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TEAM ZOELLA JANUARY 31, 2022

From Dry Skin to Depression: The Truth about Taking Roaccutane for Acne

With so much to take into consideration, we spoke with Dermatologist and Head of Medical at Skin+Me Dr Jason Thomson to discuss the pros and cons of this so-called miracle worker.

You’ve likely heard of Roaccutane – the hotly debated miracle medication famed for its acne curing capabilities – but are the extensive physical, mental and emotional side effects associated with the drug worth the end result?

Oral Isotretinoin, often prescribed under the brand name Roaccutane / Rizuderm or Accutane if you’re in the US, is an anti-inflammatory agent derived from vitamin A, belonging to a group of treatments called retinoids. It works by reducing the amount of oil your sebaceous glands produce and killing acne-causing bacteria on the skin. 

Image Credit: Kate Snooks has documented her Roaccutane journey on her blog and YouTube

Due to its potency, Roaccutane is only prescribed in severe cases such as nodular or conglobate acne and where patients have not responded to other treatments, usually antibiotics and topical creams. The list of potential risks of taking Isotretinoin can be daunting but according to the NHS website, only 1 in 1,000 patients suffer from serious side effects. However, 1 in 10 people experience common side effects including dry skin, aches, pains and headaches. 

Though serious side effects are rare, it’s important to be aware of them if you’re considering taking Roaccutane. The list of side effects include:

Common side effects

  • skin becoming more sensitive to sunlight
  • dry eyes
  • dry throat
  • dry nose and nosebleeds
  • headaches and general aches and pains

Serious side effects

  • anxiety, aggression and violence, changes in mood, or suicidal thoughts 
  • severe pain in your stomach with or without diarrhoea, feeling or being sick (nausea or vomiting) – these can be signs of a serious problem called pancreatitis 
  • bloody diarrhoea – this may be a sign of gastrointestinal bleeding
  • a serious skin rash that peels or has blisters – the skin rash may come with eye infections, ulcers, a fever, and headaches
  • difficulty moving your arms or legs, and painful, swollen or bruised areas of the body, or dark pee – these can be signs of muscle weakness
  • yellow skin or the whites of your eyes turn yellow, difficulty peeing, or feeling very tired – these are signs of liver or kidney problems
  • a bad headache that doesn’t go away and makes you feel sick or be sick
  • sudden changes in eyesight, including not seeing as well at night

Understandably, getting your hands on the drug isn’t an easy process. In the UK, it can only be prescribed and supervised under the care of a consultant dermatologist and requires a psychological assessment, blood tests and regular pregnancy tests as it can cause serious harm to an unborn baby.

With so much to take into consideration, we spoke with Dermatologist and Head of Medical at Skin+Me Dr Jason Thomson to discuss the pros and cons of this so-called miracle worker, from risks to success rates and the skincare you need to have on standby… 

What exactly is Roaccutane and why is it a controversial treatment?

Roaccutane is the brand name for an oral (taken by mouth) prescription medication called isotretinoin. It belongs to a family of drugs called retinoids which means they are all related to vitamin A. It is highly effective in treating acne and has been used by dermatologists for decades, usually to treat the more severe forms of acne. 

This is a complex area and decades of research into this link have not proven that the medication causes depression or suicide and the relationship between them remains uncertain.Dr Jason Thomson

The main reason that there is controversy around Roaccutane is due to some of its potential side effects and a possible link between taking the medication and depression and suicidal feelings. However, this is a complex area and decades of research into this link have not proven that the medication causes depression or suicide and the relationship between them remains uncertain. It’s very difficult to prove such a link and many believe that it is the severe acne itself that is contributing to the psychological distress rather than the medication and we do know that having acne means you are more likely to suffer with psychological conditions such as depression and anxiety. 

For anyone with depression, what would your advice be when considering Roaccutane?

Tell your dermatologist about this so they can properly evaluate whether or not you’ll be suitable for treatment. Having depression doesn’t mean you won’t be prescribed Roaccutane but it might mean you’ll be monitored more closely and sometimes a psychiatrist will be involved in your care too. If whilst on the medication you feel low or depressed, it’s important to get in touch with your dermatologist or GP as you may need to stop treatment. It’s always advisable to let your friends and family know that you’re on the medication so that they can keep a lookout for any changes in your mood or behaviour. Like any medication, deciding whether or not it is for you is about weighing up the risks and the benefits with your doctor and coming to a shared decision. 

Is there a psychological evaluation beforehand?

Yes, before starting Roaccutane a thorough psychological history will be taken and a psychiatrist may be involved to do a psychological assessment. As a precaution, before starting Roaccutane, dermatologists will discuss this possible link with depression and will always check with a patient if they have low mood, any mental health conditions or a family history of mental health conditions. 

During treatment patients are monitored for any signs of depression and are encouraged to ask family and friends to look out for any mood changes.Dr Jason Thomson

During treatment patients are monitored for any signs of depression and are encouraged to ask family and friends to look out for any mood changes. There are also reports of sexual side-effects including erectile dysfunction and decreased libido whilst taking Roaccutane and these should also be discussed with patients before starting the medication. This might all sound scary but it’s worth remembering that in the UK, Roaccutane is always prescribed under the supervision of a dermatologist and the vast majority of patients respond well to treatment with minimal side effects, the most common being dry skin and lips.

When would Roaccutane be prescribed and when wouldn’t it be deemed a suitable medication? 

Roaccutane is normally prescribed in severe acne that is at risk of causing scarring or in people whose acne has failed to respond to other treatments such as prescription creams, gels and oral medications such as antibiotics. It’s never prescribed in people who are pregnant, breastfeeding or trying to conceive as it can harm an unborn or nursing baby. For this reason, people taking Roaccutane who can potentially fall pregnant need to be using effective contraception (ideally two, most commonly the pill and condoms) and require regular pregnancy testing throughout the treatment course.

How does it work to target acne specifically? 

Roaccutane works by targeting the main factors that cause acne. It results in the shrinking of the skin’s oil glands (sebaceous glands) which reduces the amount of oil production and this also results in a reduction in the amount of the acne-associated bacteria Cutibacterium acnes. It also corrects the way your skin cells are shed, stopping pores from being blocked – another key cause of acne.

How long can you expect to see results?

Usually acne starts to improve after around 4 weeks of treatment and most people will be on the medication for between 4 and 7 months. 

Is there anything you should avoid when taking Roaccutane?

Alcohol should also be avoided or kept to a minimum when on Roaccutane as the medication can put strain on your liver. Dr Jason Thomson

Your skin will be very dry so avoid applying anything to your skin that can be drying or irritating. This means just very basic skincare – moisturise regularly and avoid harsh cleansers, acids or any other active skincare such as retinol or vitamin C. Alcohol should also be avoided or kept to a minimum when on Roaccutane as the medication can put strain on your liver. The British Association of Dermatologists advise not to exceed the government guidelines (no more than 14 units per week).

Do you have any product recommendations that are safe to use alongside Roaccutane? What does an ideal skincare routine look like for someone with severe acne?

The key to your skincare routine when on Roaccutane is to moisturise and protect your skin as it will be very dry and you’ll be more sensitive to sunlight. Look for simple moisturisers that are non-comedogenic (do not block pores) and also use a lip balm regularly. I advise La Roche Posay’s Effaclar H moisturiser and Bioderma Sebium Hydra which have been developed specifically for acne patients on treatments such as Roaccutane.  Avoid any skincare that can be irritating and drying such as retinol, vitamin C, chemical peels or harsh cleansers or scrubs. Try to avoid strong sunlight when on Roaccutane and apply sunscreen regularly, I advise SPF50 with UVA protection.

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Gracie Newman

Wasn’t worth it for me. Didn’t cure the acne, it came back after I’d finished the course and suffered from severe depression. This was back in 2013, after I’d finished it an article came out in the newspaper for 3 people attempted suicides. They’ve since changed the medication.

Bridgette

Don’t you love all the euphemisms and half-truths/half-lies that the dermatology organizations come up with when describing this medication?? That Accutane “corrects the way your skin cells are shed”, it’s “anti-inflammatory”, that it isn’t proven that it causes depression. This is all bull$h!t.

Accutane doesn’t “correct” the way your skin is shed – it can causes apoptosis (cellular death) in every cell of your body. This includes your muscle cells, pancreas, joints, bones, reproductive organs, and your brain. “Correction of the cell cycle” is quite frankly nothing more than putting lipstick on a pig, because accutane is a cytotoxic, dna-damaging chemotherapy drug which alters the way your cells throughout your body function, sometimes independently. This can cause a massive range of long-term health problems, including many autoimmune and degenerative diseases, including: IBD, Crohn’s disease, meibomian gland dysfunction, diabetes, arthritis, Alzheimer’s, dementia, and more.

Accutane isn’t “anti-inflammatory”; on the contrary, it can CAUSE inflammation in the body, by drying out the entire body through damage to glands and mucous membranes everywhere.

It is absurd that doctors keep playing this game acting as if there isn’t proof that accutane can cause depression and serious mental health disorders. This “medication” (actually a repurposed brain cancer chemotherapy drug) decreases metabolism of certain structures in the brain by 21%, has been found to kill brain cells, decrease neurogenesis, and one study actually found that numerous people reported long-term neurological effects and organic brain damage which was found in an MRI. Hypervitaminosis A has been very well-known and documented to cause severe Psychiatric disorders and suicidal depression for multiple centuries, ever since reports of polar explorers stated that eating polar bear liver sent people into psychosis and liver failure. Accutane is essentially a massive, extremely toxic, amount of vitamin A derivative, so it’s ridiculous to act like it doesn’t have the same effects.

Why are doctors still playing dumb and pretending that the link between accutane and depression is “not proven” or “controversial” ? This is one the most disingenuous, obvious, and corrupt money-grabs I’ve seen. Doctors these days are nothing but glorified pharmaceutical salesmen.

Juliet

I took this drug at a low dose for a few months with my dermatologist and it made me permanently lose my hair and have meibomian gland dysfunction. Neither of which I was warned about from my dermatologist or the information that came with the drug (I was told that hair shedding and dry eyes are both TEMPORARY, not permanent, side effects). The BAD (British Association of Dermatology) really needs to be honest with the public, the statements they make about the drug’s side effects (saying dry eyes and hair loss are temporary effects) are incorrect.

JP Smith

Fantastic drug! Doesn’t cause depression, that’s overstated by fear mongerers who want to demonize this drug to sell skincare products

Rob P

When will they just rename this “chemotherapy for acne”? Because that’s exactly what it is. Causes long-term/permanent negative side effects in 1 in 10 people. What other drug on the market is so dangerous and damaging???

Greg

Accutane ruins lives. It’s not a skin treatment and was never designed to be a skin treatment in the first place. This CHEMOTHERAPY drug is actually toxic to every cell in the body and causes bodywide apoptosis (cell death). The negative effects this causes can arise many years down the line, and can effect every organ negatively. I have chronic fatigue syndrome, fibromyalgia, blood sugar problems, dry skin, meibomian gland dysfunction, arthritis, tendon damage, digestive problems, and permanent hair loss since using accutane years ago. This is all permanent damage and it’s only gotten worse over time since I stopped using it. These effects all started after stopping my course, which was a dose of 10-20mg for 3 months. Don’t think you’re safe if you take this, even at a low dose it can destroy your life forever.

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