For cases of acne that are proving very resistant, a systemic retinoid (Roaccutane) is sometimes used
"Roaccutane has been used in Ireland since 1982 and remains the most effective treatment for the severe nodulo-cystic form of acne," says Dr Alan Irvine, consultant dermatologist at St James's Hospital and Our Lady's Hospital for Sick Children in Crumlin. "Treatment with the drug is associated with a number of adverse effects such as muscle aches and pains, dry skin and chapped lips.
"The therapy is not undertaken lightly because of other adverse effects, primarily the severe risk of foetal malformation for women who become pregnant while on Roaccutane. This is why female patients must enter into an agreement not to get pregnant during treatment," says Irvine.
The patient must be monitored with blood tests and, where necessary, pregnancy tests every four weeks while taking the drug.
Concerns have also been raised about the risk of depression. "In real terms, I have seen one person with reversible depression out of 700 patients treated with the drug. Minor mood disturbances can occur in a few patients."
The drug has been blamed for being instrumental in teenage male suicide but Dr Irvine says the evidence has not been well assessed yet. He says it must be prescribed responsibly. "I would, however, be reluctant to see it removed," he adds.