The musings of a fourth year English medical student

Saturday, 17 October 2015

My experience on Roaccutane (isotretinoin)

I thought I would do a slightly different post discussing how I found it taking Roaccutane. First of all, this isn't a post to try and persuade people to take Roaccutane, but I felt the need to share my own experience. This is because Roaccutane normally gets a bad reputation (thanks to the Daily Mail) and some believe it can cause depression and suicide in patients. There have been a handful of documented suicides of males particularly in adolescence who have committed suicide whilst being prescribed Roaccutane.

In the UK, Roaccutane is the brand name of the ingredient isotretinoin, a retinol largely used to treat severe acne. It is also sometimes prescribed to prevent squamous cell carcinoma and treat harlequin ichthyosis. It is a derivative of vitamin A. I think isotretinoin is really interesting because it is an optical isomer and also because the pharmacokinetics are not fully understood, despite it being incredibly effective in treating acne. Some believe it induces apoptosis of sebaceous gland cells, which would make sense given that a spot is formed in and around the sebaceous gland. 

The reason I chose to take Roaccutane was my acne. I started getting bad spots aged around 13, and despite every effort they got worse and worse. I tried 2 different antibiotics for 2 years, contraception, most prescribed spot creams you can think of, as well as high street skincare. By the age of 17 I had had enough. I never had those massive cystic spots, just lots and lots of small sized ones. I was referred by my GP to a NHS dermatologist who examined my skin and prescribed Roaccutane. If you have acne or have had it, you know that it can be so frustrating and demoralising. I was so fed up of trying countless options that brought so much hope and consistently let me down. And the amazing thing about Roaccutane is that it is by far the most successful acne treatment you can think of. I was told by my dermatologist that only 10% of patients 'relapse' and need to take more than one course of Roaccutane. The dosage was calculated by my mass; I weight 66kg at the time so was prescribed 60mg per day, for 4 months. The length of your prescription depends on whether you have been prescribed half a mg or a full mg per kilo of body mass. 6 months is a typical duration of Roaccutane prescription. 

Now of course, every drug has risks and side effects. I repeat myself: I am not telling anyone they should take Roaccutane. Every body is different. Lifestyle needs to be taken into account. And if you're a woman, it is normally suggested you take a form of contraception, if not two (i.e. pill and condoms), if you're sexually active. This is because there is an extraordinarily high chance of severe birth defects. Roaccutane also affects liver function, so blood tests are taken regularly throughout treatment to document lipids in the blood. If you're a female, a urine test for pregnancy is done before prescribing Roaccutane. In addition, you really shouldn't drink any alcohol whilst on Roaccutane. 

For me, the effects were slow. I didn't notice anything in the first month or two. By the end of the second month, my skin felt more sensitive and a lot less oily. I used to have very oily skin and now it is pretty dehydrated. Roaccutane permanently changes how your skin behaves. You won't go back to super oily skin once the prescription has finished. In addition, my skin was very red. I was prescribed a very rich cream by the dermatologist containing mineral oil and urea to apply if the skin got too dry.  The skin on my legs and arms was noticeably drier, and on my face, too. The dry lips was the worst part, and you permanently have to slather them with a thick balm. For me, Nuxe's rĂªve de miel did the job perfectly. 

Of course, the most obvious side effect people are concerned about is the depression. At the time I was prescribed it, a recent large Swedish study showed no correlation. However, I think that if you have a history of depression or currently have the disease at the time of prescription, try to put safeguarding in place. Tell your friends and family, regularly see your GP, arrange some talking therapy. Dr Sam Bunting, a Harley Street dermatologist has said that in some ways those with depression are the best ones to prescribe Roaccutane in the sense that they already have the care and safeguarding in place. If you have severe acne and are considering Roaccutane, have lots of thorough conversations with your GP and a NHS dermatologist.  For me, I began to feel mildly depressed in my last 3 weeks on Roaccutane. However, I feel it is worth noting that this was when I was preparing for medical school interviews and doing my A levels, so it was a very stressful time!! I had just been rejected from Cardiff and Leeds so that was getting me down, too. 

For me, Roaccutane was a complete game changer. Do I still get spots? Yes, I do. I get them when I don't take off my makeup or when I'm really stressed and ill. I didn't get a new spot for a good 6 months after the course of medication, though. Scarring wise, I've been really lucky. Because I didn't have cystic acne I never had the crater-like scars that you sometimes see. My scars were very superficial and very red. However, through topical use of BHAs and AHAs (salicylic acid, lactic acid, glycolic acid) which you can get in lots of high street skincare brands, almost all of my scars were gone in a year. 

Hope you found this vaguely interesting! 

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