Is there a safe acne solution?
Q: My teenage daughter has bad acne, which makes her unhappy and self-conscious. It hasn’t responded to treatment and the doctor mentioned Roaccutane, but I have seen frightening stories about it.
A: Acne, which affects 90 per cent of adolescents, can cause immense emotional distress, agrees consultant dermatologist Professor Nick Lowe. It’s due to blockages in the follicles, caused by an overproduction of sebum combining with dead skin cells. Bacteria feed on the oily sebum and multiply, leading to inflammation and the formation of pimples, blackheads and whiteheads, and often scarring.
The male hormone testosterone increases at puberty in both sexes, triggering excessive sebum production. Contributory causes include stress, a high glycaemic (GI) diet with lots of sugar and carbohydrates, and dairy products.
Roaccutane, a vitamin A derivative, reduces sebum, and also inflammation. Professor Lowe, who did the first clinical research on Roaccutane in America in the 1980s, says, ‘These drugs are valuable for people with severe acne but should only be considered when all other prescription treatments have failed because of the potential side effects [see below].’
Other treatments for females include oral and topical antibiotics with appropriate skincare, also spironolactone, a drug that at low doses blocks testosterone and can be combined with antibiotics. Laser treatment can help, as can dermabrasion and peels. Two forms of the contraceptive pill, Dianette and Yasmin, may help but are not suitable for smokers, anyone who is overweight, has a family history of deep vein thrombosis or long term.
Roaccutane must be prescribed by a consultant dermatologist according to stringent guidelines. At Professor Lowe’s London clinic (cranleyclinic.com), patients complete a questionnaire, including sections on depression, bowel problems and pregnancy status. They are given full information and sign a consent form. They must return every four weeks for monitoring and another prescription. Blood, lipid (cholesterol and triglyceride) and liver function tests are necessary before treatment, then every eight weeks.
Side effects include headaches, muscle pain, dry skin, poor night vision, inflammatory bowel disease, also flu-like symptoms, conjunctivitis and mouth ulcers, which must each be reported to your dermatologist immediately.
Pregnant women or those planning pregnancy must not take Roaccutane, because of the risk of birth defects. Professor Lowe’s female patients take a pre-treatment pregnancy test and repeat every four weeks.
In rare cases Roaccutane may cause depression, anxiety, aggression and mood changes. Very rarely, it may lead to delusions or hallucinations and suicidal thoughts. However, the issue is clouded because some people with acne are obsessed with their condition before they start taking the drug. Report any mood changes to your doctor immediately.
Lower, slower dosage may avoid side effects, including initial worsening of acne. Professor Lowe starts patients with 10mg-20mg for a month rather than the usual 40mg-60mg. If there are no problems, he increases it slowly to 30mg or 40mg for six months.
Following a low GI diet, avoiding dairy produce and adopting relaxation techniques such as yoga or meditation are vital. ‘I’m a great believer in working with patients to help them reduce stress, which is often a big factor with students,’ says Professor Lowe.
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Email your questions to s.stacey@you.co.uk
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