Acne and my experience with Isotretinoin (Roaccutane)

In this episode I discuss acne vulgaris, dispel some of the myths surrounding this common skin condition and look at the various treatments available including Isotretinoin (Roaccutane) and what happened to me when I took it.

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Transcript

 I stopped taking it and very soon I noticed that, um, it was like having. Having a shroud lifted over you some, all of a sudden it was like waking up from a foggy dream.

Hello, and welcome to a Doctor's View, a podcast looking at everyday health topics and life through a doctor's eyes. Please note that all opinions are my own. I should not replace the advice given to you by your own doctor. I'm Dr. Boli. Let's begin.

Hello, welcome to Doctor's View. Today we're going to be talking about acne. What I'd like to do is I want to discuss why we get acne, what it is, and now I'm gonna talk about the various different treatment regimes that are available for acne vulgaris. I'm also going to talk about my own personal experience with acne and some of the more serious treatments, things like isotretinoin, uh, otherwise better known as roaccutane.

And also my experiences with this drug as. So firstly, what is acne? Acne is a skin condition, and it usually manifests in spots, spots being the red, inflammatory blotches that we see. Now, you can have one or two pimples, and technically that's not classified as acne per se, more than two, and. You can define it as acne.

And what it is is when the hair follicles get plugged up with oil and, and it's, in this case, it's sebum, which is naturally produced by the sebaceous glands in the skin, and these paws get clogged up and then this cause is a buildup of bacteria and that what leads to the red inflammation. The skin.

There's different types of acne and everything in medicine or most things in medicine are usually graded between mild, moderate, and severe. So we're going to talk a bit about that as well. Later on, we see different types of spots. They range everything from. Blackheads, which is when the pores get blocked up and they end up, uh, with a, with a head on top of them, a white head whereby the pore doesn't get, um, have a head on it and it's just, you get buildup of sebum in the pore only, and then you start getting into the inflammatory acne and the cystic acne, which we'll talk about later on as well.

Now you can get acne anywhere where there are hair follicles on the body. So the only places that you can't get AC. Are the palms of your hand, soles of your feet. You will never see acne there. However, you will see acne mainly on the face, and you'll also see it all on the back and chest. These are the most common areas and the majority of teenagers can relate to this, and the reason is, In teenage life, you are, uh, you have a huge amount of, of growth hormones, and all of these hormones help increase the production of sebum.

And this is why approximately 95% of all people aged between 11 and 30 are affected by acne. It's more common in girls, uh, aged between 14 to 17 and in boys slightly later on in life 16 to 19. But still, this is. Majority, uh, demographic that is affected. Everyone tends to have acne on and off, and as we get older, symptoms do improve.

There's what's called the 25 rule in for people looking for acne cures whereby, uh, when you reach mid twenties, your acne tends to subside quite substantially. However, In about three in every hundred. So 3% of adults will have acne later on, and the, even over the age of 35, they will still develop acne.

And this can be quite a traumatic thing to, to have, depending on how severe it is. Now I'm going to discuss the different treatment. That are available for acne and why you may want to choose one over the other. The treatment that you choose will depend on the type of acne or the severity of acne that you have.

As I said before, this ranges from mild to severe. So let's go with mild first. You've got mostly whiteheads and blackheads. You get a few papules, few pules. So this is the odd, um, the odd red inflamed spot, which has. That pasta, um, we, we see in, in films and teenagers, uh, squeezing into mirrors. Then you go to moderate, and this is more widespread, so it sounds very rudimentary and, and quite crude in terms of this grading system, but it, it's a more widespread, um, Whitehead blackhead picture with a lot more papules and pastures.

Then we go to severe, and this is. You have lots of the pules loads of them. You have nodules, you can get Cs, and you can sometimes see scarring in some people. And there a lot of the times this is quite painful as well. So depending on the type of, um, acne that you have. This will determine the type of treatment that you might want to choose.

Now, one of the most popular and common treatments is a topical cream called Benza Peroxide. This is available over the counter, um, definitely in the UK at least, and you can get it in different strengths, 2%, uh, or 2.5%, and 5% believe the strengths are. And what this does is it does dry out the skin. This is very, very good in terms of controlling the oil production or, or limiting the oil production of the skin.

And if you limit the oil production, the semen production or, or you're drying out that extra oil, you're going to have less oil presence, so you're gonna clog up less pores and less bacteria and therefore the acne will improve. This does have some downsides, however, and that is, it dries the skin incredibly.

Also makes your skin very sensitive to sunlight. So it's always recommended, uh, for a lot of these treatments, all the topical treatments. In some cases, some of the treatments you take as tablet forms as well, but I'll come to that later. It's always recommended that we take, um, use sunscreen as well Now.

To help with the drying out, it's worth using it with a moisturizer as well, preferably one that isn't oil based because you are, you are self-limiting the, the, the benefit of the benzo peroxide. By doing that, I've used benzo peroxide, uh, used it for many years and as a teenager and I found. It was useful.

I believe there's studies to show that the concentration, the strength doesn't actually have much of an impact in terms of the higher strength, doesn't necessarily mean that you're gonna have a better outcome. So a lot of people find better outcomes with the lower strengths, the 2.5%, and that's because it doesn't dry out the skin excessively, and you've suffered less side effects with it, and it's a bit better tolerated.

The one thing I will say with benzo peroxide is if you do choose to use it, be sure to use old pillow cases and also old um, towels because whatever it touches, and I mean whatever it touches, will. It will bleach it, it will destroy all your towels. It'll turn them white with patchiness on them. Doesn't matter how careful you are.

If you get it on a t-shirt, as you take your t-shirt off, um, for the night, it will, it will bleach that as well. You'll wake up in the morning and your pillowcases will be a different color, so just be sure to use old stuff or stuff that is white or things that you don't mind getting ruined, essentially.

This actually puts a lot of people off. Now, there is a fantastic website, uh, that I, I saw, um, actually at the time when I was suffering quite badly with acne, and it's, it's built on that. And there's an acne.org website, and there's a chap there that talks about the, the regime, and this is mainly benzo peroxide based, and he's got huge number of testimonials in terms of his regime and how it, how it works.

The basic principles of it is uses very, uh, small amounts of benzoyl peroxide and then uses quite a lot of moisturizer afterwards. If you go on that website, there's video instructions and, um, and it explains to you very well, um, the, the whole routine that he does and the testimonials actually do speak for themselves.

He's also got some products as well there too. Now that's benzo. Very cheap, over the counter, effective for, for the very mild acne, and in some cases actually even the more moderate acne as well, other topical treatments and by topical things that are applied to the skin include topical antibiotics now antibiotics.

We normally associate with a tablet, um, or an injection in hospital, but it can be in, in a topical form as well, like a cream or a roll on even. And these can be quite effective too. It has to be prescribed. Your GP or, or doctor has to prescribe it for you, but it has been shown to per to, to have notable benefits, especially for this, the, the multi moderate side of acne.

Unfortunately it doesn't work overnight. None of these, none of these treatments work overnight. In fact, we usually say eight weeks before you start noticing some type of notable improvement. And the reason is eight weeks is roughly your skin cycle. So, Whilst you start applying some of these antibiotics or um, benzo peroxide or whatever it is, treatment that you're, you're using, it will take the next skin cycle for you to start noticing these benefits.

And often this is where downfall happens whereby the. People become discouraged by the lack of progress that they're making. They're trying these new regimes, they're trying different, different medicines. They're trying different creams and gels, and after a week, two weeks, they notice things might even get worse, which, which can happen.

And that's, that can be a normal part of the, of the treatment process. And then they become disheartened and stop things altogether. You go back to square one. Unfortunately, nothing works overnight, so topical antibiotics can be a very effective treatment. Next we've got oral antibiotics, and as the name implies, it is an oral tablet.

Usually this is, starts off with something quite simple. In the UK we tend to use things like Lyme cycling, which is a a, a forte cycling. And it's relatively well tolerated. Some of these antibiotics, you can't take milk with them. And, um, there's, there's various different things that you may have to adapt, but your, your doctor will let you know about that if need be.

Now, before I talk about roaccutane or isotretinoin, there I will mention diet. And the reason why mention diet is there's very ac very little evidence about diet and acne. Or at least good evidence. Now I find this, this is gonna be slightly anecdotal. This is based on my own, um, principles or my own experiences, but.

I noticed every time I was moving places my acne would clear up. When I was at university, moving from one place to another thing, things got better. Uh, every time I'd move somewhere different and it was, it was quite odd and I couldn't pinpoint why. And then I, I realized I thought it's got to be something that I'm not doing.

My fridge is always empty in that first few days when I'm, uh, when, when I'm moving into a new flat or a new new house to rent and. What I realized was, the one thing that I never, that took me a few days to buy was milk. And I did a bit of research on this and it actually makes quite a lot of sense. Now.

Milk is taken from pregnant cows. All milk is taken from pregnant cows, and by default, that milk because the the has to. Growth hormones for the baby cals to to grow. And these growth hormones replicate a lot of the hormones that are produced in puberty. So often there is a lot of people that, whilst it might be anecdotal, is a lot of people that suggest that milk.

Is really, really strong exacerbator of acne. And I found I cut milk out for a little while. I replaced it with soya milk. Um, or, or something similar because obviously you still need to get your calcium levels and, and all sorts. So I. I replaced it with, with soy milk, and I noticed a dramatic improvement in my acne.

Now, this was quite a few years ago, and I don't have that same susceptibility anymore to it, and so I can have milk and, and I don't have the outbreaks of acne, but. The changes were dramatic and I managed to pinpoint that. For me, I mentioned it because whilst I can't write concrete evidence for it, it might be something worth trying or discussing with your doctor to think about some form of dietary changes and they can advise you into how to do this safely.

So I'm now going to talk about ire. Or Roaccutane. This is a controversial one. It's been in the news quite a lot over the years, and I'll explain what it is. Firstly, isotretinoin is the actual name of the drug. The brand name is Roaccutane. Some example would be in UK you have Parasol, which is the actual drug, and you have Panadol, which is the, the trade name, a brand name of of Parasol.

Tretinoin belongs to a group of drugs called retinoids. And these are closely related to vitamin A and they work in different ways, and their aim of it is to limit the amount of oil or sebum production in the skin. And by doing so, you limit the amount of, of blockage, of the pore, of the hair follicles, and subsequently your acne will reduce.

It's usually taken once a day and it's a course that lasts for a few months and. You know, nine out of 10 people notice an improvement in their acne, in severe acne. We're talking, um, cystic acne, um, the type that leaves scarring, and also the ones that are extremely painful. And this is, after all, everything else has failed.

Sounds great. However, It's not all great, and I'm going to talk about this now. Firstly, the list of side effects for ISO tread snowing are huge, absolutely huge. If you are everyone, virtually everyone who takes it will notice dryness and cracking of the lips. And this. You know, a relatively small thing, but it can last forever.

Um, it's not very well documented, but I have heard of cases where the dryness never, never subsides. It changes your blood sugar levels. It can cause inflammation. You might notice blood and your urine. It has huge effects on the. And you need to take, um, sorry. You need to constantly have a liver function tests done whilst you're on it.

You need to have blood tests done whilst you're on it. And I noticed, at least when I was on it, my liver functions became deranged as well. So it does actually have a big effect on it. I Stressin is also a teratogenic. A teratogenic is a drug that causes damage to an unborn baby. So if. Female childbearing age, you are advised not to use Tretinoin.

If you're pregnant, uh, or you think you're, you're pregnant, it's, it's contraindicated. You should not be doing it. You'll be asked to provide, um, a pregnancy test before being started on isotretinoin. You have to have a pregnancy test before, during, and after the treatment as well, and the birth defects are severe for taking it.

It's definitely something that needs to be considered if you are planning on starting a family. And also it's not suitable if you're breastfeeding either. It does pass through into the milk ducks. The next very serious side effect is, One of the reasons why this drug has become so controversial and why people have asked for it to be banned and outlawed and the reason is cause of mood changes.

There's been a number of suicides in the UK at least, and I'm, I believe in, in the states being quite a high number two of uh, people who have been taking isotretinoin and it is associated with mood changes. The controversy lies because it's very, it's still unclear as to what it is that's causing it. Uh, the, the mood changes.

Is it. The fact that you have the acne that is depressing you, and that's led to the mood changes in the subsequent suicide. Is it other factors or is it the fact that, um, you are on the isotretinoin? This is unclear. My own personal experience would suggest that yes, it does. Deeply, deeply affect mood in some people, for sure.

Uh, I noticed it hugely, I could not finish my course when, um, I was at university. This was, albeit quite a few years ago now. I took it for about four weeks, and I remember going into an exam At the time it was, uh, an osky, which is, uh, uh, our practical exams. I couldn't function very well. I, I noticed that.

I was burning up entirely. The amount of energy that I was just producing just to, just to stay, stay alive whilst taking this drug was, was astronomical. It was, I was always red, I was always hot, and I remember just always running to a, to the fan whilst taking the, um, whilst taking this practical exam in between each station.

I would just run towards a fan to try and get stay. Cool. I noticed. My mental function had decreased. I couldn't calculate basic things, things that you can do very, very quickly and very easily. I remember one station was working out a bmi, body mass index. Very simple equation, very simple formula. It took me most of the station to work out this, this patient's bmi.

I couldn't function at my normal level. I also noticed that in the few weeks that I took it, I became very, very depressed and. This was in spite of seeing an improvement in my skin. So, uh, I don't believe it was because of the acne that was causing my depression. I did attribute it, um, very strongly with the roaccutane.

With the isotretinoin. I just noticed I would, I didn't want to do anything. I just wanted to, to sleep. I wanted to just curl into a little ball and to be left alone and to sleep. When I, the, the turning point was when I went home, uh, to visit family and they looked at me and they could see something wasn't right.

I had lost a huge amount of weight. I had, um, I just looked tired, I looked drained, and I just wasn't my normal self. And I was advised by a family member to. You know, stop taking it. And at the time I couldn't, I couldn't attribute it to the roaccutane. I couldn't, it, it was, it was like a shroud as it were.

And I thought, well, maybe they're right. Maybe it is cause of this. I stopped taking it and very soon I noticed that, um, it was like having a. Having a, a shroud lifted over you some, all of a sudden it was like waking up from a foggy dream, um, over the next few days. And it, I, I got all my clarity back and.

I realized just how dangerous this, this medicine was for me. Equally, I know of people who have taken it and have had no problems with it other than say, minor side effects. So I can't speak for everyone. I can only speak anecdotally from my point of view. It's, I I, if it was up to. Would I ban it? I'd have a very, very good look at it.

And would I have prescribed it for a patient? Probably not. I would not. Um, I think it should. Firstly, if it is going down that route, it should be reserved. And, and thankfully in the UK at least, it usually is reserved for patients who have very, very severe cys. Acne, um, the type, like I say, scars and causes, causes problems later on, or is very, very painful, but I, I just can't recommend it.

Um, unfortunately, and especially with all the side effects, I, I've, I've listed only a few of them. You know, th this is forgetting things like the pancreatitis, hair loss. The mentioned the liver, the, like I say, some of these side effects don't get better. So I, there are studies and there are, uh, sorry, there are, there are case reports out there of people suffering with these symptoms long term and a lot of regrets in ever taking it.

I know from myself, the lip dryness for example, that took years for it to subside for me. Um, I would say, Over six years for it to, for it to go. It was not very pleasant. Whilst it got better, as soon as I stopped taking it, I did notice that over winters and even, even in the summer, I would just have constantly dry lips and they'd be very painful.

They would crack. They would bleed, and. It wasn't every day, but it was definitely something and I'd notice it, and I would think to myself, I really regret taking that, that drug. Um, I only took it for a few weeks because I, I was suffering too badly from the side effects and ire known was actually developed as a form of chemotherapy for some types of skin cancer.

And I think if we are going down the route of chemotherapy for. For an acne treatment, essentially. Essentially there's gotta be a very good reason for it. And in the UK it must be a specialist, uh, doctor, a dermatologist who prescribes it. I think in some cases a very specialist. Uh, GP who focuses on, on skin conditions can have a license to prescribe it, but mainly it's with a dermatologist.

Um, who, who sees you in clinic advises you, tries everything else before it goes on it. My point about this drug is it's not without its faults and it's not without its risks. So it's not the simple one-stop shop that. It might be promised to you in forums, so please be very careful. Remember that it is a ter.

It will cause birth defects if, if you are pregnant around the time of taking it or during taking it and or your breastfeeding, it will cause potentially liver problems. It can cause kidney problems, it can cause all sorts of things. Ultimately, it can also cause quite severe, um, mood changes and depressive symptoms, and it has been linked to suicide in the past.

There is a topical form of it, uh, retinoid. Um, It's like a roll on that you put on the skin. So it, it's, the side effects aren't as severe, but again, it can still cause the, um, birth defects and, and things like that because it does get absorbed by the skin. Whilst I believe it is more, uh, better tolerated.

I don't know too much about it, but it is something that can be discussed with a dermatologist. Now, there are complications that may arise from having. Just by itself. And these are usually cosmetic complications. Acne can lead to scarring and it can lead to a low mood. And I do think it is important to treat it at least, you know, um, maybe not with Roaccutane, of course, but I do believe it's important to go to your doctor and have.

Uh, a good discussion about what the, what the steps would be. The, just the, the start off with the gentle things and discuss a, a plan with them. And overall, this can help prevent scarring from happening and help later on in life, because whilst in most cases acne does subside later on in your in life, late in the mid twenties, early thirties, What you don't want is to have been picking at your spots and been, uh, trying all these harmful regimes causing scarring and hyperpigmentation and things like that, and then have acne clear up later on and be left with all the scars, which can be very difficult to treat.

Prevention is better than. Treatment and cure. So you, you want to try and prevent them from happening in the first place. So do speak to your doctor. They can advise you and they can also refer you on to a dermatologist, someone who has specialized in skin conditions and can provide you with really good treatment regimes and can and can advise what the best.

Way forward would be. Before I end, I'm gonna try and dispel some myths about acne. Firstly, you can't catch it from anyone. It's not contagious. It's not a skin condition that is cause of poor cleansing. It's mainly hormone related and. It's not because you're not washing enough. In some cases it's because you're washing too much.

Why are the big temptations, especially when you're younger and your, your hormones are all over the place. You want to go to parties, you want to impress, um, your friends, you all these, all these things. There's a tendency to want to clean your. As often as possible. And you going, you go to the supermarket, you buy, um, some, sometimes quite caustic, um, face creams and you use them 2, 3, 4 times a day.

It, it makes it worse in some cases. Just simple water. Is more than enough. A simple oil-free soap, um, twice a day wash very, very gently over rubbing the skin can, can make things worse, can cause further inflammation. You then just pat dry with a towel. That's all you need to do. Don't rub your face with a towel, just pat dry it.

Other things that can be done in terms of um, just normal everyday things I mentioned di earlier on, that's gonna be a bit hit and miss, um, depending on, on who you are. I found it worked for me. Changing pilo cases often is a very, um, very, very good thing I noticed. When I was doing on-call, um, or even now when I do on calls and I stay in the OnCore room, um, cause it's a different pillow, different pillow case, I do often end up with a, with a mild outbreak of acne, which, which subsides, you know, after my on-calls finish.

And I'm sure it's due to being up on during the night and changing hormone balance and all sorts. But I have noticed that, um, since starting to use my own pillow cases, um, I, I've notice. A big improvement in that and changing them frequently. Don't just leave them for a week, two weeks, change them every other day.

Use fresh towels as often as possible. I appreciate if you're doing the, uh, benzo peroxide treatment. This might be a bit tricky, but try and alternate bedding, try and alternate pillowcase. Try and alternate your, your toweling as well. All these things do help you. You are limiting the amount of bacteria that will go back onto the skin.

Also, please don't pick them. I know it's, it's easier said than done, and I can tell you this from personal experience, but you do, you, you do end up with scarring and you'll regret it later on. Once your actually does clear up. I will say one final thing. For everyone who is affected by acne and for those who are being troubled by it and are at loose ends and wit their wit end to try and come up with a solution and they've tried everything and, and it's really getting them down.

The one thing I will say is no one cares that you have spots. I don't mean that as. No one cares that you are suffering. I mean that as no one associates you with your spots. They associate you for your personality. They associate you for the way you treat people. They associate you for the way you present yourself in every other way.

I guarantee you the person that notices the SP spots the most. You and no one else, no one will even notice that you're having an outbreak, as it were, or, or having a bad skin day. It's not the first thing people notice about you. They, they associate you with you, not because it's not gonna stop you from making friends or anything like that.

It's easy to say, and I, we are all guilty of being self-conscious. Of course, I do understand, but please remember, it doesn't define you. With that, I will leave you. Please do subscribe to this channel and I release a podcast every Wednesday. And if you get a chance, please leave a review. And if you have any topics that you'd like me to discuss, please leave me a comment either on my website or doctor's view.co uk or by emailing me at a doctor's view@gmail.com and as.

Please take care of yourselves and I'll join you again next time. I'm Dr. Polyvios. Goodbye.