Should the NHS prescribe Isotretinoin (Roaccutane)?

Is Roaccutane safe for acne treatment

The acne treatment Isotretinoin (often known by its original brand name in the UK, Roaccutane) was the subject of a recent BBC Victoria Derbyshire programme covering the stories of a number of patients who had experienced rare side effects of it.

The headline of the BBC website for the story reads: ‘The parents of young people who have killed themselves and patients unable to have sex are calling for the NHS to stop prescribing acne drug Roaccutane’.

They reported the story of Ed Henthorn who took the drug when he was 19 for three weeks. He decided to stop because he experienced erectile dysfunction, psychosis and suicidal thoughts which he still suffers from five years after discontinuing the medication. His is a tragic story and it is not the first time that isotretinoin has been the source of controversy, or that campaigners have called for the NHS to ban the drug on the basis that its side effects mean that its risks outweigh the benefits.

As the BBC acknowledge in their article, the majority of patients who take Isotretinoin have a positive experience and the Manufacturer Roche can claim with justification that ‘millions of patients worldwide have benefited from taking the drug’. The British Association of Dermatologists points out that many people who have not experienced severe acne may see it as a minor, cosmetic issue.

However, there is extensive evidence to show that acne is a disfiguring skin complaint that can cause irreversible scarring and can lead to low mood, low self-esteem and a negative body image, which for some patients can have an extremely detrimental impact on their quality of life. Although there have been reports of a minority of patients taking isotretinoin experiencing mood disorders for many years and more recent reports of male sexual dysfunction it is very difficult to establish in any individual case that the drug has caused these symptoms.

Evaluating acne treatments

Acne is one of the most commonly treated skin diseases and accounts for 3.5 million visits to GPs and dermatologists in the UK every year. Milder cases are often treated by GPs with creams and gels and oral antibiotics. Isotretinoin is used to treat more severe cases that have not responded to other treatments, or scarring acne.  It is estimated that more than 30,000 patients take the drug annually in the UK.

The British Association of Dermatologists encourages members to follow guidelines regarding acne and isotretinoin that stress the importance of taking a comprehensive history from patients before and during treatment.  It is recommended that healthcare practitioners should discuss with the patient from the outset the possibility of low mood, including depression, and review this throughout treatment. There should be documentation of mental health and/or mood state whilst on isotretinoin, both at the initial assessment for treatment and at follow-up appointments.

The association has informed members of the 2017 MHRA alert about adverse sexual effects in men who have taken isotretinoin, and our patient information leaflet on this medication has also been updated accordingly.  For this reason, while isotretinoin is a highly effective treatment for a distressing skin disease, doctors have to very carefully weigh up the potential risks and benefits of the drug in each individual patient.

For more information, call 01483 555 907 to book an acne consultation with Dr Juliet Williams.