Isotretinoin is a form of retinoic acid (Vitamin A) sold under the proprietary name of Roaccutane or Accutane (1). Isotretinoin is prescribed by medical specialists (2) for the treatment of deep cystic or scarring acne which has resisted conventional treatments (including antibiotics).
Observationally here in Australia, Isotretinoin as oral Roaccutane appears to be readily offered to post-pubertal teenagers for a few troublesome ‘zits’ rather than its original intended purpose – that of a ‘last resort’ therapy in the treatment of scarring, cystic acne (3).
Though usually very effective in resolving severe acne concerns, Isotretinoin comes with many potential side effects – some minor and some life-threatening.
Scalp hair texture changes and hair thinning is a frequent consequence of Roaccutane treatment seen by Trichologists. Again observationally – if the young person has the ‘genetics’ to show androgenic pattern hair loss, this is often prematurely revealed during Roaccutane therapy.
Commonly seen side effects are:
· Drying of the skin sometimes accompanied by ‘chapped’ or cracked lips.
· Dry mouth; dry, irritated eyes due to lacrimal (tear duct) compromise. Eye issues may also extend to ‘night blindness’ so care when driving is advised. Some patients have reported they are unable to wear contact lenses due to dry, irritated eyes from Isotretinoin therapy.
· Muscle or joint aching or pain; dry, itching skin rashes.
· Abnormal liver function pathology, often with elevated Vitamin A levels (4).
· Epistaxis (nose bleeds) to varying degrees of severity.
· Vaginal dryness or vaginitis has been reported by young females.
Lesser seen but significant potential adverse effects:
· Spontaneous miscarriage or stillbirth or severe birth defects in the foetus of a pregnant woman if Isotretinoin is taken whilst pregnant (5).
· Cerebral swelling (pressure on the brain) which in extreme cases may lead to blindness and death.
· Mood disturbance as depression, suicidal ideation, loss of self-confidence or social avoidance.
· Gut dysbiosis potentially leading to inflammatory bowel disease (IBD).
When considering drugs such as oral Isotretinoin (with its intense side effect profile), it’s vitally important one weighs up the advantages versus risk – particularly when its being prescribed to a young still-developing body.
Acne is a common sign of puberty – particularly in males. I would encourage parents to also assess their teenager’s diet, lifestyle and (zinc) pathology levels before considering a potent drug with (sometimes) irreversible harmful effects.
Copyright Anthony Pearce 2024.
1. Accutane is no longer commercially available. Other brand names for isotretinoin include Absorica®, Amnesteem®, Claravis®, Myorisan®, and Zenatane™.
2. Dermatologists and medical practitioners.
3. Author’s opinion only.
4. Liver function tests may reveal elevated liver enzyme levels indicating hepatic (liver) stress. As a fat-soluble Vitamin, Vitamin A is metabolised by and stored in the liver. Cholesterol may become elevated – particularly triglycerides and LDL levels (ie: the ‘bad’ cholesterol).
5. Two negative pregnancy tests are usually required AND the female is consistently taking approved contraception before Isotretinoin will be prescribed.