This oral retinoid is extremely effective in the treatment of acne. It has been used worldwide in over 25 million people with acne.
 

However, it is highly damaging to unborn foetuses (teratogenic) and can only be prescribed by a dermatologist in hospital outpatient department and cannot be obtained from a general practitioner.

How does it work?
Its effects include reduction of sebum production and shrinkage of the sebaceous gland leading to a decrease in bacterial colonisation of the ducts. The course is usually 4 months long, though a lower dose can be used for longer. The facts about the treatment success are:
 

• 90% of people clear their acne during the course of treatment
   

• 70% of people remain satifactorily clear after treatment
   

• A further course can be given
   

• Greasiness of the skin with some small spots normally occurs after a course of treatment
   

• With some new spots coming after the treatment be reassured that the acne does not become as severely as before the course was given
   

• The acne does not suddenly flare up and become severe again
  
  The improvement with isotretinoin is often maintained for months or even years after treatment has finished.
  
  Who can have isotretinoin - roaccutane?
  Initially, isotretinoin treatment was used only in patients with severe acne and scarring. However, the range of indications has now widened to include:

• Acne causing scarring

• Moderately severe acne that has failed to respond to 18 months or more of other treatments

• Acne that relapses promptly after a good response to conventional treatment

• Individuals who are severely upset and psychologically affected by acne are also prescribed isotretinoin.

Isotretinoin therapy is associated with side-effects. These settle completely on stopping the treatment. The treatment can be stopped at any time without any problem, at any time during the course.

So what is involved in taking a course of isotretinoin?
You will have been referred by your general practitioner to a consultant dermatologist and the treatment decided as the best course of action.

How long is it for?
The course is normally 4 months in duration at a dose of between 1 and 2 milligrams per kilogram - usually between 40 and 80 milligrams per day. A lower dose can be given for a longer period of time, over 6 months for example.

The tests needed before starting
A blood test will be taken, though this is not always essential. This is because of rare , though not serious side effect of raising the fats in the blood (lipids) and causing inflammation of the liver - hepatitis.

Females will need a pregnancy test prior to starting treatment and to take approprate contraceptive protection.

Other side effects are:
 

• Dryness and cracking of the lips - chelitis. Nearly everyone gets this and vaseline is the most effective treatment to prevent this
   

• Dryness and redness of the facial skin and other areas of skin. This is due to the drying effect of the treatment
   

• Drying of the nose leading to nosebleeds - epistaxis
   

• Drying of the eyes and soreness - conjunctivitis
   

• Headaches
   

• Aching muscles - myalgia and joints - arthralgia, particularly after exercise
   

• Infection of the skin with bacteria due to the dryness - staphylococcal infections
  
  These are reversible after stopping the treatment.
  
  Damage to unborn children
  Female patients must avoid pregnancy while taking isotretinoin and for one month after completion of treatment due to its effect on unborn children - the teratogenic effect.
  
  Emotional effects of roaccutane
  In a proportion of people taking isotretinoin - roaccutane an alteration of mood is reported. In some it is reported as feeling depressed, however it resolves after stopping the treatment. This reported alteration of mood however cannot be easily proven as a causative link, in other words it is not possible to say that the drug caused the depression.
  
  Having severe acne at a vunerable time in life, during the teenage years, can also be a cause of depression and there are patients who have committed suicide because of the degree of acne.
  
  Of over 25 million people taking isotretinoin particularly teenagers with acne, some will attempt to take their life and some have succeeded. It is a tragedy for all concerned, though it is not possible to say that isotretinoin caused this.
  
  Research is ongoing to try to clarify this situation.
  
  The positive emotional effects of taking isotretinoin
  A much more widely reported effect is of a person's mood increasing due to the happiness of seeing the acne resolve.