This article is for informational purposes only and does not have the aim to endorse Isotretinoin (commonly known as Roaccutane or Accutane). Its aim is to inform people that are thinking of doing the treatment and want to know what the process would mean and what would happen.
Note: This article refers to the steps you make through the NHS (National Healthcare System) which is the public healthcare system in the UK. If you are a British citizen or have pre-settled or settled status, you will receive all appointments free of charge. In Scotland, Northern Ireland and Wales, all prescriptions are also free of charge. However, in England, there is a fee for collecting your prescription.
This article is for those of you that wonder what steps there are to get Isotretinoin (Roaccutane) prescribed in the UK. The first step you need to do is to go to your GP (General Practitioner) and ask for help with your acne. Please do not feel like your GP cannot help with this and do not feel embarrassed to make an appointment for it. Asking your GP for help is the first step in managing your acne and getting treatment for it.
Based on the severity of your acne the GP will prescribe creams or antibiotics. The creams might contain Adapalene or Benzoyl Peroxide and you will be asked to use them for at least a few months. If that does not show the desired improvement, your GP might prescribe antibiotics for you. I think there is a procedure in place and you need to take oral antibiotics first for at least six months before you can be considered for Isotretinoin. Isotretinoin is a serious drug with severe potential side effects and thus it is only prescribed if you literally tried everything else and nothing worked.
The problem with oral antibiotics is that almost no one gets rid of acne permanently, and they weaken your entire body. Antibiotics can damage your liver and have other unpleasant side effects which is why you will need blood tests done during this treatment. Unfortunately, Romanian doctors seem to always prescribe antibiotics first as well. Be careful as in the UK I have noticed that GPs encourage you to take antibiotics for a very long time, even close to a year. This is not healthy for you, especially since as I said, acne usually comes back as soon as you stop taking antibiotics.
Your GP cannot prescribe Isotretinoin to you, it can only be prescribed by a specialist. This means that your GP needs to refer you to a dermatologist for you to be able to discuss Isotretinoin as a course of treatment for your acne. Referrals in the UK through the NHS can take years, depending on the area where you are located, especially as the healthcare system is still working through the delays caused by the pandemic.
If your acne is severe, you can try make a case to your GP about being referred sooner rather than later. However, they might still want to go through all the steps with you before referring you. This means using creams for months, taking antibiotics and other potential treatments. It will all depend on your journey and how much you have already tried for treating your acne.
If no creams helped, if you have tried hormonal contraceptives and they did not help (for people who menstruate), if you have taken antibiotics and acne came back and so on, then they will refer you to the dermatology clinic to potentially discuss Isotretinoin. The wait between your GP’s letter to a dermatologist and your first appointment can last quite a while (it was around six months for me in 2018).
Once you go to the dermatologist you will find out what they recommend. If they agree on the fact that you need Isotretinoin, they will give you information about the drug and the official leaflet for you to read at home. You can take time to think about it, or go again just to ask questions, but keep in mind that the appointments are generally very spaced out, with months of waiting in between. For me, I had dermatologists try to convince me to take Isotretinoin than the other way around. The specialist said I clearly tried everything and that the severity of my scars was bad enough that they thought only Isotretinoin could help. If I remember correctly, it was the formation of scars that worried them the most, as the key aspect to acne treatment is to try and prevent the formation of permanent scarring.
Once you get prescribed Isotretinoin in the UK you follow a very strict set of rules which have never been bent for me.
Steps for getting the first prescription:
- (People who menstruate) You must start two forms of contraception at least one month before starting your treatment. For people that are already on the pill, the process is simple. However, if you have not taken the pill or any hormonal contraceptive method, you will need to discuss this at length with your doctor and decide upon it months in advance. I suspect you would need a GP appointment in order to get the pill, which could take a few weeks as well.
- (People who menstruate) Once you have been on the two methods of contraception for at least one month prior to the treatment, they do a pregnancy test which has to be negative.
- (People who menstruate) You sign a form taking full responsibility that you understand the risks if you get pregnant and that you will use appropriate methods of contraception during treatment.
- They do a blood test to make sure your liver and kidneys are functioning normally, as well as to check your glycaemia and other functions of your body. Your blood results have to be satisfactory for you to be able to start taking Isotretinoin.
- They do a mental health test which is very lame in my opinion, with obvious questions targeting signs of depression.
- They weigh you, as the cumulative dosage you need to reach with the treatment depends on your body weight.
- The UK prescribes different daily dosages than the USA and Romania for example. Recent studies have shown that a high daily dosage is not necessary as long as the patient reaches the optimum cumulative dosage at the end of the treatment. This means that in the UK they will start with the lowest dosage possible for your body weight and then gradually increase it depending on how your body reacts to the treatment. In Romania and the USA, they use previous studies that state that the higher the initial daily dosage is, the more effective the treatment is. You can find plenty medical studies about this topic online or you can ask the doctor about it.
- They will call you a few days later to tell you the blood test results, and if they are okay, you need to go to the hospital’s pharmacy in order to pick up your first prescription. Only certain pharmacies give Isotretinoin.
- People that menstruate will have seven day to do this. If you fail to collect the prescription within seven days, you need to have another appointment and do another pregnancy test. This can cause major delays in receiving your treatment.
How the treatment will continue
For people who menstruate, Isotretinoin will be prescribed to you in periods of 30 days. Before receiving the prescription and therefore receiving the 30 additional pills you need to do a pregnancy test and have an appointment with your nurse/doctor. This means that you present yourself to the Dermatology Clinic at the hospital and urinate in a cup which then the nurse on duty tests for pregnancy. If the result is negative, you then proceed to your appointment, which will almost never be with the same person as before, which I believe is really bad, as no one can see the continuous progress you are making or if you present any side effects that you did not have before. This, in my opinion, would be very important when checking the mental health of the patient. The nurse (as it is usually not a doctor) first asks you how you feel, if you had any mental health related changes, and how the skin looks. The appointments are based on your stories and perspectives – almost like an informal chat with the practitioner. They compare notes from previous appointments, and if everything is well, they prescribe you another 30 days with the dose they feel it is suitable. You can also choose the dose yourself. For example, if you have an important job or project you can request a lower dose for the month.
After that, you make another appointment at the reception, if possible, within the next 30 days so you can receive the new prescription in time before interrupting your treatment. The dates are quite difficult to choose as they never have too many available appointments, but sometimes you do have a chance to choose a later time of the day in case you have a full-time job. However, this means that you will either get an earlier appointment than four weeks or a later one (five to six weeks later). In my case at least, it was common that they would arrange my next appointment after more than six weeks. If you are person that menstruates, things are complicated, as I said. They refuse to give you more than 30 pills even if it means you will lose weeks of treatment.
After arranging the appointment, you will do a blood test every three months (or whenever necessary depending on what your doctor or nurse decides). You will find the results at your next appointment if you ask. However, if the results are worrying I presume they would call you and suggest stopping the treatment. The blood tests are a requirement for everyone.
You then go to the hospital’s pharmacy, which is the only place where you can pick up your Isotretinoin. If you are a person that menstruates, you have seven days to collect your prescription as after this date you need to repeat your pregnancy test. Waiting times at the hospital’s pharmacy can be quite long. I advise to try pick up the prescription after your appointment as you would save another trip to the hospital in the same week.
The nurses do not really tell you what skincare to use or not, other than reinforcing the importance of sunscreen at all times. They never give any advice in protecting your hepato-functions of your body (liver) or to take Isotretinoin with an intake of fat. Nor do the pharmacists give any advice other than avoid sun exposure and take the pill after a meal. In short terms, you are on your own about optimising the treatment for yourself. However, you do get a long leaflet that contains a lot of information about the medication and advice on how to take it.
Near the end of your treatment
You have to reach the right cumulative dosage for your own body weight before you can finish the treatment. Some doctors will encourage a small daily dosage in order to minimise side effects even if this means a longer treatment. Other will try and prescribe you higher daily dosages in order to speed up the treatment. The good news is that you can customise the treatment to your own needs and to the side effects that you experience.
I do not remember my exact cumulative dosage but I did try to reach mine towards the higher end of it rather than just reaching the minimum target (the cumulative dosage will be estimated with a minimum and maximum range).
After you finish the treatment you will have a follow up appointment at the dermatologist to discuss how you are feeling. In 2019 my follow up appointment was set for three months after the end of the treatment. The dermatologist offered to prescribe me acne creams in case acne returned but I refused. Your skin is still really sensitive after ending the treatment and it might take a while for it to go back to normal. It will be your choice how to decide to manage your skin after ending the treatment, and this is something you can discuss with your doctor.
To be continued…
Next Post will be about how I optimise the treatment of Isotretinoin (Roaccutane) to suit me the best. I will talk about dietary options and what products help in minimising the side effects.
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This article was last updated on 6 November 2022.
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