Acne, Accutane and teen mental health concerns, anyone faced this decision?

[Superspecs]

My son has acne and it is really getting him down, he is struggling to get up and out to school in the morning on a more spotty day and it’s is making him sad and anxious, his dermatologist has suggested Accutane for him.

I would be all for this but we have a close family history of poor mental health and suicide, and I am terrified of the small potential suicide risk in people who take Accutane.

It feels like being stuck between a rock and a hard place because my son’s mental health is being severely effected by the acne, but then I am struggling with the idea that he may be taking a drug that heightens a potential risk of suicide, even by a little bit.

Has anyone been in this situation and come to any conclusion? All advice is gratefully received. I spoke to his psychiatrist (who he sees for anxiety) and he said that on balance he thinks it would be okay to go ahead with the Accutane, but the idea of it is still making me very nervous. My son would like to take it.

Thank you

We’re a family of four who’ve all had roaccutane! For me, it was a life saver, I was so shy and lacking in confidence and it transformed my skin within a year. I had to take another lot about 8 years later but other than that, my acne has been manageable for the rest of my life.

Dh had poor mental health when he took it but this might have been the case anyway due to living with abusive parents.

Ds and dd both took it and had no mental health crises when they were on it - dd did start to struggle about a year later, but I think she would have done anyway due to genetics.

However Ds did struggle with particular side effects - bad backache and headaches, and nose bleeds - and sadly for him the positive effects on his acne only lasted for a month, so it was a complete waste of time. I didn’t expect that as it worked so well for dd and I.

I’ve not heard of AviClear - how soon did the acne clear and are the effects as long lasting as roaccutane?

We ended up doing it, very cautiously while monitoring closely. The overall results were completely transformative. There was a spike in anxiety and he had a therapist to help. But we are very glad that we did finally do it.

I had bad acne as a teenager

took this at 19. No history of any depression or mental health issues at all.

but within 6 weeks I felt depressed - to the point I couldn’t attend my summer job, and couldn’t do anything but sit on the sofa and cry. I felt like there was a black cloud and it was far worse than the acne for me at least.

my mum took me off it - and I made a quick recovery: it did make me realise what true depression feels like though.

alas my skin is still quite bad as a 40 year old so I never really found another solution for my skin issues - but that’s another point.

This is so hard- my family went through similar! Both sides of our my parents family have history of mental health issues and suicide, my cousin had terrible acne and was stopped from being allowed to start Accutane for these exact reasons- it affected her so much though! Her school years were awful, her self confidence etc and eventually at 18 she started it and it worked wonders. She does feel resentful that she wasn’t allowed to start sooner and feels it affected so many of her life choices and situation now, but she understands why her parents said no. My little sister then had acne and although not as bad as my cousin, my mum was in bits trying to decide how to help whilst worrying about the MH side- in the end, she took my sister to a dermatologist who suggested Accutane and my sister had to commit to open discussions with my mum. It worked well on her skin, she became so close to my mum and eventually after 6 months decided to come off it and suffers the odd flare up now in her 30s but doesn’t feel the need for mediation. She explores products and treatments like red light etc, but I think that is because of her age and priorities. Your teen years are so vital for self image and confidence and who you become. I’d say have open discussions with him, he knows your concerns and if he is emotionally mature enough- which he sounds like he is, then I say opt to allow it for him. It’s a small risk, and you already running the risk of his MH taking a decline with how he feels with skin now. You can always stop it if you start to worry or question his state of mind.

It took three sessions with about 4 weeks in between each. It took all 3 before it was cleared completely. There was some purging after the first session and then it started to improve pretty quickly. I believe the effects are permanent as it works by the same process as roaccutane - the shrinking and destruction of the oil glands - but without systemic medication.

https://aviclear.com/en-uk/

I tried Norse with my son and it didn't work at all. We tried lots of stuff and it's actually really messed up his face (he has a vitiligo effect of lighter, very dry patches mostly around his mouth). He is now on accutane and been fine (month 2) so far but it's a low dose due to the messed up skin. The patches are gradually clearing up now he's stopped the norse, and a gel from the GP. He's just using a wash and one moisturiser so his skin can rebalance a bit. The accutane has really made a massive difference to his skin, which has been great for his confidence.

I was in this situation with my dd a year ago when she was 14. The Dianette contraceptive pill had cleared my own face and body acne up when I was 16, so after trying all the various prescription topical treatments as well as different antibiotics, dd then tried Dianette at the age of 14. We were told by the NHS Derm that if that didn’t help, then the only option left would be accutane. Unfortunately Dianette actually gave my dd awful low mood and mood swings, so after 2 months she stopped taking it. Her skin was really clearing up on it, but she just couldn’t deal with the mood side effects from the hormones. She had a couple of months off it, then tried a different contraceptive pill but the same thing happened.

So I started researching accutane, as had a vague memory of it being in the news some years ago, court cases and the company stopped making it, then started making it again under a new name. I took a real deep dive and I recommend doing the same before you make a decision op. There’s a fb group called accutane survivors, a YouTube video by Dr Josef Witt Derring I think his name is? Glad I found those. Anyway, I involved dd in the process and made sure she knew all the potential risks to be weighed up against the benefits. We decided we didn’t want to take the risks, but every case is different and I’ll be open about the fact I’m a risk adverse person generally! Dd was already suffering with some general anxiety, and my dh and I have both had mh struggles over the years, so I was concerned dd might be predisposed to any depression that could be triggered by taking accutane.

Yes there are plenty of awful horror stories out there, but likewise many cases of people saying they only had a few side effects, no mh issues and they ended up with lovely clear skin, that it was the best thing they ever did. It’s such a tough call when they’re still so young. Obviously if they get to 18 and decide to take accutane then as adults that’s their decision fully. I think if dd changed her mind at 16 / 17 and wanted to try it, I’d want to find a private clinic where they are happy to microdose accutane, from what I’ve researched, that mitigates the risks somewhat even if progress is slower.

As a pp mentioned it’s worth looking into LED masks, I can’t remember the brand now but there’s one that’s meant to be very good for acne. My dd has body acne that’s worse than her face though so masks wouldn’t cover the areas like chest and back, so we haven’t tried it. Her face is fairly well controlled with Epiduo, and the best topical she’s tried for the body has been Aklief, it’s a new cream that is a newer generation of retinoids, it’s really improved her body acne and will give it a few months and see what the results are like then. If your ds hasn’t tried Epiduo and Aklief yet I’d ask to try them. There’s also a new cream called Winlevi, we might try that at some point, but our NHS trust doesn’t fund it so would have to go privately.

Then as a pp said there’s Aviclear, which is supposed to be results similar to accutane but by using laser treatment. There were only a few private Derms offering it at first, but now there seem quite a few clinics around the UK that offer it. I think it costs a few grand for the full treatment though? We’re considering it as another option for dd though we’d have to take some time to save up. I think I’d want to exhaust all other treatment options before accutane, well that is supposed to be the way it’s prescribed anyway, as a last resort when all other treatments have failed due to the potential risks. You have to sign a consent form and waiver I believe unless it’s changed? For girls you used to have to either also be taking the pill, or take a monthly pregnancy test, though obviously that won’t apply to your ds!

@randomrandomer thanks, I’ll look into this further for Dd who can’t have roaccutane

Have you been offered Spironolactone?

I suffered with mild/moderate acne from being a teen into my 40s. Only the combined contraceptive pill, in particular Dianette, kept it clear. NHS dermatology were not helpful, so when I was in my early 40s I saw a private dermatologist to discuss Accutane. She gave me the name of a fabulous female Dermtatology Consultant based at a hospital a bit of a drive from home, and I asked my GP to refer me. I saw her and explained how my skin had been and still was, and she immediately suggested Spironolactone. Worked a treat - it basically acts on the androgens which cause oily skin. i had no side effects and was happily taking it until I hit full blown menopause and now don't need it.
Worth a try?

it’s a drug that people have very strong feelings about but it is extremely effective and can be literally life changing for some people. It is worth speaking to a dermatologist about.

I had severe acne in my 20s. It more or less solved my problem. Still get a but now but v mild. The ongoing risk of being depressed because of it is worse imo. I would absolutely do it.

Edited to say mild-moderate MH problems have been an issue for me and my family

My DD took it and it worked amazingly for her, the transformation in her personality was positive. She could leave the house with no make up for the first time ever as she felt confident enough to do so. We monitored her very closely as we had heard there could be mental health side-effects but she had none. I wish I had been able to have it when I was battling acne through my teens and 20s.

We have familial acne- I took roaccutane at 40 and it was life changing. DD2 took it at 13 and 15 and had no problems. DD1 had severe mental health problems at 18- at 21 she wanted to take roaccutane and I was very, very nervous. She said she was an adult and that her skin was making her depressed and came out unscathed with clear skin.

As a skin treatment it has been extraordinary for my family- however the consultant told us that it can send a small % of people suddenly into a dark place- so only worth trying if you can keep a close eye on your loved one.

I struggled with this. Asperger’s, adhd child, history of anxiety. Horrid cystic acne. Went for it in the end. Worked brilliantly. Profoundly wish I had done it earlier before his back got scarred.

and better when they are at home, under your eye, than them getting it themselves away at uni.

No direct experience but in a very situation as yourself. My daughter is 14, has very low self esteem and very bad face and back acne that exacerbates it. My daughter has researched it, the GP have given another round of Duac cream antibiotics (although first time was just the duac), I'd be cautious but inclined to trial it for your son, as I will my daughter if this treatment doesn't work.

@SlenderRationsthats interesting as my daughter is autistic (but she prefers to say Asperger due to her primary disability being socially awkward and highly anxious).

let us know how you get on OP

I took it on my 20s, had 2 courses. Clear my acne. I think it impacted my gut though and increased candida; which later gave me a thiroid problem, that is my theory at least. I did a hair analysis and read lots and figured it out. I started looking after my diet, cutting down on sugar and no more thiroid problems; but I did have tablets for it for a year. I also suffer from anxiety but not sure it was the accutane or just the way I have always been.

Friends daughter took it; 2 courses. Beautiful skin now but lots of bowel problems.

My daughter friend took it, antibiotics didn’t work for her. No acne now and no side effects I am aware of.

DD took antibiotics for 6 months and keep it under control with prescription creams, cerave face wash face wash, probiotics, well teen girl tablets, omega 3.

please stop diary, cut down sugar and gluten

Botanycl screen clear elixir from H &B has good reviews

Not sure what's in Epiduo but it bleached DS's towels and initially caused the facial dry patches. He then moved to a different gel to see if that would stop the dry patches, and used the Norse alongside, but the patches continued to get worse. Now they are much paler than his skintone and don't grow hair so he has bald patches when he has stubble. Dermatologist said his skin had been through too much 🙁. He's on a low dose of accutane and managing ok.

Just to say that topical ointments are not risk- free either! And now DS has a different skin worry to affect his confidence.

I've just had a dermatology appt for my own teen.
We've opted for a course of Spironolactone instead. It's actually a blood pressure treatment but it is used off licence for the treatment of acne.

We're only be prescribed it today so cant report on results but that might be worth a discussion?

I agree with some other PP - once you get to the stage of seeing a dermatologist any over the counter treatments or diet changes are unlikley to be effective

did he put too much and too often? Washed his face in the morning? Use suntan-lotion everyday.

The avi clear sounds great. Is it safe?

Is it safe? Any risk?

Can you send the link please?