Roaccutane as a first line drug - TGA warning

At Skin Essentials one of the common concerns we treat is acne, specifically mild to moderate acne. 

In adolescents aged early teens to 25, acne is common and related to the hormonal changes puberty brings about. While it affects 4 out of  every 4 adolescents ie 80%, it can persist or present for the first time in young people ages 21+ and last into adulthood. 

In women it can also present at later stages in life, often for the first time known anecdotally as “hormonal acne” or adult female acne (AFA) which can require more aggressive management than in adolescence. 

Regardless of how you treat it, it’s important to understand that left untreated, acne is more than just an annoyance; it’s an inflammatory condition that leads to long term consequences – scarring and pigmentation changes in skin that can sometimes never be completely resolved and costs a lot more in time and money to improve. 

It’s no wonder then that based on internet searches, we often have prospective patients contact to ask if we prescribe this class of drug – oral isotretinoin also known as Accutane or Roaccutane. 

For simplicity let me be clear – we do not prescribe this medication. It is indicated for severe cystic acne which is far less common than the other types of acne- 1 in 5 people or less with significant side effects, especially when there are other options worth trying first. 

So it was heartening today to read about the Therapeutic Goods Administration (TGA) warning of just this, listed here warning about the potential impact of isotretinion use on both mood and sexual function and advising physicians prescribing these to be mindful of the impact and to screen for it. 

It’s also worth noting that isotretinoin is indicated under the PBS in circumstances where (severe) acne is resistant to other treatments and drugs, and not usually indicated as a first line treatment. 

Perhaps due to the use of prescription medication as a commodity, patients are conducting online searches of their own and shopping around for drugs, as also evidenced by the many online teledermatologist services that have sprung up in recent years for similar reasons, especially as the current wait to see a dermatologist may be anywhere from 3-6 months or more even for review. 

Nonetheless in practice my staff knows to advise patients who call to ask specifically if I prescribe this drug that: 

• I am a specialist GP with extensive training in dermatology and 
• I do not prescribe oral isotretinoin 
• I can assess and treat mild to moderate acne in most people and related skin disorders and 
• I can also organise referral to a teledermatologist if we don’t see adequate results in 3-6 months of other prescription treatment and manage the ongoing symptoms with you

   

it’s important as always to remember that prescription drugs are prescription for a reason: they carry risk if used incorrectly and may have significant side effects and need ongoing clinical supervision and oversight. 

They are not intended to be used like over-the-counter medications and not meant to be stopped without medical supervision. 

They’re meant to be used for a minimum of 6+ months to see results and then weaned off if appropriate to see if the disease recurs. 

The warning from the TGA now clarifies the additional issues all doctors need to screen for in considering prescription of these medications, specifically: 

• a history of mental health or mood disorders 
• a history of sexual dysfunction or issues while on the medication

   

As always, at Skin Essentials we urge patients to remember that as with all of medicine, you are paying for advice, guidance and someone’s expertise on how best to manage your concern not a drug or a prescription. 

A personalised assessment and advice always trumps internet searches and advice by unqualified people. 

Any medication prescribed is in consultation with you, as being likely the best plan forward until review in a few weeks. As with all medications, it’s important to understand that it may not work first time around, the dose may need adjusting to get to ideal and almost always, skin takes some time to get you results, minimum at 3 months, and to peak around 12 months, if all goes well. 

In summary? 

Prescription medications are not retail goods to be ordered based on internet searches nor influencers on social media. Please go in with your concerns and potential solutions, by all means, but please also be prepared to be guided by your doctor based on their experience with hundreds and thousands of people with similar concerns.