I wasn’t going to write an op on Roaccutane as earlier Moose wrote an excellent op on this drug and she asked me to give my professional opinion on the drug and I commented on the op mentioning the things which I thought were necessary and thought that was enough, until I realised a few things that lead me to the decision that clarification of few things were required from a professional point of view.

First of all it is in the category of Over the counter medicine which to the best of my knowledge is not true and misleading (I have requested Ciao staff to change this.) because although a very useful drug it is potentially very dangerous and should be used only on the recommendation of a Consultant dermatologist.

Secondly Press has projected this drug as controversial which is again not true and is not helping the general population in anyway.

Before I discuss these matter, a few basic details.

WHAT IS ROACCUTANE

It is Isotretinion(13-cis-retinioc acid) a form of Retinoids derived from Vitamin A.

IT’S USES.

It is mainly used for the treatment of different forms of Acne. Retinoids are used for many diseases but that is beyond the scope of this op so we will only discuss this drug in context of Acne here. Its main uses are in Acne vulgaris (common acne) if not responding to other treatments, other severe forms of acne like nodulocystic acne and acne conglobata. Acne persisting after the age of 30(normally acne resolves by the age of 28).

HOW DOES IT WORK?

1- It reduces sebum production
2- Reduces Comedogenesis (Black heads formation)
3- Reduces colonisation of P.Acnes.(Bacteria present in acne papules. Does not effect the bugs in brain.)
4- Acts as an Anti-inflammatory.

ADVERSE EFFECTS

Possible side effects are too many and few worth mentioning here are.
May cause abortion or damage the unborn baby.
Liver damage.
Dryness of the lips and skin with scaling.(liberal use of moisturisers is recommended)
Nose bleeds.
May increase blood cholesterol.
Muscle or bone pains.
Headache, nausea and diarrhoea.
Mood changes and Depression.

CONTRA-INDICATIONS

Pregnancy, this is an absolute contra-indication.
Breast-feeding.
Liver disease.
High blood cholesterol.
Compulsive Alcoholic.
Psychologically unstable person.
Certain other medicines.

Now you must be thinking that if there are too many and serious side effects then why am I recommending it. First of all these are possible side effects and not every patient would experience every side effect. Secondly these are all predictable and can be easily anticipated by the doctor and do not really effect the management. The only important thing is that the treatment should be under supervision of a specialist dermatologist and must be regularly followed, as certain tests are necessary before and during the treatment. A negative pregnancy test and use of contraception one month before and after the treatment is a must. Alcohol is contra-indicated during treatment and if you are a habitual drinker and can’t control your desires than you should not use this medicine. (After seeing Moose’s picture I must appreciate her efforts to restrain herself from drinking for 4 months.) And I hope Karen(Wigggly Pufff) never requires this drug, as this will effect her “Pubbing and clubbing”.

WAKE UP

Now to the last and most important point. Is this drug controversial?
NO it is not, and the fact is that it is one of the most important and useful drugs invented in the last two decades. It was licensed in UK in 1983, and since then it has revolutionised the treatment of Acne. The normal course is of 4 months and 85% patients are completely cured. 13-14% may require a treatment of 6 months and 1% may need a longer course of I year. According to a world-renowned Dermatologist these 1% are the sons and daughters of doctors and lawyers.
Sorry I can’t laugh because I fall in this category. (Although I never had acne).
These are excellent results far superior then any other treatment.

The other debate is it’s cost effectiveness. It is no doubt an expensive drug costing nearly £400 to £500 per treatment but according to the published data a normal teenager with acne may use a lot of antibiotics and local creams for 3 years on average before getting rid of acne which ultimately costs more than this. Then Acne (Not mild acne) may leave scars in 30% of patients on other treatments and may cause significant psychological morbidity in 12-13% and these can be prevented by early use of Roaccutane, hence proving that it is a cost-effective drug by all means.

Finally the press had a lot to say about depression and one reported case of suicide.
Depression is an important side effect of this drug but is rare. And there is no proof that the suicide caused by depression was actually due to Roaccutane. We must not forget that acne itself is a major cause of depression. So although it is a possibility and any change of mode during treatment should be reported but this should not effect your decision before starting treatment.
So there is no real controversy. It is the best treatment for Acne(First line therapy in some cases and second line in others) and although it is potentially a very dangerous drug it can be safely used under the supervision of a Consultant Dermatologist.

(These are just a few facts for information and the drug must not be used without consulting your Doctor.)

It is a common practice to use the word drug for medicines in UK but don’t use the word “Drug” in USA otherwise you and only you will be held responsible for the consequences