Acne and Roaccutane: point in 10 questions

gainst the severe acne, isotretinoin (Roaccutane ® generics active principle) is an effective treatment. But how is this drug? What are the conditions of limitation? What are the precautions to be taken?… Doctissimo answers to ten frequently asked questions.


What is isotretinoin?

Isotretinoin is the active principle of the generic Roaccutane®, which has been removed from the French market in 2008. It is used in the treatment of severe acne since the beginning of the 1980s. This molecule is a derivative of vitamin A, a substance naturally present in our body.

Treatment For Acne

Cases in which is this drug prescribed?

The drug isotretinoin are indicated only on order, for the treatment of severe acne such as Nodular acne, acne conglobata (severe acne of the back) or any acne which can cause final scars. This drug is never prescribed primary. Not without side effects, it will be proposed only when acne will be resisted treatment for at least three months, with an oral antibiotic local treatment. Only your doctor can assess if your situation requires such treatment.

What is the mode of action?

Isotretinoin is primarily by causing a reduction in the size of sebaceous glands and by inhibiting the secretion of sebum. In addition, it limits the bacterial development and local inflammation.

What is the mode of use?

Isotretinoin comes in two forms: the way oral or even topical treatment. Your doctor can offer you capsules to swallow, 5 mg, 10 mg or 20 mg your weight. Isotretinoin gel is reserved for particular types of acne.

Duration of treatment for what efficiency?

The General duration of treatment varies between four and six months. If the treatment is well, there is a complete disappearance of acne in more than 85% of cases. The risk of relapse are included between 20 and 40%. But in two third-party cases, usual therapy – antibiotic or cream – enough to treat these relapses.

What are drug interactions?

During treatment, it is generally not recommended to apply another drug, particularly a local cream. Isotretinoin must not be associated with tetracyclines (antiacnéiques antibiotics). Any association to a drug containing vitamin A is also prohibited, due to a risk of poisoning it.

What are the precautions to be taken?

Isotretinoin that may result in a dry eye, it is advisable to avoid wearing contact lenses. If you use, report it to your doctor who will prescribe you preemptively “artificial tears”. Isotretinoin may also result in loss of night vision, attention therefore if you are going to take the wheel. Finally, all use of Scrubs, scrubs and waxes for hair removal is not strongly recommended, because of the fragility of the skin during the treatment.

What are the adverse effects?

Like all medicines, isotretinoin has adverse effects. Here, these effects are especially characterized by dryness of the skin and mucous membranes. Thus, in 80% of cases, patients suffer from gercements lips, dryness and irritation of the skin, itching and bleeding from the nose. Finally, acne may be aggravated at the beginning of treatment, but this reaction is only transitional.

What are the risks for women?

The prescription of isotretinoin is highly monitored in women. Indeed, this molecule is highly teratogenic, i.e. it causes birth defects fetal in pregnant women. Thus, to follow this treatment, women are subject to strict monitoring. Effective contraception will be therefore be implemented at least one month before the beginning of the treatment, and during the month following its decision. Blood pregnancy tests will be also conducted before and during the treatment (every two months).

What are the links between this drug and the onset of depressive symptoms?

The announcement of suicides of teenagers under Roaccutane caused vivid controversy in France and in the United States. The occurrence of psychiatric disorders in isotretinoin oral is under a particular monitoring of pharmacovigilance. What led to modify the information on the safety of this drug, and to inform health care professionals with the assistance of learned societies, and the public. Even if all of the data available does not establish an association between isotretinoin intake and the occurrence of psychiatric disorders, it is recommended that health care professionals to strengthen monitoring of the psychological state of patients acne adolescent, as severe acne itself can lead to psychological and behavioural disorders. As such, the French Agency of sanitary safety of health products (Afssaps) launched in November 2010 a study to assess the accession of dermatologists and patients to a tool to find symptoms of depression, in support of severe acne in adolescents before and during treatment with isotretinoin. Based on a recognized scale, the Adolescent Depression Rating Scale (ADRS), this simple and short auto-questionnaire (in ten items, true/false responses) will be so tested to 100 dermatologists. The results will be available the end of 2011.

Personally, without alarm, we must remain vigilant. If you feel victims of mood disorders and/or you feel black ideas, talk to your physician immediately.