And it’s for the most part a very well tolerated, very effective drug. And actually the benefits for most people far outweigh any risks. Most people on the treatment will get dry skin. And that’s partly the way it works by, you know, making your skin less oily, less productive of sebum. And that’s why it helps the acne. So, dry skin is almost to be expected. The other risk which happens in a lot of people is they can get a flare up of their acne when they first start using it. So it’s maybe prudent to start on a low dose and kind of build-up gradually, so you don’t get that flare up of your acne, which can be very disheartening. Also makes you more sensitive to the sun. So you have to be quite careful if you’re, you know, sun-exposed or you’ve got fair skin. The other risks are really unusual. I mean, the main thing for females is they mustn’t get pregnant. Because it does, you know, we know that it has a very- it’s very something called teratogenic. So it’s very likely to cause a problem with the fetus if you did get pregnant. And that’s why it’s important for them to be contraception or discuss the risks of pregnancy when they get prescribed this medication. But the other risks are really quite unusual. So we do monitor blood tests to look at liver function and the fat levels in people’s bloods. But normally in young people, you know, these are unproblematic and it’s very unusual to have problems with those. And it can occasionally cause muscle aches and pains. The thing which it’s always been associated with and people are concerned about is mood and depression and even suicide risk. If that is associated, which it’s not clear it is, it seems to be a very esoteric, individual, you know, thing that happens. Most people I see who start isotretinoin, their mood improves because their skin improves. And that’s by far the most common psychological side effect, is that people feel better because their skin is better. But it does, you know, it takes a few weeks for things to settle down. And often the beginning it can be a bit, you know, they have to sort of wait for their skin to kind of get used to it, in a way. Whether it really causes severe depression and suicide is still unclear. And as I said, if it does, it’s very much a kind of idiosyncratic reaction, which is not- you can’t predict. So even if someone has had depression or even suicidal ideation, you can’t- it’s not a reason not to give them isotretinoin if their skin warrants it. And you wouldn’t be able to predict if they were the sort of person that might have mood problems with it. Certainly if you look at big groups of people on and off this medicine, it’s not- it’s not clearly associated. And it’s something which again, will be considered by any doctor, but mostly the benefits will outweigh the risks.

Every time I had it I started on a lower dose, I think you start with like half the quantity and then after like a month or two you move up to the full dose. and so I think that kind of like eased it in without like too many side effects straight away but like, yeah just like horribly dry skin [laughs] and like your lips just peeling all over the place [laughs]. and, I mean I don’t, I mean they do say that like it can affect your mood, but I mean I think I was quite upset about the whole process anyway so I don’t think it was necessarily the pills that were making it worse. But yeah I mean I guess I didn’t have any of the really, really awful side effects that you read about on the packet which are quite daunting, you know, you read it and it’s like, Oh I could get jaundice, or whatever but . Yeah I mean I guess it wasn’t that bad but it’s just like, you know, it does make your skin worse before it gets better and that’s, that’s always quite hard to go through and yeah but you just have to use tons of moisturiser and loads of Vaseline [laughs] and then, and then it improves, but yeah.

Yeah, so I do, for my job I’m a gymnastics coach. So, which is a bit strange. But basically one of the side effects is you get muscle fatigue and like joint pain. And I started my job and A-, Roaccutane (isotretinoin) around the time I went back to school. So there was a, like in September, so there was like a lot of stuff going on. So I was really tired in a lot of the times. And also it affected the, my shoulder joint quite a lot. And probably for my job, it didn’t help but it got really sore. And the dry skin. So you get really dry like, mostly it was your lips. So I used to always get like, not cold sores, but it used to crack in the corner of my, my lips. So that used to be quite painful. And it was mostly just fatigue and then the dry skin. But luckily I didn’t get any of the, some people like got nausea and stuff like that. I didn’t get any of that.

How did you deal with the side effects that you had?

Well, I knew that, well, I, I thought it would get better like after a while. Cos I knew that I was taking this and I knew the side effects. So I thought if my skin would get better then I could deal with it at first. And just kind of ploughed through I guess [laugh]. And, yeah, and I kept looking at the, the blogs that I’d found online to see that they’d gone through the whole side effects as well and they’d gone through it. So I thought oh, I can do it too.

So, it’s hard to like just like tell whether it is the Roaccutane (isotretinoin) or whether it’s what’s going on, cos I was quite stressed cos I was doing my A-levels. So, I did like cry a few times when I didn’t really know why I was crying and it was just at home; like I was fine at school like and everything. And like, I think my Mum like pointed out to me like, you know, “This isn’t normal, you are not coping, you are being more upset than” cos I’m quite like a positive person I think. But yeah, that was quite hard but yeah it’s hard to tell like whether it’s you or whether it’s the situation or the drug. So, I wouldn’t want to like tell other people not to go on it or, encourage them to go on it cos I think everyone deals with it differently. But I think it did definitely affect my emotions or made it harder to deal with things and then, with the A-levels, that was like a combination and just made things a bit difficult yeh.

Yeah. Were there any other sort of aspects, like stresses or triggers for you that you knew kind of made it harder, either physically with your skin, or emotionally to sort of cope with it?

I think it is annoying physically as well because you do still have the spots while you’re on it. So, that make, like obviously it affects things. But, I don’t know, I think it’s sort of, yeah the triggers I guess would be like academic stresses or like, if you’re having like, you know a sort of family argument or, any like friendship problems, I feel like that becomes more of a trigger than it would have been. So, I think that it is triggers but I think you just lose your ability to cope with them as well and yeh.

So, you lose your ability to cope from them because of the emotional?

Yeah I think you just lose the ability to see that it’s not a big deal and you just, I think you just become more dramatic about it I think yeah.

But with alcohol, I guess the main thing to say is like, on Roaccutane (isotretinoin) I couldn’t drink for a while which is a bit annoying especially like when you’re eighteen and you sort of wanna have fun with your friends. But I didn’t let it stop me like I’d go out and not drink or I’d or I would like still drink a bit and I think, yeah you don’t have to let it stop you doing it.

How did you sort of assess how much it would be OK to drink?

Well, at the beginning I drank nothing, I literally had, maybe the most I’d have was like a sip or something. I went out quite a few times and just drank nothing. Even like going clubbing I would not drink anything just because I felt, at first it was, I was just like a bit afraid I guess. Like, cos it’s really drummed into you shouldn’t drink on it because it’s affecting your liver and then you don’t want to add more like stress on your liver. But after I’d been on it for ages it just sort of it feels like you’ve got over the side-effects maybe and I just felt like I could drink and I felt like that, because there was less of an ache maybe that I felt more comfortable so.

Because the alcohol was the only thing that really interfered with it. Although, you know, I had to be careful about drinking a lot more fluids because my throat was very dry. And it meant that if I went out, I had to take eye drops with me and like I used to make sure that I didn’t wear too much like eye make-up that was going to get smudged because I, just because obviously I was staying up-, I kept my contacts in longer, I would need to like go to the toilets and like put eye drops in. Just because they’d start to get dry by ten, 11 at night. I think alcohol was, it was a bit difficult because I was still in fresher’s. Or my first year at uni. But luckily, my friends were quite cool about it, and going out and getting really, really drunk was not something that I had to do to enjoy myself with my friends and on socials. It was, it was awkward at times because especially with kind of socials where, you know, it was like drinking games and things like that. And having to be like, I can have one glass but I can’t have more. It’s sometimes, it sometimes meant I had to sort of say that I’m not going to drink anything because it’s simpler for people to understand than, I can’t drink more than one unit a week [laughs]. I didn’t always like keep to the exact guidelines, but I, yeah. I spoke to my dermatologist about that, and was quite honest with him and be like, Look, I had like this many units last week, do you think that’s okay? And he was good about it and said, Yeah, no actually it’s not that bad, it’s just we’d like you to keep it down, you know, keep it as low as possible. It saved me a lot of money, [laughs] in my first year, so there were some positive side effects. But yeah, I think it was, it was frustrating, I think. A few of my friends were like, Awr, are you sure you don’t want to kind of delay the treatment? But it was more important to me to have my acne sorted out than it was to drink a lot. And I didn’t mind, didn’t mind it in the long term because I knew that it was going to have, yeah, like a positive effect. And I would have chosen to be sober, and to have my acne sorted like any time. So I didn’t mind that, I just- it just meant that I’m kind of glad that I’d researched it quite a lot and I knew what I was going for, and I was quite sure that I wanted it because I think it’s quite a, a big ask. You know, it sounds silly to say it’s a big ask to not drink, but I think you are in your first year in uni and there’s a lot of social things on. It is something that you have to be quite sure that you want to not drink.

For Roaccutane (isotretinoin), I think it was something like in the US they are very careful about administering it, because if you take Roaccutane and you get pregnant the fetus will be deformed because Roaccutane mimics the structure of vitamin A. So it prevents-, yeah. So it’s not, it’s not even like a risk, like it’s 100% the fetus would be deformed. So that was, that was something, that was a consideration, I think for people who’re in my age group, I suppose. But I was much younger then. But like now it would be a consideration, yeah.

So how old would you have been when you were on Roaccutane?

Like 16. Yeah.

And did your doctor talk to you about those risks?

Yeah.