If you or your teenager has ever suffered from acne, you will know the distress it can cause. Acne-sufferers struggle with low self-esteem and limit themselves when it comes to social activities, sports and relationships.
Outbreaks of blackheads, pimples and cysts on the face and upper body can cause severe embarrassment as well as pain and scarring. As parents, we want to do whatever we can to help our children’s skin clear up, but can the ultimate treatment actually cause new symptoms, including dry eyes?
What is Isotretinoin?
One of the most powerful treatments for severe cystic acne is a prescribed medicine called Isotretinoin (commonly branded as Roaccutane®) This drug was discovered in 1979, and it was used to treat patients with severe acne with successful (and lasting) results. Today, it is still the go-to treatment for severe acne that does not respond to retinol skin creams and antibiotics, as the results are fast, positive, and often permanent.
How does Roaccutane® work?
This drug affects acne and how it develops in a few different ways.
1. Firstly, it has anti-inflammatory properties
2. Secondly, it drastically reduces the size of the skin’s oil glands and dramatically reduces the amount of oil produced by theses glands. As we know, acne is very much related to oily skin types.
3. Thirdly, the acne bacteria (p. acnes) live in the skin oil. By reducing the amount of oil in the skin, Roaccutane® is able to reduce the bacterial load of the skin.
4. Fourthly, within the pores, this drug is able to slow down the rate that skin produces skin cells, which in turn prevents pores from clogging up.
Often acne can get worse for the first few weeks of treatment, but the final results outweigh this initial setback. Isotretinoin can completely clear acne in up to 95% of people, regardless of whether their acne is inflammatory or non-inflammatory.
So, what’s not to like? If something so nasty can get cleared up so quickly and efficiently, what’s the downside?
What are the side effects?
Side effects of Isotretinoin can vary from moderate and reversible, to severe and long-term. There are an alarming range of side effects, and everyone who takes this drug is likely to suffer from some of them. Women of child-bearing age must not get pregnant when taking this drug, as it is damaging to the developing foetus. Skin and lips become dry and sensitive to the sun. One of the more common side effects is dry eyes.
Roaccutane® and Dry Eyes
At The Eye Practice, we specialise in the effective treatment of dry eye. Some of the more severe dry eye patients that we see have been on Roaccutane®. Symptoms range from gritty eyes, to severe foreign body sensation (where it feels like there is something stuck in the eye).
This feeling is unrelenting and often cannot even be soothed with lubricating drops. Patients find themselves administering drops hourly to try and get some relief.
As mentioned earlier, one of the main reasons this medication works so well for acne is because it closes the size of the oil glands. We have found that patients who have had Roaccutane® treatment in the past, their oil glands in the eye lids have also reduced in size and in many patients the glands have completely atrophied.
This is a huge issue when it comes to dry eyes. The tear film in the eyes is made of three layers.
1. The mucous layer
2. The aqueous layer (watery tears)
3. The lipid layer (oily tears)
The lipid layer is the top layer that protects the other two layers and keeps the eyes lubricated. This lipid layer is produced by the oil glands in the eyelids. When these glands atrophy, there is little or no oil production of oil and the eyes dry out.
What can you do?
Dry Eye Syndrome has been seen to be a long-term effect of Isotretinoin and one that causes debilitating pain. If you have ever taken Roaccutane® and are starting to feel any symptoms of dry eye, now is the time to act.
The sooner you seek the appropriate treatment, the better the outcome.
If you, or someone you know suffers from acne, speak to your doctor and read as much information as you can on the available treatments before progressing with the drug.
It does work, but is it worth the long-term damage?