Acne is the most common skin disease. Despite thousands of research articles, the cause of acne is still not fully understood. However, treatments are none the less very effective. Treatments are aimed at drying up and reducing the production of grease (sebum) from the skin’s grease glands (sebaceous glands), removing and reducing bacteria on the skin that may play a role in acne and manipulating the effects of natural hormones on the skin. One of the best treatments for acne that has failed to clear with other the counter remedies or low dose anti-inflammatory antibiotics is isotretinoin. In the UK isotretinoin can only be prescribed by a specialist dermatologist.

Will isotretinoin work for me?

In Dr Nelson’s experience it is very rare to not respond to isotretinoin. As long as the dose is correct and the patient is able to tolerate the side effects (dry lips and dry eyes being the most common). Isotretinoin is ideal for cystic acne effecting the face, chest and or back. 

How long is a course?

Usually 4-6 months but some people need longer. Dr Nelson would recommend that you continue on treatment until you have been spot free for at least 2 months.

Does it make you depressed?

Isotretinoin is given to many young people with acne. Young people with acne are also prone to suffering with low mood. Consideration of the limited data available would suggest that the incidence of depression and suicide during isotretinoin therapy may be no greater than the background incidence. A causal relationship has not been demonstrated. The occurrence of an idiosyncratic reaction to isotretinoin producing major depression and suicidal ideation, as suggested by case studies, remains a possibility — although, if so, this would seem to be a relatively rare occurrence.

Will I need to be monitored?

Yes. Women of childbearing age should be counselled regarding the teratogenicity of the drug. This means that the drug would be extremely toxic to the fetus if a female patient were to become pregnant while on it. Once the drug is stopped it does not affect future pregnancies. Female patients are required (unless they can confirm thy are not at risk of falling pregnant) to enrol into the pregnancy prevention program. Monthly pregnancy tests are carried out prior to issuing any further medication. Dr Nelson will fully counsel you regarding the drug and also discuss other alternatives.

What about acne in adulthood?

Jawline acne is more common in women in their 30s and 40s. Believed to be caused through excessive male hormones acting at the follicular level within the skin this type of acne can respond very well to spironolactone, a type of blood pressure medication. Spironolactone used in acne has been shown to be very effective in some people with jawline acne due to its anti-androgen effects. Doses ranging from 50mg to 150mg daily taken for 6 months are initially required.

Acne scar removal

Acne can leave small unsightly scars. These can be removed by punch excision or scar release. Contact Dr Nelson to find out more.

More information




For Wood MediSpa Okehampton please call: 01837 516629 | For The Duchy Hospital, Truro please call Claire on 07812 095769 or email: enquiries@tobynelsondermatology.com. A referral from your GP is preferred.