Many patients with severe acne will at some stage be offered roaccutaine to treat it. There has recently been an industry statement released with regards to its use, and anyone with acne or who knows someone with acne should be aware of this information. We had a chat with Dermatologist Dr Benjamin Carew, Program Coordinator for the UQ Master of Medicine Skin Cancer and Director, South East Dermatology Stafford in Brisbane, about Roaccutaine (Isotretinoin) for the treatment of acne.
It is well known that Roaccutaine is commonly prescribed for those with severe acne and has been for years now, but we want to know why the Australian College of Dermatology (ACD) is now releasing a position statement on its use. Dr Carew informed us that in the last couple of years both the American & European dermatology associations have also released fairly major updated guidelines for acne, and earlier this year there was a global alliance that released a consensus statement for management of acne. He said “You’ve got a number of the different international groups updating their guidelines in the last 2 years and an international consensus, so it’s pretty much time for the aussie group to update their position.” Dr Carew also advised us that the ACD has recently released an “A – Z of Skin” which is a fantastic resource for doctors, health professionals and members of the public to be able to access information about skin conditions from the peak body of the community – the Australian College of Dermatology (ACD). It’s also a great resource to clear up a few of the misconceptions about roaccutaine – it’s been around for a long time. The way it’s used has changed in recent times with lower dose regimes so it can be a much easier treatment protocol than it has been in the past.
Did you know it must be prescribed by a dermatologist?
It is only specialist dermatologists who are able to prescribe a patient with Roaccutaine. For those in rural areas, where a dermatologist is not available, a physician (GP) may be able to prescribe this for you.
Is there a risk during pregnancy?
Dr Carew advised us that there are issues with education particularly with women and the risk of pregnancy when using roaccutaine. He said “It’s a teratogen which causes birth defects and organ problems in a developing foetus, so it’s a disaster if a woman falls pregnant, so there’s a bit of education about using contraception while taking Roaccutaine, and monitoring during the treatment course needs to be done.” Dr Carew did specify that Roaccutaine is flushed out of the system quickly with no long term effects so if you are looking at trying to conceive you simply need to cease use for one month and one menstrual cycle.
What are the other possible side effects?
The statement released by the ACD provides advice to all doctors on the use of the medication in women of childbearing potential, as mentioned above, along with other contraindications. While mental health is not actually contraindicated with Roaccutaine, the emerging evidence is that acne is actually a strong risk factor for mental illness, anxiety, and suicide risk, and anecdotally the people that are put on roaccutaine are those with the worst acne and hence the higher suicide risk. Dr Carew advised us that there are actually a lot of studies that contradict each other with the risk of the effect on mood. He says, “I know that the American guidelines released about 2 years ago said most studies show there’s an improvement in mood and there’s no studies that suggest a link between roaccutaine and anxiety.”
The Australian guidelines around the use of Roaccutaine are good because they require the practitioner to assess the patient of their risk before starting treatment. Adolescents are already considered a high risk group for anxiety, depression etc, so it’s sensible to assess them at that time.
What about alternative solutions to acne?
In recent years we have seen an increase in non-surgical aesthetic devices showing improved results for treatment of acne. While acne patients should definitely be aware of their options, we asked Dr Carew if he thought more dermatologists and medical personnel should be looking at those devices for treatment of acne instead of medications such as antibiotics and Roaccutaine that have suggested side effects. He pointed out that the evidence appears to be mixed. “There’s not a lot of evidence for some, but a lot for others. You can look at lasers, and all these treatments have a place – it may be if people are not willing to have oral, they can have other treatments such as Kleresca activated gels, they have good improvements. However, these things are often expensive compared to the standard topical treatments and not as effective.”
Dr Carew agreed. “Roaccutaine is hands down the most effective treatment and with the low dose treatments used in Australia and NZ they are very well tolerated for acne. They are cost effective, clinically effective and with these low dose regimes patients don’t experience side effects with them.”
So how does it work?
Roaccutaine works on the oil glands by reducing their size and hence the oil production and slows down the cellular turnover in the pores and the skin so you don’t get the extracellular debris that clogs the pores.
What about oral antibiotics?
With regards to oral antibiotics, keep in mind that doesn’t change what goes on in your skin and pores, so you need a topical treatment or roaccutaine that’s going to help with that.
So how do I get more information?
If you’d like more information on Roaccutaine or anything else discussed in this blog check out the Position Statement released by the Australasian College of Dermatologists here.
If you’d like to have a consultation with Dr Benjamin Carew, you can get in touch with him here.