Isotretinoin availability under threat

Isotretinoin (Roaccutane), a treatment of last resort for many patients with acne, has been banned by two health authorities on cost grounds, according to Miss Alison Dudley (chief executive, Acne Support Group). She believes that “this is probably the tip of the iceberg”.

Speaking recently at a meeting of the All Party Parliamentary Group on Skin, she explained that isotretinoin was helpful in 70 per cent of patients with severe acne (including patients with persistent scarring acne and those with acne-related psychological disorders). Dr Roger Allen (president of the British Association of Dermatologists [BAD]) added that, as the drug had to be prescribed by a dermatologist, and waiting lists were so long, irreversible scarring often occurred while patients were waiting for isotretinoin to be prescribed.

Miss Dudley explained that acne affected nine out of 10 teenagers and lasted, on average, for eight years. A major problem was getting the best advice to affected teenagers. Generally they self-medicated but did not continue treatment for long enough to see the effects. Surveys had shown that more people sought help from cosmetic assistants than from pharmacists. It was important for teenagers to understand that failure to seek professional advice in time could result in permanent scarring. Teenage boys were a particularly difficult group to reach in this respect, as they did not regard acne as a disease. Currently, laser treatment was the only remedy for scarring, but it was costly and scarce. Dermabrasion, which had been used in the past, was now out of fashion.

Many teenagers perceived the community pharmacist as someone who handed out prescriptions but not as someone from whom to seek advice, said Miss Dudley. She called for information on practical dermatology to be incorporated into pharmacists’ training. Pharmacists should also be aware of what was available from patient support groups and should be able to put patients in touch with these groups.

Dr Allen said that a joint project was now under way with the Royal Pharmaceutical Society to survey the types of questions that community pharmacists were asked about skin disease and to devise guidelines which they could use.

Dr Stephen Kownacki (Primary Care Dermatology Society) explained that one in seven GP consultations concerned a skin complaint and yet it was still possible to qualify as a doctor without studying dermatology at all. The great majority of dermatological conditions were treated in primary care and there were significant unmet needs, he said.