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Whether you are taking isotretinoin (Roaccutane) or are coming off it, here’s what doctors say is the best (and worst) skincare for you to use
If you’re a severe acne sufferer and have been prescribed Roaccutane by your doctor, you’ll have been warned of possible side effects alongside the benefits of taking it. For a lowdown on how the acne drug works and all the things to pay attention to, we’ve put together an expert’s guide to Roaccutane.
“Roaccutane has a tendency to make the skin dry and sensitive within a few days of starting treatment,” says consultant dermatologist and acne specialist Dr Anjali Mahto. It’s one of the first things you’ll notice when starting on the drug, alongside chapped lips and hands and uncomfortable symptoms affecting scalp, hair, nails and eyes. It may all come as quite a shocker if your skin has previously been very oily. So we asked Dr Mahto and some of her fellow skin doctors for their advice on how to adjust your regime to off-set the side-effects, the best skincare to look out for, and ingredients to steer clear of during Roaccutane treatment. The doctors will see you now…
How will your skin change while taking Roaccutane?
“The medication works by reducing the size and activity of the skin’s oil-producing glands, significantly dialling down sebum production(which, in addition, results in a reduction in the number of acne-associated bacteria),” says Mahto. “It will lead to varying degrees of dry skin, plus nearly everyone will suffer from dry lips. Skincare should be changed to reflect this, ideally as soon as the medication is initiated and certainly within the first week of treatment,” she says.
What is the right skincare to use while taking Roaccutane?
“The only focus when looking after skin that’s being treated with Roaccutane should be to support and protect the skin barrier – any brightening or anti-ageing strategies will need to be suspended,” says pharmacist with a special interest in dermatology Dr Marine Vincent. Dr Mahto adds that “the ideal Roaccutane-supporting skincare routine should be geared towards dry and sensitive skin. Choose products that are alcohol and fragrance-free so as to not further irritate the skin.”
She points out that deeply hydrating and barrier-building products don’t always need to be rich and heavy although, when on Roaccutane, you may find that only the most heavy-duty moisturisers will do. "I would normally advise clients to opt for creams that are non-comedogenic so as not to risk clogging pores, but skin is so incredibly dry and dehydrated when on the drug that you really need a good set of occlusive and emollient ingredients to protect it and its fragility," says Mahto. "Some of my favourite ingredients in this instance are cocoa butter, paraffin and coconut oil. The latter in particular is notoriously comedogenic, but when using Roaccutane, many patients find it's the only thing that will keep their skin feeling comfortable."
If you are naturally dry-skinned and suffering from acne (yes, it happens!) a moisturiser on the richer end of the scale is the obvious choice; see below for product suggestions ranging from light-ish to rich. And whatever your skin type, keep things simple and stick to two or three products: “Less is more,” says GP with a special interest in dermatology Sonia Khorana. “And don't forget your body will be dry too!”
As non-negotiable as a good moisturiser is wearing a daily SPF. When taking Roaccutane, it’s even more important than it is for everyone else. Roaccutane brings fresh skin cells to the surface, “making the skin extremely sensitive to sunlight,” says Mahto. “It is far easier to get sunburnt whilst going through treatment (even when the sun is weak), so a high SPF is absolutely essential.”
Doctor-recommended skincare to use while on Roaccutane
With barrier-building products all the rage, it’s easy to find products that will help your sensitised skin. But these come with the added seal of approval from skin doctors. All our expert physicians are big fans of the French pharmacy brands: “for the most part they are effective and available at a reasonable price point,” says Mahto.
The gentlest cleansers for Roaccutane users
Avène Tolerance Extremely Gentle Cleanser for Sensitive Skin, £14.50
A simple, milky formulation that cleanses without irritating or stripping the skin.
Gallinée Perfume-Free Cleansing Bar, £13
It’s a super-gentle bar cleanser (not a soap) that “protects and rebalances the skin microbiome without stripping the lipid barrier,” says Vincent.
Balance Me Pre and Probiotic Cleansing Milk, £22
The brand’s first foray into fragrance-free products for sensitive skin, this soothing milk packed with manuka honey, squalane and willow bark is massaged into dry skin and rinsed off, so you get the moisturising benefits while cleansing.
Curél Foaming Facial Wash, £12.50
Pumps out a lusciously creamy foam that’s nonetheless oil-free and will dissolve all grime and makeup while boosting ceramide production in the skin.
The most healing moisturisers for Roaccutane users
La Roche Posay Effaclar H+ Moisturising Cream for Sensitive and Blemish-Prone Skin , £19.88
The lightest of the bunch, this easily-absorbed lotion hydrates combination to oily skin that has been through the wars due to aggressive acne treatments. “It’s been specially formulated to strengthen the skin barrier and soothe fragilised skin,” says Vincent.
Zelens Omega Shiso Replenishing Serum, £75
A milky, instantly comforting serum rich in barrier-replenishing omega oils, ceramides and humectants and healing, anti-inflammatory antioxidants, this doctor-formulated serum is designed to help skin recover from major upsets.
Uriage Bariéderm Cica Daily Gel Cream, £19.99
Vincent says this deeply moisturising but balancing and purifying gel-cream will soothe and repair irritated skins.
Dr. Jart+ Ceramidin Ectoin-Infused Cream, £50
This favourite of Dr Khorana’s doesn’t feel heavy but nonetheless forms a protective shield packed with five ceramides, plant butters and oils, glycerin and antioxidant and prebiotic ectoin. It’s a true barrier saviour.
The best SPFs for Roaccutane users
Heliocare 360 MD A-R Emulsion SPF50, £26
By a brand favoured by skin doctors, this milky liquid-like lotion has very high UVA and UVB protection, a gentle tint and an anti-redness system to prevent and reduce flushing in sensitive skin.
Dr Sam’s Flawless Gossamer SPF50, £33
Doctor-formulated with sensitive and breakout-prone skin in mind, this 100% mineral SPF won’t irritate the most reactive of skins and leaves a very minimal white cast that disappears after a few minutes’ wear.
Cerave AM Facial Moisturiser SPF 50, £16
Deeply moisturising but not greasy and rich in ceramides, this cream doesn’t really feel like an SPF so is easy to slap on with abandon, as you should.
La Roche-Posay Anthelios UVMUNE 400 Invisible Fluid Tinted SPF50+, £18
Boasting a state-of-the-art new sun filter, this fluid also has antioxidants, a lightweight but hydrating texture and a flattering tint, making it a favourite of Dr Khorana’s along with the Cerave SPF50.
Ingredients to avoid while taking Roaccutane
- Acids - “Any exfoliating ingredients and acids such as salicylic acid, AHAs, retinoids and ascorbic acid (vitamin C) must be avoided when on Roaccutane,” says Vincent. If you can’t be bothered to scour ingredient lists, Mahto’s advice is to avoid products designed for oily or ageing skin altogether, as these often are based on the above ‘active’ ingredients. They’ll be simply too much, she says, as the skin is so exceptionally sensitive and fragile whilst taking Roaccutane.
- Scrubs - Fragrance (including essential oils) and mechanical scrubs or exfoliators will only sensitise skin further, says Mahto, while the cell-renewing effect of Roaccutane does not warrant sloughing off of dead cells with a scrub as well.
- Oils - Dermatologist Dr Anne Wetter cautions against the use of certain plant oils: “I recommend being careful with vegetable oils. The likes of olive oil used on cracked skin, for example, can cause long-term contact dermatitis.”
How should you deal with rashes when taking Roaccutane?
“Skin rashes and dermatitis are a relatively common problem whilst taking Roaccutane, particularly for those with a history of eczema and those taking the tablets during the cold winter months, says Mahto. “It’s best to speak to your dermatologist early should this develop, as topical steroid creams may be required for short periods of time to help to reduce reactivity.”
As for ‘natural’ topical creams to soothe rashes and eczema, Khorana advises caution. “A lot of ‘natural’ creams can contain irritating agents and allergens such as essential oils, and are not the way forward when treating eczema,” she says. “Some natural ingredients such as colloidal oatmeal do have a place in eczema treatment, but it’s always best to speak to your doctor about the best options.”
How to tackle ‘Roaccutane lips’
Even though lips don’t have oil glands, the decreased oil production in the body will parch all its mucous membranes, with cracked, swollen or even split lips as a result. “Almost everyone on Roaccutane will suffer with lip dryness,” says Mahto. “It’s extremely important to keep a lip balm or treatment in each bag and jacket pocket so that you don’t get caught out without it.”
Here, formulas cannot be rich or occlusive enough, and they should be applied frequently. “Petroleum jelly (Vaseline) is perfect, as it prevents any moisture from escaping and is inert and fragrance free, so won’t irritate,” says Khorana. It’s also super-cheap – bonus! Other great ingredients to look for a shea butter, beeswax, castor oil, lanolin and glycerin.
The hardiest lip balms for Roaccutane users
Eucerin Aquaphor Intensive Lip Balm , £7
Recommended by each of our doctors, this fragrance-free anti-chap remedy is based on occlusive plant oils and waxes, with soothing licorice extract thrown in.
Lanolips Golden Dry Skin Miracle Salve, £11.99
A super heavy-duty blend of lanolin, vitamin E and healing Manuka Honey, this could shield lips and skin in an Arctic blizzard, so will work great for compromised Roaccutane lips.
Elizabeth Arden Eight Hour Intensive Lip Repair Balm , £21
Former acne sufferer Victoria Beckham swears by this restorative petroleum jelly, beeswax and shea butter-based balm to keep flakiness at bay; the menthol oil may irritate some lips, though.
How should you treat your skin post-Roaccutane?
“Roaccutane usually works its way out of the system over a period of about 28 days after stopping treatment,” says Mahto, “but often, dryness starts to improve in as little as a week. Skin should become less sensitive and fragile and should return to what most would consider a ‘normal’ state, so not too dry and not too oily,” she says. It means you may well revert to less intensive moisturisers in the space of a few weeks.
“Other agents can usually also be re-introduced, for example retinoids and AHAs/BHAs, says Mahto. “I prescribe my patients a topical retinoid to use as a maintenance treatment at night after they complete their course of Roaccutane. This helps to keep the skin clear of blackheads and can also reduce any marks or scarring that the acne has caused.”
But as skin remains delicate to a greater or lesser degree in the months after your course, Dr Wetter warns against ‘tweakments’ such as microneedling and radiofrequency treatments - wait until skin is fully recovered and always discuss any potential treatment plan with your doctor or dermatologist.
How should you look after hair and nails when on Roaccutane?
“The scalp is skin, so it’s equally vulnerable to dryness,” says Mahto. “During treatment, many people notice that their scalp becomes far less greasy and that they don’t need to wash their hair as frequently as before.” That, she says, could be a bonus, but if the scalp becomes inflamed and problematic, she suggests considering the use of over-the-counter shampoos such as T-gel or Polytar that may help to reduce scaling and irritation. “Should the problem continue, talk to your dermatologist, who can give you prescription shampoos with or without a mild steroid lotion to calm the scalp,” she says
As for hair thinning, “this is a known side effect of Roaccutane but it isn’t that common,” says Khorana. “The higher the dose of Roaccutane and the longer it is taken, the more hair loss may occur – but this is more from circumstantial evidence, as some studies say the problem isn’t always dose dependent.” She says it’s important to remember that no two people react to medication the same (so some people may experience hair loss while others won’t) and that the situation is temporary. As for the why, “Roaccutane slows down the anagen (growing) phase of hair follicles, with defective anchoring of the hairs in telogen (resting) phase – this accounts for hair shedding,” she says.
The drug, she says, can also temporarily interrupt nail growth, which can lead to fragile or ingrown nails and sometimes infection. “The mechanism of how Roaccutane affects the nail plate is unknown,” she says
According to Mahto, the best way to look after your hair and nails is to follow a balanced diet rich in fruit and vegetables. “If you’re concerned, speak to your dermatologist: in some circumstances if there’s a suggestion of a B vitamin deficiency, taking a supplement such as biotin may be helpful,” she says.
To help brittle nails, Dr Wetter recommends adding a daily cuticle oil to your regime. And if your eyes get exceedingly dry (which is not unlikely), Dr Vincent recommends an eye lubricant in the shape of Hylo-Tear Eye Drops, £16.50.