The most effective and powerful treatment for acne is an oral medication called isotretinoin, which goes by the brand name Roaccutane or Accutane (in the USA). This treatment will typically completely clear acne within about 4-6 months and can then often be stopped. Acne usually then either completely stays away or clears for a long time, particularly if a gel or cream is used to maintain the improvement.
In about one-in-three people acne comes back, but usually does so gradually and after a delay of months or years. Treatment with isotretinoin can be repeated, and it can even be used, (under expert supervision) in low-dose in the long term to keep acne under complete control.
So why don’t all patients get prescribed isotretinoin? The reason is because of possible side effects. All patients experience side effects, but in most these are mild. Everyone gets dry lips which have a tendency to chap, some people will get dry skin, especially if they already have a tendency to dry skin or a history of eczema.
About one in four people get a worsening of acne at the start of treatment. Some people find that their muscles ache a bit, but these side effects do not tend to occur at the lower doses that are often used these days. The side effects that get the most attention are the possible effect on mood and the risk if a pregnancy occurs during treatment.
Acne is an upsetting condition which can have huge effects on people’s self-confidence, desire to socialize and even the ability to get the jobs they want. It is associated with anxiety and depression. If you look at a group of patients receiving isotretinoin treatment for acne, their mood improves significantly as their acne vanishes. However in some people, perhaps one in fifty, the medicine itself seems to cause feelings of lowness or depression and these can continue for several months after stopping. This does not seem to relate, in my experience, to people who have had a history of depression before. So it’s important to be aware of this before starting isotretinoin, and to let your dermatologist know if you or your family or friends notice any change in the way you are behaving. It is also vitally important not to become pregnant whilst on isotretinoin and for females to use reliable contraception – two simultaneous forms are recommended. Isotretinoin is out of the system within a few weeks so it is safe to become pregnant 5 weeks after stopping.