Isotretinoin |
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| 12 min read
Isotretinoin, also known as Roaccutane or Accutane, is an oral retinoid. It is one of the most effective treatment for acne with approximately 85-90% of patients seeing a long term improvement in the skin after completing a course of treatment. It is also used to treat rosacea which has not responded to other treatments. Despite the potential side effects listed below, in my experience, the vast majority of patients tolerate treatment well.
Isotretinoin is taken as a course of treatment with the total amount required to complete the course determined by your body weight. The average duration of treatment is typically 6-9 months. You will start with a relatively low dose since there can be a temporary flare in your acne at the beginning of treatment and to allow you to get used to any side effects. After the first month or so the dose is typically increased.
The British Association of Dermatologists has produced a very helpful information leaflet and it is very important that you have read this and discussed any questions before starting the medication. As for any medication it is also essential to read the information that comes within the packaging and contains a full list of all recognised side effects.
In October 2023 the Medicines & Healthcare products Regulatory Agency (MHRA) introduced significant new regulations governing the prescription of isotretinoin. This has important implications for patients with mental health issues and for patients with the potential to become pregnant. These rules apply to all doctors prescribing isotretinoin and may mean that you need to attend for more appointments than previously or that you need to have a mental health assessment prior to starting treatment.
The MHRA has stated that all patients must complete questionnaires for mental health conditions at the time of starting treatment and at any follow up appointments.
If you have previously suffered from anxiety/depression or if the screening tools above identify evidence of depression or anxiety then it is important that you are assessed by a psychiatrist before starting Isotretion to determine whether it is safe for you to take this medication.
Isotretinoin causes serious birth defects and it is critical not to take the medicine if pregnant or breast feeding or for at least a month after. The MHRA mandates that patients with child bearing potential are enrolled in a pregnancy prevention program. Previously patients were allowed to take responsibility for not becoming pregnant and opt out of this program however this is now no longer permitted.
The MHRA states the following: "A person has childbearing potential if they have a uterus and at least one ovary unless they: (a) Have undergone surgical sterilisation (tubal ligation), confirmed by a healthcare professional. (b) Are post-menopausal, confirmed by a healthcare professional."
For patients with child bearing potential the MHRA has defined 3 groups of patients and this determines how often you need to attend for follow up:-
Females in Group C will need to attend every 4 weeks for a pregnancy test before a prescription can be issued.
The MHRA has made it a legal requirement that all patients undergoing treatment with isotretinoin read and complete the following consent form prior to starting treatment:-
The MHRA has stated that all patients (male or female) will need to attend for a follow up appointment after the first month. Males and females with no reproductive potential or falling into MHRA Groups A and B can then attend every 12 weeks. Females falling into group C will need to attend every 4 weeks. Prescriptions for isotretinoin can be for no longer than 12 weeks.
You will be charged a fee whenever you attend for a follow up appointment. In some cases this appointment can be conducted remotely (for example over the telephone), however a fee will still be charged.
If you have medical insurance the cost of initial and follow up appointments may be covered, however you should check this carefully as not all insurance companies will cover the cost of acne treatments or follow up appointments.
Before starting treatment and at the time of any follow up appointment you will need to complete an online questionnaire to identify any side effects that you may be experiencing. Please contact my practice management team if you have not received this link.
You will need blood tests (a minimum of one blood test prior to treatment and one blood test whilst taking isotretinoin - usually after 1 month). You must not take isotretinoin without completing the advised blood tests or being informed of the results as you are at risk of serious or life-threatening side effects.
If you have medical insurance, your insurance provider may cover some or all of the cost of blood tests. You should check this carefully to ensure that you are not charged a fee by the hospital.
You can also ask your GP if they would be willing to perform the blood tests for you. Many GPs are willing to do this when asked, however they are not obliged to do so for patients receiving private treatment.
All females with childbearing potential must perform a pregnancy test at the time that a prescription for isotretinoin is issued. If you perform this in a clinic or private hospital then you will be charged a fee for this. An alternative is to perform the test at home and bring a photograph of the result.
The costs of treatment are as follows:-
There are now very strict regulations governing the prescribing of Isotretinoin and if you would like me to prescribe then the following steps will need to be completed. These can be completed during your initial consultation:-
To book an in person consultation, enter your details below and my practice management team will contact you to schedule the appointment. Alternatively call 0203 389 6076 (calls are answered during working hours) or email: contact@drmagnuslynch.com.
