8 June 2005

A drug widely available through the Pharmaceutical Benefits Scheme for severe acne can adversely affect patients and exposure to the drug in pregnancy can cause severe birth defects.

In the latest issue of Australian Prescriber, John Sullivan, a dermatologist at Liverpool Hospital and the University of New South Wales, Sydney, says the drug, isotretinoin, must be prescribed with caution and warns that pregnancy prevention is of paramount importance for women taking the drug.

Isotretinoin helps sufferers of cystic acne - acne which can result in permanent scars if inadequately treated. These people often become increasingly self-conscious, and many isolate themselves to avoid social interactions. Cystic acne is associated with an increased risk of depression, occurring relatively commonly in males in their late teens and early twenties.

"Isotretinoin is an effective oral treatment for patients with severe cystic acne, but it has some serious adverse effects, "Dr Sullivan said.

"Female patients should be using at least one effective contraceptive measure reliably and have a recent negative pregnancy test before starting therapy. Teenagers and young adults may require counselling to correct misbeliefs on the effectiveness of, and the best and safest ways to use contraception", he said.

"I discourage patients from purchasing isotretinoin via internet or mail order pharmacies as there is no opportunity for regular face-to-face reminders about the damaging effects of isotretinoin in pregnancy."

To minimise the risk of the drug causing adverse effects, Dr Sullivan recommends patients be given a list of recommended changes to make in their personal care and lifestyle before starting isotretinoin. Common problems include dry, cracked lips and dry skin, dry or irritable eyes, eczema and a dry, cracked nose and nose bleeds.

Isotretinoin can only be prescribed by dermatologists and early referral to a dermatologist should be considered for patients with progressively worsening, moderately severe acne, or a family history of severe scarring acne.

ENDS

Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals. It is published by National Prescribing Service Limited (NPS), an independent, non-profit organisation funded by the Australian Government Department of Health and Ageing.