An anti-acne treatment with a very high success rate is oral isotretinoin (a retinoid). It’s available only on prescription under the brand names ROACCUTANE, ORATANE, ISOHEXAL and ACCURE. Isotretinoin attacks all the contributing causes of acne. It reduces the amount of sebum made by the glands in your skin, reduces bacteria and inflammation, and opens clogged pores. But it can have serious side effects, including depression and birth defects. Isotretinoin should only be prescribed for people with severe acne.
The Roaccutane debate
Thousands of young Australians have used oral anti-acne drugs containing the active ingredient isotretinoin. It's an effective treatment for severe acne and treatment failure is uncommon. The effects can last long after you stop taking the drug, and there can also be severe side effects.
Women who take the drug during pregnancy have a very high risk (30–40%) of serious birth defects in their baby. The main effects are on the heart, brain and ear. For this reason, doctors will want to rule out any possibility of pregnancy before treatment begins. Effective contraception should be used diligently during treatment and for one month before and after. Breastfeeding is also not advised while taking this drug.
The drug’s been linked to serious depression and even suicide. The US Food and Drug Authority (FDA) revealed in 2000 it was receiving a growing number of reports of psychiatric side effects, including suicides, in patients taking the drug Accutane (the US version of Roaccutane). However, while it does happen, reported mood change associated with isotretinoin is relatively uncommon. Current medical estimates put it at 1–2% of patients. Doctors point out that it’s difficult to determine whether the drug really is the cause because people with severe acne are more prone to depression, as are teenagers.
Generally only dermatologists can prescribe isotretinoin. While for some people it’s the only solution to a debilitating medical and psychological problem, there’s concern overseas that it’s too often prescribed for mild and moderate acne that could be treated some other way.