Today i come to you with a guest post from the amazing Dr Natalia Spierings, a consultant dermatologist one of the best in my opinion and today we are going to talk about how to deal with the effects of Roaccutane.
My name is Dr Natalia Spierings and i am a consultant dermatologist working in Leeds, i also specialise in dermatological and micrographic surgery.
Isotretinoin (Roaccutane and Accutane) is considered the gold standard treatment for acne vulgaris. In the UK, it can be prescribed in the NHS by a dermatologist or privately by a Dermatologist . It is incredibly effective; when I am treating any skin disease, especially acne, my treatment goal is always skin clearance. And for acne, that means no spots. Not a single one. My end-point for treatment (so when I stop the medication) is when my patients are completely free of any new spots for at least 4 weeks. From clinical experience (this is the medication I prescribe the most and I have had literally hundreds if not thousands of patients take it, including myself) I know that this end-point is most likely to keep my patients clear of acne in the long run.
There are many myths and misunderstandings about isotretinoin in the media and on the web. I will leave tackling those for another blog post!
Here I would like to just focus on some of my key tips if you are just about to embark on your isotretinoin or if you are already taking it. (REMEMBER: Do not take this medication if you are pregnant, breastfeeding or trying to conceive. It can cause severe birth defects).
- Start low and go ssllloooowwwww: I almost always start my patients on the lowest dose possible for the first few weeks of treatment. And I have not prescribed anyone more than 40 mg per day for the past few years. Why? Lots of reasons! If your dose is too high (so to me, too high is over 0.5 mg/kg generally) the side effects get really unbearable. It’s the dry skin, dry lips and nose bleeds that are just very annoying. The lower your dose, the less likely you are going to really suffer with these problems. My aim is for your skin to improve without anyone really noticing that you are on the treatment. If your lips are cracking and bleeding and your skin is flaking, it’s hard to hide. Having bad acne requiring isotretinoin is hard enough to deal with every day so I want to make your treatment experience as pleasant as possible. Generally, I also find it better in the long run if patients are on a lower dose for a bit longer – though I recognise this is annoying logistically because of blood tests, follow-up visits, pregnancy tests and so on. But it will be worth it in the end because your risk of relapse in the future will be much lower in my experience. If you are going to take this medication, aim to do just one course and do it properly. Don’t rush it.
- You will get an acne flare-up in the first few weeks of treatment. Your acne might even get worse. In really severe cases of acne, I will try to lessen this by prescribing another oral or topical acne treatment at the same time and closely monitor your progress to make sure you don’t get a really bad flare-up. If your skin does flare-up or takes a bit longer than you had hoped to clear, don’t panic – this is normal. I know this can be disheartening but you need to trust your doctor and stick to the plan.
- Stop doing stuff to your skin while you are on the treatment: this means no laser treatments, no facials, no facial waxing (!!!), no masks, no microdermabrasion. You get the picture. Isotretinion is powerful stuff – let it works its magic without interfering! I also recommend switching your skin care completely to just the very basics – cleanse (gently – don’t scrub or exfoliate!), moisturise and wear a SPF during the day if you are outside. And that’s it. No fancy serums, no vitamin C potions, no glycolic acid. Leave your skin alone. After you finish the treatment, I would still stick to your simplified skincare. Hopefully when your skin is clear you won’t feel the need to buy every product available because having great skin will just be a normal part of your life.
- If your lips get super mega dry and cracked, your dermatologist can prescribe a mild topical steroid ointment to apply once or twice a day for a few days to get them to heal. But my patients generally don’t need this (see point 1 above). I recommend a great lip balm that you apply constantly to keep your lips moisturised. My faves: Kiehls number 1 lip balm, Carmex and Clarins replenishing lip balm (the blue tube). For guys who don’t want shiny lips, plain old Chapstick is great! But just remember to keep a few tubes around and reapply very often. It’s all about prevention when it comes to the dry lip issue and isotretinoin.
- Isotretinoin does not get rid of acne scars. I generally get my patients clear of active acne before tackling any residual scarring. It makes no sense to treat acne scars while there is still active acne present: not only can the acne scar treatments make your acne flare-up a bit but also if you still have acne you potentially might still be getting new acne scars. It is important to remember that getting rid of acne scars is a long and tedious process and getting rid of them entirely is almost impossible. But this does depend on what type of acne scars you have and how severe they are. A consultant dermatologist can definitely help you figure out the best options for your skin.
Will your acne ever come back? If you take the course properly with the right end-point, generally no. I tell my patients it is a long-term cure for over 95% of patients. But if you are acne prone or you had very severe acne, you might get one or two spots every now and then and that does not mean the treatment has failed. You do however need to use a maintenance treatment in the long run and I usually prescribe a topical retinoid like adapalene or tretinoin for this purpose (check out www.dermatica.co.uk). Also, if you go through a massive life change (like pregnancy or menopause) the change in hormones might also trigger acne. If this happens to you, there is no harm in repeating a course of isotretinoin.
There are so many questions that I get about isotretinoin every day – these are just a few of my top tips. Bottom line is that isotretinoin is a fantastic treatment but definitely see a consultant dermatologist to discuss your skin and your specific skin needs as well as your general health before starting it. And remember, getting great skin is a marathon, not a sprint!!
Have you been on Roaccutane?
What was your experience?
Leave a Comment!