When I first heard about Roaccutane (also referred to in the UK as Isotretinoin), it seemed too good to be true. It was an Instagram story a friend had posted, showing off their shimmering skin along with the caption: “God bless Roaccutane”. Having had, like countless others, my own battles with acne over the years, the post immediately stuck in my mind, but it wasn’t until I moved to London a couple of years later that I considered starting the treatment myself.
After being prescribed three separate medications for my skin (two topical and one oral – all to no avail), my GP took a sharp intake of breath and recommended I take Roaccutane for my “treatment-resistant acne”. With self-confidence crippled by months of trial and error and late-night Google searches, I was initially relieved to be offered a solution that had a good chance of success.
But, in many ways, it was too good to be true. From being encouraged to pursue treatment privately to severe side-effects that directly compounded my anxieties, Roaccutane opened its own Pandora’s box of issues that I needed to overcome before I could achieve the results promised to me in that Instagram story all those years ago. Fortunately, however, it worked, and my skin has been mostly acne-free ever since (touch wood).
With the UK recently being found to have the second highest rates of acne in the world, and with diagnoses skyrocketing globally, this is a tough choice that young people are increasingly weighing up. An estimated 48,000 people are currently on Roaccutane in the UK, many of who discover the treatment online or through private ‘skin clinics’ that allow sufferers to cut sizable NHS waiting lists, for a fee. Going on Roaccutane, however, is not a decision that should be taken lightly. So, we’ve spoken to people who’ve recently taken the drug, as well as London-based clinical dermatologist Dr Emma Wedgeworth to provide some practical pieces of advice for anyone considering the treatment.
“Most people will not need a course of Roaccutane,” says Dr Wedgeworth, “There are a number of cream and tablet options which can be extremely effective in treating acne.” While this was not my personal experience, in the UK, Roaccutane is only prescribed as a last resort and in extreme cases, due to its risk of side effects. In this spirit, it’s important to experiment with various skin routines – from face washes to different moisturisers to a change in diet (skin-gut axis) – and lighter prescription treatments before pulling out the big guns.
Speaking on the UK’s recent designation as one of the acne capitals of the world, Dr Wedgeworth suggests that “it could be due to a combination of diet, lifestyle, pollution, stress or even the way people access healthcare”, that has led to an increase in acne diagnoses in recent years. While she is nonetheless careful to emphasise that the exact causes are as of yet unknown, it is therefore also key to explore wider lifestyle factors that may contribute to your acne. For me personally, I noticed that my skin got much worse when I moved from Brighton to London, spending less time outdoors by the sea, and more time in crowded, polluted environments.
Given the availability of the drug online and the proliferation of private ‘skin clinics’, Dr Wedgeworth makes sure to highlight that “the decision to prescribe Roaccutane should be taken by a consultant dermatologist who has experience in prescribing this drug”. She adds: “The concern is if people are getting treatment from an disreputable source and not being adequately monitored or followed up.”
These warnings parallel a conversation I had with my own GP before starting Roaccutane. After months of futile treatments, they phoned me and discretely suggested that I pursue private treatment due to waiting lists of over a year on the NHS. They cautioned that there were many private clinics which preyed on insecurity and encouraged me to keep my wits around me when choosing a clinic. I eventually found a prescription for Roaccutane online and, although they kept a fairly close eye on my progress with bi-monthly blood tests and consultations, the treatment cost a staggering £2,500, not to mention the overpriced supplements they peddled throughout (£70 for Omega 3 fish oil? No thanks).
All of the other people I spoke to for this article, however, did pursue treatment through the NHS, including Jenny*, who was prescribed Roaccutane at 24. “It was initially recommended to me in my late teens, but I turned it down because I thought my acne would pass as I got older and my mood was unstable so I was scared to go on a drug that might heighten this,” she explains. Years later, after persistent symptoms, she decided to book a GP appointment and brave the year-long waiting list for a dermatology assessment. “After the assessment, I got a blood test and pregnancy test, and then I was prescribed 20mg for 13 months. New legislation is that you have to check in with the doctors every month, and have a blood test quite often,” Jenny* says.
Scared of going outside because people might comment on your appearance? Well, unfortunately, this is also a common experience for those who take Roaccutane, too. The treatment has a range of severe (and sometimes bizarre) side effects, including dry skin and a sensitivity to sunlight, which can lead to further self-consciousness. “My side effects were extremely dry lips, this meant I was constantly applying lip balm and having people ask me why my lips were so gross,” says 19-year old Jordan*. “Wasn’t good for my self-esteem.”
Archie*, who was prescribed Roaccutane as a teenager, also mentions dry skin inside his nostrils (causing nose bleeds) and hair which became coarse and brittle. “I reckon it changed the texture of my hair forever and turned it curlier, while I had it. I began wearing hats, feeling super insecure,” he explains.
More concerning, however, is the substantiated link between Roaccutane and low mood – a particularly unfortunate combination considering that many will be driven to the drug by insecurity to begin with. At its most extreme, there have been cases of people committing suicide while on the drug, so it is imperative that you make sure to have safe guards in place before starting the treatment, including healthy lifestyle choices and support networks to keep your mood in check. “I’d get waves of depression, especially if I was drinking, so walks home from a night out were never a fun thing,” says Jordan*.
Rounding off this list of side effects, Dr Wedgeworth states: “Women must not get pregnant on Roaccutane as it can be harmful to unborn babies.” In addition, I personally suffered eczema and angular chestitis (mild bacterial infection at the corners of the mouth) during the treatment – both of which came with their own courses of treatment and anxieties. Finally, Jenny* adds that “a side effect I feel is kinda stigmatised is lowered libido. I managed this by remembering that it is temporary and letting my partner know that it’s a common side effect.”
Overall, despite the copious side effects, none of the respondents here regretted taking the drug. “Really positive experience, but it’s a very hard process,” says 25-year old Henry*, while Jenny* adds: “My skin is much clearer, I am so much more confident with no make-up. It makes me realise how bad my skin was before. I wish I did the treatment when I was younger so I could experience more of my adult life feeling confident and having more days make-up free.”
With such glittering reviews, however, comes with a necessary warning. Although Roaccutane is in many ways a wonder drug that has totally changed my skin, it’s not as if I wake up every morning and marvel at my own beauty. Far from it. Anxieties around my skin were promptly replaced with those surrounding my side effects during the treatment, and yet new anxieties once I’d finished. It’s important to be aware that insecurity about your appearance rarely hinges on just one issue – particularly as we live in a capitalist culture designed to make us feel insecure so that we will keep buying “solutions” – and, in my case at least, requires just as much work on the mind as on the body. So, as tempting as it is to reach for that easy fix, if your skin is causing you extreme distress, it’s important to zoom out and put it all in perspective. Those mental health walks and forced positive thoughts were just as necessary before I started the treatment as afterwards.
“Acne is entirely treatable, so please seek help. Sometimes even small changes like adjusting skin care or using a medicated cream can make a big difference” – Dr Emma Wedgeworth.
“Boots card for Vaseline, ‘trust the process’, don’t book holidays in the sun/take it during winter” – Henry*.
“It will affect your mood but [in my experience] only in the way that contraception medication does – you’re still yourself, just more sensitive. If you are in a particularly low place, wait to go on it, and let those around you know that it can have an effect on your mood” – Jenny*.
“Only do it if there’s not any other way of clearing up your skin, and if you do then invest in proper good lip care” – Jordan*.
* Names have been changed
