Sue Ibrahim, Elan Medical Skin Clinic’s nurse consultant in dermatology, is keen to outline the facts about the acne drug Roaccutane – and to dispel some of the myths.
Roaccutane is a brand name for the oral drug Isotretinoin, which is closely related to vitamin A. Oral Isotretinoin works in a variety of ways, targeting several of the factors that cause acne and other skin conditions including the production of sebum (an oily substance produced by the skin) and the production of keratin (outer scales of skin) that block the pores of the hair follicle and cause acne.
Due to ongoing concerns, a review of psychiatric reactions was carried out in 2014, which considered all available evidence from published literature and individual case reports. Conflicting study results and limitations in the data determined it was not possible to identify a clear biological mechanism by which Isotretinoin would cause psychiatric disorders.
Acne itself is associated with psychiatric disorders and the age that many patients take isotretinoin is also the age that some psychiatric disorders are commonly diagnosed. However, patients on Roaccutane require careful monitoring, which should include monthly blood tests and close supervision regarding low mood. The drug is now generally prescribed at a lower dose for a longer period of time.
Who can prescribe it?
Roaccutane Isotretinoin is licensed in the UK and commonly used to treat moderate and severe acne, often where there is risk of scarring. Your dermatologist may occasionally use Roaccutane to treat other skin conditions such as hidradenitis suppurativa and rosacea. In the UK Roaccutane may only be prescribed if you are under the care of a consultant dermatologist.
Will Roaccutane cure my acne?
A large proportion of patients (about 9 out of 10) see a significant improvement in their acne with a single 16 to 24 week course of Roaccutane, although during the first few weeks of treatment the acne may worsen before it starts to improve.
A small number of patients continue to have milder, although improved, acne following Isotretinoin that can be controlled with conventional therapies, such as antibiotics. Others may relapse after stopping treatment with Roaccutane, and occasionally, a prolonged or second course of treatment is required.
Who can’t have it?
According to Government guidelines, the following people should not receive treatment with Roaccutane:
- children aged 12 years or younger
- women who are, or who might be, pregnant (please download the leaflet below)
- women who are breast-feeding
- people with impaired liver function
- those with high levels of fat in their blood
- people with hypervitaminosis A – the presence of too much vitamin A in the body, symptoms of which include:
- skin changes
- hair loss
- stomach ache
Isotretinoin should be used with caution in people with:
- a history of depression
- dry-eye syndrome
- impaired kidney function
- people who are allergic to peanuts, soya, or the sugar sorbitol as some brands of Isotretinoin may contain these ingredients
What are the rare side effects of Isotretinoin?
More serious side effects may occur although these are fortunately rare. Isotretinoin can lead to changes in mood and/or behaviour and less commonly, unusual experiences including thoughts of self-harm and suicide. There have also been reports of patients attempting suicide.
If you have ever had low mood, suicidal ideas or any other mental health problem, please discuss this with your doctor before starting treatment. If you have a history of depression your dermatologist may ask a psychiatrist to see you before starting Roaccutane to determine if it is safe for you to take.
For more information, please read the leaflet attached below that has been produced by the British Association of Dermatologists or contact Sue Ibrahim.