You’ve tried it all — expensive cleansers, benzoyl peroxide spot treatments, infomercial-approved Proactiv — and you’re staring at yourself in the mirror wondering why none of it has worked. Your acne has become a stubborn problem and your only solace is a poorly lit room.
And then your GP recommends Roaccutane (AKA Isotretinoin/13-cis-retinoic acid) — one of the more extreme measures in ridding yourself of those volcanic pimples once and for all.
But what actually is Roaccutane? And what about all those rumours that it causes dry skin or depression? And why is it considered the gold standard for acne remedies among the many cheaper treatments available at your local chemist? Here is your guide to everything you’ve ever wanted to know about taking Roaccutane — and why it’s less terrifying than you think.
I want to try Roaccutane, but what is it exactly?
According to dermatologist Debra Jaliman, M.D., Roaccutane is a derivative of Vitamin A that patients take orally (often twice a day). You might find that the name Isotretinoin is used interchangeably, too — the product branded “Accutane” is no longer on the market, in fact. It’s just the name most of us are familiar with now. In Australia we call it "Roaccutane".
Isotretinoin is meant to reduce inflammation and the number of bacteria in your pores, clearing up any acne problems as a result. Both dosage and treatment depend on the person. If your problem is severe, you might receive a higher dosage—though Jaliman added that it’s often only recommended for patients with severe acne problems who’ve failed using other treatments.
Why does it work so well?
It’s effective because it attacks acne on all fronts, according to dermatologist Joshua Zeichner, M.D. “It addresses all of the major causative factors of acne, including oil production, acne-causing bacteria, sticky cells blocking the follicles, and inflammation,” he said. Part of the scare factor around Isotretinoin is its side effects, which can be severe, depending on the dosage your doctor recommends.
What kind of side effects are we talking about?
One common side effect is dry skin and lips: You’ll need constant moisturising throughout treatment (and often after treatment, too), so pack a lip balm wherever you go.
The list of Isotretinoin’s potential side effects is long and a little scary, but many of them are pretty rare. According to Jaliman, you might experience some physical side effects like joint stiffness, loss of appetite, headaches, mild nosebleeds, eye irritation, temporary hair thinning, increased sensitivity to sunlight, and blurred vision.
It also increases the level of triglycerides in your blood (a type of fat), which could mean larger effects on cholesterol which could result in an increased risk of heart disease and liver damage. She added that there are some reported mental health-related side effects too, like a depressed mood, trouble sleeping and concentrating, and general changes in behaviour—which yes, all sound a little scary at first, but we’ll address that shortly.
For women, the drug is much more dangerous, because of the high risk of birth defects and miscarriage. “Female patients need to make sure they maintain use of the methods of birth control discussed with their physician,” she said. “Preventing pregnancy is crucial.”
For this reason, women are required to complete two negative pregnancy tests a month before receiving their first month’s supply. Throughout treatment, women are required to commit to two forms of birth control and a monthly pregnancy test (as well as one after you have completed treatment). You’ll also have to fill out a monthly questionnaire, which we’ll get to in a bit.
Few skin conditions torpedo self-esteem the way acne does. As it turns out, a face full of painful lesions — not to mention unsolicited, tone-deaf advice from family and strangers alike — has a way of driving people into hiding. Throw in a whole internet's worth of unverified anecdotes about banishing acne for good and you've got a recipe for disaster.
Wait, so this could cause depression?
The results, for the most part, are mixed. In the past, depression and an increased risk of suicide have been linked to Roaccutane, but there’s no evidence that it actually causes them (confusingly, a 2017 study found that Isotretinoin wasn’t associated with any increased risk of suicide, which calls into question the supposed link).
“In all my years of treating a patient with Roaccutane I have never seen someone become depressed because of it,” Jaliman added. “If anything I have seen their mood change for the better once they see their acne clearing up. Patients who are depressed and are undergoing psychiatric treatment often get approval to begin Roaccutane and are closely monitored. I don’t think the risks should scare them off.”
Still, if you do have concerns, make sure you inform your dermatologist before starting any treatment.
What should I do first if I’m interested?
Consult with a dermatologist, and find out the dosage you’d be on and how long you’d have to be on it. A low dosage might mean you’re on treatment longer, while a high dosage would mean the opposite (a low dose, incidentally, might mean reduced side effects, according to Zeichner).
You’ll have to factor in a number of lifestyle changes before beginning any treatment, too. Because of its effects on your triglycerides and liver, you’re often not meant to drink or take any additional Vitamin A supplements, Jaliman said.
There’s also the investment of time you’ll need to make, too.
What is the time investment like?
Every month you’re on Isotretinoin, you are responsible for heading to your doctor’s office for a blood test (mostly to check numbers indicating your cholesterol levels and liver function, Zeichner said). As mentioned, if you’re a woman, you’ll also need to take a pregnancy test in-office every month.
Both men and women are responsible for completing a monthly questionnaire about your experience, as part of the iPledge Program. In order to receive your medication, both you and your doctor are responsible for completing this regularly (it’s pretty simple, but you can’t forget to complete it or otherwise risk missing out on a month’s supply).
If you want to expand your skincare routine beyond cleansing, moisturiser and sunscreen, exfoliation is a good next step. Exfoliating serums and scrubs boast that they can fight acne, clear your pores, reduce fine lines and make your skin vaguely brighter. Some of those promises are true, but they're not the whole story. So here is your scientific, medically backed look at exfoliation: what it can (and can't) do for your skin, and which effective, inexpensive products you can try out.
Can I expect immediate results?
It depends—it took me two months before I saw any results. “Some people notice [improvement] a few months into treatment and some don’t notice any great results until they finished the whole course,” Jaliman said. In other words, you might have to endure treatment for six months before seeing any sign of its effectiveness.
Some also get worse before getting better, she added. Some users experience an initial breakout or “purge” while beginning treatment. It’s temporary, however, and only lasts a few weeks.
What can I do to save my skin while I’m undergoing treatment?
Moisturise! You should have some kind of lip balm on you at all times. The Strategist pulled together some recommendations too, which include gentle facial creams, moisturisers, and Aquaphor (perhaps the most necessary)—it’s a mix of petroleum jelly and mineral oil and functions as both a general moisturiser, as well as lip balm and makeup remover.
“It’s important to use gentle cleanser and moisturisers to help keep your skin barrier in good shape,” Zeichner said. “If you develop itchy rashes, your doctor may also give you a prescription cream to help calm the inflammation and reduce the itch.”
Will this save my skin forever?
I went through treatment twice (once at 16, again at 21) and have rarely broken out since. Still, the results of my first treatment left a ton to be desired, so it’s not fool-proof—especially not at first.
A 2014 study that followed 146 patients with severe acne found that 96.4 per cent of them experienced a complete clearing of their acne with a low-dose of Isotretinoin. In a 5-year follow up, however, 7.9 per cent had experienced some form of relapse.
According to Insider, some doctors claim the relapse rate for their patients is somewhere between 20 and 33 per cent. Still, the odds look pretty good if it’s something you’re considering and you’re willing to put in the time (and money).
And if you’re still having doubts, again, speak to a dermatologist or your GP and find out if it’s something you can deal with. It isn’t easy, but compared to another year of useless acne medications, it could be worth a shot.