Isotretinoin

Isotretinoin is licensed for treatment of acne under 3 conditions

  1. scaring acne
  2. severe nodulocystic acne
  3. acne not responding to standard therapy

It is a highly effective treatment when taken at adequate doses over a 4 to 8 month period. It is also occasionally used for treatment of hidradenitis suppurativa

It is not without its problems however and careful pre-treatment counselling is needed. Issues include

  1. Teratogenicity- a baby conceived when taking isotretinoin will have a high chance of being very abnormal. Isotretinoin changes the way cells grow and can change the growth of a fetus. Pregnancy prevention with 2 types of contraception is needed for 1 month before and 3 months after treatment. After 3 months the isotretinoin is completely removed and pregnancy is safe again.
  2. Dry skin, dry lips- often worse in the first month
  3. Worsening of acne during the first month of treatment
  4. Muscle aches
  5. Sun Sensitivity
  6. Occasional effects on blood fats and the liver requiring blood monitoring
  7. Possible effects on mood. Although widely discussed on internet forums the scientific evidence for an effect on mood is weak.  There is a strong link between bad acne and depression and many researchers now believe that isotretinoin has been associated with depression whilst not being the cause. A landmark study from Sweden showed that mood disorders began to arise 3 years before patients took isotretinoin suggesting that the acne was the cause and not the drug http://www.bmj.com/content/341/bmj.c5812.long. Regardless of a link the mental health of acne sufferers needs careful attention and any signs of depression from whatever cause need to be handled appropriately. Due to the controversy surrounding isotretinoin and mood disorder and the fact that depression is common in acne Dermatologists will still enquire about mood disorder and may seek assistance from other experts if isotretinoin is prescribed in patients suffering from depression. Some patients with low mood may have been reluctant to seek help for depressive symptoms but do seek help for their skin. This can be a good opportunity to help with both problems. Most patients with severe acne report an improvement in their mood following successful treatment. The possible links between isotretinoin and depression were recently reviewed by the UK government: https://www.gov.uk/drug-safety-update/isotretinoin-roaccutane-reminder-of-possible-risk-of-psychiatric-disorders

Any side effects of the drug are dose dependent so lowering the dose will reduce the side effects. Side effects resolve completely after one month off treatment.


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