Roaccutane (isotretinoin) is a synthetic derivative of vitamin A.
It is usually taken for 4-6 months and in many cases induces prolonged remission of acne. However 20% require a second course, there are non-responders and there are potential side effects that the patient and parents need to be aware of. Roaccutane is a powerful drug and it is only prescribed based on suitability and under strict guidelines and management.
How does roaccutane work?
- It reduces sebum excretion by up to 90%, but this returns to normal after cessation of therapy.
- It reduces the bacterium propionobacterium acnes, at both at the surface of the skin and within the pilosebaceous unit.
- It decreases the plugging of the lining of the duct.
- It reduces inflammation within the pilosebaceous gland.
- It reduces epithelial proliferation and differentiation of the pilosebaceous unit.
What skin conditions are treated with Roaccutane?
It is predominantly used to treat acne vulgaris that has not responded to other therapies, or nodulocystic acne at risk of scarring or hyerpigmentation. It can also sometimes be used to treat hydradenitis suppuritiva or rosacea.
Will Isotretinoin cure my acne?
90% of patients see a dramatic improvement in their acne within 4-6 months of treatment. However there are non-responders, although this is rare. Acne may worsen it the first few weeks of treatment and sometimes your Doctor may put you on a course of oral prednisolone to counteract this. There can be recurrences of acne after stopping roaccutane and 20% of patients need a second course of roaccutane. If it only mild acne sometimes facial skin products for example salicylic acid cleanser and benzoyl peroxide or 1% retinol will suffice.
Other options (excluding the oral contraceptive pill or long-term antibiotics) for treating severe acne are blue light laser or micro-needle fractional radiofrequency. A course of therapy is needed but results are very good.
What are the common side effects of roaccutane?
Dryness of the skin, lips, and eyes is almost immediate but is better tolerated as time goes on. No active products should be used on the skin if using roaccutane; just bland face washes and bland moisturisers, your Doctor will advise. I would recommend a daily sunscreen while using roaccutane. Your skin is very delicate for up to 6 months after taking roaccutane so waxing, chemical peels, laser therapy etc. are not recommended while on roaccutane and for up to 6 months after stopping the drug.
There is an increase in the risks of skin infections and tonsillitis because the skin and mucous membranes are cracked and damaged and nosebleeds can occur because the skin inside the nose is very dry. Contact lenses can become difficult to wear. Muscle and joint aches occur especially after exercise. Temporary hair thinning can also occur. Roaccutane can affect night vision and should be used with caution in patients who require good night vision for example pilots, air traffic controllers, van drivers.
Blood tests need to be carried out once per month before collecting you next prescription for Roaccutane. Roaccutane can inflame the liver and increase fat levels in the blood so lipids and LFT’s need to be checked. For this reason it is recommended to avoid alcohol completely while taking Roaccutane.
Blood samples are sent for analysis at the local hospital or through private screening programs. The Adare Clinic charges €150.00 per visit during the patients treatment timeline. This fee includes blood tests and pregnancy tests where necessary.
Private Health Insurance may cover this treatment and it would be worthwhile contacting you health insurance provider for further details relating to levels of cover.
What are the rare side effects of taking Roaccutane?
A number of more serious side effects have been reported although these are very rare. There have been reports of mood change and depression and even suicidal thoughts. If you have a prior history of depression or mental disorder or it is in the family, please discuss this with your doctor before starting roaccutane. These patients are not necessarily excluded but would need to be monitored more carefully both by the doctor and their family.
Rarely inflammation of the liver or pancreas can be seen. Very rarely benign intracranial hypertension can occur so if you start developing severe early morning headaches see your doctor immediately and explain that you are taking roaccutane.
Can I take other drugs with roaccutane?
There are a number of known drug interactions with roaccutane notably tetracycline antibiotics and methotrexate. Let your doctor and pharmacist know you are on roaccutane if you are to be prescribed any new medication.
Pregnancy and Roaccutane
If a pregnant woman takes roaccutane the baby will be harmed leading to severe defects such as abnormal appearance, handicap or miscarriage.
Roaccutane should not be taken in pregnancy. You must not become pregnant while taking roaccutane, or for at least one month after stopping roaccutane, You should not breast feed while on roacctuane,
If you do become pregnant you must stop the medication immediately and contact your doctor. If there are no contraindications, women who are sexually active should be on proper contraception usually the OCP with barrier contraception (condoms) while taking roaccutane.