All you need to know about Roaccutane
published in Reader's Digest,
31 October 2016
Up to 650 million people live with acne, it’s one of the most common skin conditions. Countless anti-acne agents exist, and when they have failed, Roaccutane may be prescribed. For some it’s a cure; others believe it’s a curse. Hailed as a miracle drug; condemned for its nasty side effects. What's the truth?
This is my story. I developed acne as a young teenager, mainly on my face. At first I ignored it, considering it minor, hopefully temporary, and merely a rite of passage to adulthood. As the spots persisted, I was surprised by the profound psychosocial effects upon my life. My confidence plummeted along with my self-esteem. I didn’t want to show my face: my face didn’t fit and I couldn’t put a brave face on it. Skincare experts recognise the emotional blight that acne can cause.
Skincare experts recognise the emotional blight that acne can cause.
Thus began the attempts to clear my skin. Beginning with over the counter wipes, masks and cleansers, I progressed to prescribed creams designed to kill the appropriately-named P.acnes bacteria that underlies acne. Oral antibiotics were then administered and work in a similar fashion but they didn’t work for me; doctors limit their use to avoid the growing problem of antibiotic resistance.
Not having a boyfriend at the time, I was surprised then to be prescribed an oral contraceptive pill. This combats the effects of testosterone (that contributes to oily skin) and showed some effect. For me, though, Roaccutane was the real cure, finally achieving a dramatic improvement in my appearance and psychological wellbeing.
Roaccutane is strong medicine. It’s only prescribed for short courses and by dermatologists. It dries up the skin’s oily secretions, which in turn reduces P.acnes populations. The dryness, however, extends to your lips, eyes, nose and vagina, causing minor bleeding and irritation.
Roaccutane is incredibly dangerous to unborn babies, causing abnormalities and miscarriage.
More seriously, Roaccutane is incredibly dangerous to unborn babies, causing abnormalities and miscarriage. For this reason, users have to promise not to become pregnant (see the appropriately-named iPLEDGE programme).
It’s also suggested that Roaccutane can lead to mood swings and depression, though this is hard to prove since the teenage years (when Roaccutane is commonly prescribed) are already a time of turmoil with significant biological, psychological and social changes.
Some parents believe that Roaccutane has led to their child’s suicide. 16-year-old Jack Bowlby expressed ‘very dark thoughts’ on Roaccutane and killed himself; the coroner recorded an open verdict. Between 1982 and 2005, 190 suicides were reported amongst Roaccutane users.
The late Dr Richard Lehne, a leading nurse educator, acknowledged the possible mental health effects of Roaccutane, stating “with some patients, depression developed while taking Roaccutane, resolved when the drug was discontinued, and then resumed when Roaccutane was resumed”. He notes, however, that “there is no definitive proof that Roaccutane was the cause, and no mechanism for inducing depression has been established”.
Whilst doubt remains, doctors and families of Roaccutane users are urged to monitor for signs of depression. Meanwhile, the ‘Face The Day’ Acne Tracker App may be invaluable as it allows Roaccutane users to record and share their acne journey with doctors, who can intervene accordingly.