as well as transform in speciliased tissue cells to support the growth and repair of organs, including muscle and cartilage (read more). Retinoic acid, the active metabolite of Accutane, inhibits β-Catenin signalling which leads to the breakdown of cartilage structures.
This breakdown of cartilage is key to understanding the complaints of skeletal and joint pain during acne treatment. However, cartilage isn’t only present in joints, in fact it makes up the majority of the nose too! This is perhaps why many patients treated with the acne drug often attest to shrinking of the nose.[4][5] This also impacts the development of new bone which relies on cartilage as template, which can even result in stunted growth during puberty (read more).
It’s for this reason that complaints of joint pain are fairly common for those treated this acne medication. A meta-analysis of over 3000 patients found as many as 17% reporting joint discomfort. [6] Unfortunately Cartilage is one of the few tissues in the body that’s bad at self repair. In mature cartilage structures, Chrondrocytes have a limited capacity for proliferation. This is why surgical intervention with grafts are often employed to restore damaged joints. [7] However this suggests that a noticeable reduction in the size of the nose after Accutane treatment would likely be a lasting change.
Conclusion
Whilst a slightly smaller nose could be seen as an attractive bonus for those seeking relief from their acne, it points to the troubling effect of Retinoic acid on cartilage throughout the body. This is of particular concern to those undergoing treatment during their key years of growth during teenager hood. This is because cartilage is also needed to form the template for new bone growth in a process of Endochondral Ossification. It’s possible that by prematurely sealing these growth plates, young patients may fail to achieve their predicted height goals, with one case study of an individual losing up to 5cm. [8] The impact of Accutane on joint health should be carefully considered before initiating treatment.
Article Summary
- Whilst the exact cause of Accutane’s efficacy in treating acne is still poorly understood, it is at least partially to do with shrinking sebaceous glands.
- There’s plenty of anecdotal evidence for Accutane visibly shrinking the nose, an effect often attributed to reducing the size of these oily glands on the surface of the skin.
- The cause of the ‘Accutane nose job’ is likely more than skin deep, and has to do with effects of Retinoic Acid (the main metabolite of Accutane) on the cartilage structures.
- By disrupting the cells that make up cartilage called Chondrocytes, Accutane can not only visibly shrink the nose, but also cause joint discomfort and even damage.
- Cartilage has a limited capacity for repair, suggesting the ‘Accutane nose job’ may well be lasting. Equally, any detrimental effects to joints could also persist after treatment.
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References
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[1] https://www.sciencedirect.com/science/article/pii/S0022202X15326403
[2] https://www.sciencedirect.com/science/article/abs/pii/S0959804912003541
[3] https://link.springer.com/article/10.1007/s11060-008-9518-4
[4] https://www.sciencedirect.com/science/article/abs/pii/001216068790409X
[5] https://www.sciencedirect.com/science/article/abs/pii/0012160686902587
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9180136/
[7] https://onlinelibrary.wiley.com/doi/abs/10.1002/jbm.a.36087
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