If the doctor decides that I should have isotretinoin acne treatment, how long would I have to take it?
I am 22 and have had mild acne for about eight years, and I've tried loads of antibiotics and Dianette and acupuncture as potential acne cures. A friend has heard about Roaccutane - how do I get hold of it? My friend says you can get it via the internet.
Roaccutane is the brand name for isotretinoin, a tablet form of the retinoids you can use as topical treatments. It is usually available only through dermatologists, because it has quite a few side-effects and you will need some blood tests before and during treatment. Because of the side-effects it is not usually used for mild acne. Do not buy it via the internet, as taking it in the wrong way or dose could cause you harm. It is also quite expensive: $400-$500 for an average course.
My friend went to a great dermatologist who told her that she could use Roaccutane on a two week on two week off basis, ongoing. This really seems to have helped her. My acne is as bad as hers was, but my doctor told me that this way of treating acne is dangerous because it uses the drug 'off license'. What does that mean? Should my friend see another dermatologist for another opinion?
One of the ways that a medical acne treatment improves is by trying different ways of using approved drugs. The licence for a drug is issued for certain conditions in specific dosages that have been tested in proper research trials and found to be safe and effective. The company marketing the drug can promote only this particular way of using it but doctors can try other dosage regimens that could be just as successful. This is what 'off licence' means. Your doctor is not right to say that it is dangerous, especially if it's used in the on-and-off way you've described. Some people use it for just one week a month, as for them this produces the benefits while keeping side-effects to a level that they can cope with. Your friend's dermatologist is good and is willing to be flexible with the treatment to get the best out of it for each patient.
I hate needles! Why do I have to have blood tests before and during isotretinoin acne treatment?
Blood tests are a requirement of the licence to use the drug, and should not be ignored. The drug can raise the levels of liver enzymes that get through to the blood, suggesting damage to the liver, and of fat (e.g. cholesterol) in the blood. If there were a problem before starting the treatment, this could lead to extra side-effects, so your blood is tested before-hand to check this. Even if the first test is normal, it is sensible to test again during the treatment in case you are over-sensitive to the drug. In practice, liver or cholesterol problems are very rare.
