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This 25-year-old woman had intractable acne, unresponsive to systemic antibiotics or anti-androgens which was causing scarring. She was commenced on 13 cis retinoic acid (Roaccutane (UK), Accutane (US)), whilst continuing on her oral contraceptive. Normal liver function is a prerequisite for its prescription. |
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This picture shows the patient after 10 weeks of treatment and there is already improvement. The drug is taken for a total of 16 weeks in a dose of 1mg/kg body weight. It usually takes at least a month before any real improvement occurs. |
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This picture shows the patient 11 months after treatment commenced. She has been off treatment for 5 months and the improvement is striking. The drug is a major advance in the therapeutics of acne but it is a teratogen and appropriate contraception is mandatory. It should be prescribed only by those experienced in its use. |
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This dryness of the lips is seen in every patient who takes the drug. It is a mild inconvenience which can be easily controlled with emollients such as vaseline.
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13-cis-retinoic acid interferes with the growth and development of the sebaceous gland, and dryness of the lips is an inevitable consequence of the treatment. Dryness and sometimes eczema of the face and hands may occur in cold weather conditions (and in atopics in particular). |
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Side effects other than dryness are not that common. Muscle aches occur in teenagers, nose bleeds in those who are prone, dry irritable eyes in contact lens wearers and very occasionally pyogenic granulomas as on this adolescent's shoulder. The mechanism is unknown but can be managed by curettage and cautery. |
