Is Roaccutane deserving of its bad reputation? STELLAR chats to a patient and a dermatologist.
Roaccutane is the brand name for a widely known, controversial “wonder drug” named isotretinoin. But what is it, and what does it do?
Isotretinoin is a vitamin A derivative which targets the sebaceous glands that are responsible for causing acne. The drug decreases the size and activity of the sebaceous glands in the skin, which reduces the amount of sebum that is produced. This stops the glands becoming blocked, and means bacteria are less likely to thrive. It also reduces the inflammation in the skin.
The medication is known to be the best route to take to clear up severe acne, however it is a route people are hesitant to take due to the rumours and misconceptions about the side effects that can be experienced from a course of the drug, the most prevalent being mood swings and depression.
If you’re struggling with acne and are unsure whether Roaccutane is the right step for you, we’ve spoken to the experts – the dermatologist who swears by the drug and the patient who has taken it – to debunk the myths and misconceptions about Roaccutane.
Bríd Browne was first prescribed Roaccutane in 2015 at age 20 after years of various pills, creams and antibiotics. She had suffered from acne since she was 14 and was first suggested to take Roaccutane at 17 – however, she held off on starting her course until she finished school in fear that the side effects of the drug would affect her Leaving Certificate.
After hearing the side effects Bríd experienced when taking Roaccutane, I had a chat with dermatologist Dr Rosemary Coleman of Blackrock Clinic about the side effects a patient should or shouldn’t be worried about when taking Roaccutane and why they happen.
Although Bríd didn’t note any depressive signs during her course of Roaccutane, mood swings and depression is one of the biggest fears in people considering the drug. Dr Coleman says that the biggest myth of taking Roaccutane is that it’ll cause depression.
Acne causes far more mood swings and depression than Roaccutane ever has. A March 2017 study published in the Journal of the American Academy of Dermatology study showed that isotretinoin did not appear to be associated with the increase of depression, moreover the treatment of acne seems to ameliorate depressive symptoms. This just verified all our clinical experience that says acne causes far more depression than Roaccutane and for people with acne who are often depressed, a course of Roaccutane can improve their mood.
One fact about Roaccutane that is not a myth is that a woman must take all precautions against pregnancy when taking the medication. “If you get pregnant when you take Roaccutane there’s a 60% chance that there will be a foetal abnormality,” Dr.Coleman explained.
“There’s no problem getting pregnant after the recommended dose, usually a month after you’ve finished your course, because the Roaccutane does not last in your system. No abnormalities have been recorded in any babies when the person conceives after the month.” Bríd told us that she was required to have a pregnancy test at her dermatologist’s office every month while on Roaccutane, just as a precaution.
A lot of women choose to take the contraceptive pill while taking Roaccutane to avoid pregnancy. Dr Coleman suggests this could be a reason why women have depressive symptoms while taking Roaccutane. “People can get depressed when they’re on Roaccutane and when that happens I find it is invariably in females when they’re taking the pill. The pill causes far more depression than Roaccutane ever caused, and girls usually have to take the pill when using it. If I have someone whose mood is upset and I change their pill, that usually sorts it out.”
We have a problem in Ireland with suicide in young men and we’ve over 400 suicides per year between the ages of 19 and 26, they’re not all on Roaccutane. Needless to say it’s very common for people to take Roaccutane and it’s very common in that age group so every now and again someone’s been on it in the past and then there’s a connection. It’s just something that seems to have been propagated.
After two months on Roaccutane Bríd began to notice her skin becomming extremely dry and peely. “I had cracked hands, lips and ears, and slight nose bleeds”. Dr Coleman explained that dry skin isn’t a myth of taking Roaccutane, it’s a sure and necessary side effect:
If you don’t have dry lips you’re not absorbing the drug properly. Roaccutane acts by drying up the sebaceous glands, so of course it dries up the lips. Most people get nothing other than dry lips or dry skin and if they mind their lips properly and use the lip balms, they are totally in control. It’s up to the patient to look after their lips and take the advice given from the dermatologist to minimise dry lips.
After Bríd finished up her first course of Roaccutane her skin was “immaculate”. However, about six months later her acne came back. Dr Coleman says this only happens with 30% of people who take Roaccutane. During her second course of the drug, Bríd had most of the same side effects, but her skin was also extremely sensitive. “I would sunburn extremely easily and any cuts or scratches didn’t heal properly and left marks,” she said.
Dr Coleman says that while on Roaccutane, “skin is slower to heal because the reservoir of skin that helps the healing comes from what we call the skin appendages, which includes the sebaceous, so if you were to get a graze or a burn or a bad cut on Roaccutane it will be slower to heal as you don’t have that reservoir of cells because the sebaceous glands shrink down when you’re on it.
Then when you come off it they recover fully. So it doesn’t scar, in fact, it stimulates collagen and has been abused in places like America because people say your skin looks better as when you stimulate collagen it plumps the skin up.”
Bríd noticed that she’d lost weight while taking Roaccutane because she didn’t drink alcohol while taking the medication. However, Dr Coleman said that not being able to drink on the drug is a myth. “The company guidelines say you should not consume alcohol. In practice I say to my patients if they want to drink alcohol they can but just not much,” she said. “I would say no more than five units a week.”
The only person Dr Coleman would be hesitant to prescribe Roaccutane is someone who is actively depressed and attending a psychiatrist for treatment of depression. “In this case I will ask their referring doctor for a letter saying that the mood is stable, because if their mood is not stable and you put them on a drug with all these misconceptions and nonsense about it, it will be blamed for the deterioration.”
In Bríd’s case, her acne has completely cleared up thanks to the medication and Roaccutane seems to have “worked it’s magic”.
I only wish I’d gone on it a bit sooner because my acne left some scars that could have been avoided.
One thing Dr.Coleman wants STELLAR readers to remember is to “watch out for all the doctors out there who pretend they are dermatologists and who pretend they are experts in skin disease, because they are not necessarily the type of people to be managing the drug we use every day of the week. If you want to find a skin expert please go to the Irish Association of Dermatologists website, we are all listed there.”
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