Consultant dermatology · London
Isotretinoin (Roaccutane) clinic - London.
Private isotretinoin prescription and monitoring for severe or refractory acne, delivered by a named UK consultant dermatologist under the current MHRA safety framework.
What isotretinoin is
Oral vitamin A derivative for severe or refractory acne.
Isotretinoin - 13-cis retinoic acid, brand name Roaccutane - is an oral retinoid derived from vitamin A. It shrinks sebaceous glands, cuts oil production, normalises follicular keratinisation and reduces the Cutibacterium acnes load. For nodulocystic and scarring acne it is the only treatment with a genuine chance of long-term remission after a single course.
NICE recommends isotretinoin for severe acne, acne with scarring, and acne that has not responded to a full trial of topical treatment and oral antibiotics. In the UK it is a consultant-only prescription, initiated and supervised by a consultant dermatologist working within the MHRA safety framework.
MHRA 2023 safety update
Stronger warnings, consultant-only prescribing.
Following a national safety review, the MHRA strengthened warnings on isotretinoin in 2023. The changes tighten how the drug is started and supervised.
- Consultant dermatologist prescribing only - GPs cannot initiate isotretinoin.
- Documented baseline mental health assessment before the first prescription, then at every monthly review.
- Documented baseline sexual function, with monthly review for changes in libido or erectile or lubrication function.
- Two-prescriber sign-off for patients under 18 before starting.
- Reinforced patient information on serious psychiatric and sexual side effects, and a lower threshold to stop.
Who is eligible
The patients who benefit most.
- Severe acne that has not responded to at least six months of topical treatment plus oral antibiotics.
- Nodulocystic acne.
- Acne with a significant risk of scarring, or where scarring has already begun.
- Acne with clear psychosocial impact on daily life, work or relationships.
- Adults with acne that keeps relapsing after antibiotic courses.
- Selected patients with truncal acne, hidradenitis suppurativa or PCOS-related acne, where the risk-benefit balance supports treatment.
Workup before you start
What is checked before the first prescription.
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Baseline bloods
FBC, LFTs, fasting lipid panel, creatinine and glucose. Repeat at week 4, then bimonthly through the course.
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Pregnancy Prevention Programme (PPP)
For any woman of childbearing potential: two forms of contraception, monthly pregnancy tests, signed patient acknowledgement form before the first prescription and monthly thereafter.
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Psychiatric baseline
Documented mood, sleep, past history of depression, anxiety, self-harm or suicidal ideation. Recorded at every monthly review.
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Sexual function baseline
Documented baseline libido and erectile or lubrication function, reviewed monthly, per the MHRA 2023 safety update.
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Two-doctor sign-off
For patients under 18, MHRA guidance requires two prescriber signatures before starting isotretinoin.
Regimen
Dose, duration and cumulative target.
Standard treatment is 0.5 to 1 mg/kg/day taken in divided doses with food, for four to six months, aiming for a cumulative dose of 120-150 mg/kg. This dose range gives the best chance of long-term remission after a single course.
For milder cases, patients intolerant of standard dosing, or maintenance after a first course, low-dose regimens of 20-40 mg daily are increasingly used. Low-dose treatment has fewer side effects but a slightly higher relapse rate and is a shared decision at consultation.
Monitoring
What happens every month.
- Monthly face-to-face or video review with the consultant.
- LFTs and fasting lipids at week 4, then every 8 weeks.
- Monthly pregnancy test for any woman of childbearing potential, before each new prescription.
- Adverse-effect review at every visit, including a specific psychiatric and sexual function check per the MHRA update.
- Prescriptions issued 30 days at a time, dispensed within 7 days.
Common side effects
What almost everyone gets.
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Dry lips
Universal - budget for a heavy lip balm from day one.
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Dry eyes and nose
Preservative-free drops, saline nasal spray, expect occasional nosebleeds.
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Muscle and joint aches
Common, worse with exercise, usually settles between doses.
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First-month flare
Acne often worsens in the first four to six weeks before it improves.
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Sun sensitivity
SPF 50 daily, no sunbeds, care with laser and waxing during and for six months after.
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Transient hair thinning
Reported by a minority, usually reversible after the course ends.
Serious adverse effects
Rare, but they need to be named.
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Deranged LFTs or lipids
Detected on routine bloods - dose reduction or pause usually resolves it.
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Pancreatitis
Rare, associated with very high triglycerides.
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Inflammatory bowel disease
A debated association - baseline gastrointestinal history is documented.
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Teratogenicity
Absolute - severe fetal malformations. Non-negotiable contraception rules.
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Mental health worsening
MHRA-warned. Any new low mood, anxiety or suicidal thought needs same-day contact.
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Sexual dysfunction
MHRA-warned since 2023. Report any change in libido or function immediately.
Aftercare
After the course ends.
Post-course review at three and six months to check for relapse, monitor lipids and LFTs back to baseline, and confirm skin recovery. Bland moisturiser, SPF 50 and a gentle cleanser stay in the routine for at least six months. Any laser resurfacing, deep peels or waxing is deferred for six months.
Where scarring has been left behind, we plan a separate treatment pathway - microneedling, subcision, TCA CROSS or fractional laser - once the skin has fully settled.
Cost
What it costs privately in London.
- Initial consultant consultation: £250-£450.
- Medication via private prescription pharmacy: £45-£120 per month.
- Monthly monitoring visit with bloods and pregnancy test where required: £180-£320.
- Typical all-inclusive 6-month course: £1,800-£3,500.
Where in London
Consultant dermatology clinics that run isotretinoin.
- Cadogan Clinic Dermatology, Sloane Street.
- Cranley Clinic, Harley Street.
- London Dermatology Centre, Wimpole Street.
- HCA Wellington Hospital Dermatology, St John's Wood.
- Chelsea and Westminster Private, Fulham Road.
- Skin Care Clinic, central London.
- NHS pathway via GP referral to a consultant dermatologist (waits typically 12+ months for non-cancer referrals).
Frequently asked
Questions patients ask before starting.
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Does isotretinoin cause depression or suicidal thoughts?
The MHRA 2023 safety update strengthened warnings on serious psychiatric side effects, including low mood, anxiety and suicidal ideation. Baseline mental health is documented, reviewed monthly, and the drug is stopped at the first sign of change. Anyone with a personal or family history of significant psychiatric illness needs a careful risk-benefit conversation before starting.
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Is a course of isotretinoin a permanent cure for acne?
About two-thirds of patients get long-term remission from a single full course (cumulative dose 120-150 mg/kg). Around a third relapse within two years and may need a second course, low-dose maintenance or topical treatment. Truncal acne and very young age at start are the strongest predictors of relapse.
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Why is pregnancy prevention so strict?
Isotretinoin is one of the most teratogenic drugs in routine use. Even a single dose in early pregnancy causes severe malformations. The Pregnancy Prevention Programme requires two forms of contraception, monthly pregnancy tests before each prescription, and one further test five weeks after the last dose. Prescriptions are limited to 30 days and must be dispensed within 7 days.
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Can I drink alcohol on Roaccutane?
Alcohol raises triglycerides and adds to the load on the liver. Occasional light drinking is usually tolerated in patients with normal bloods, but binge drinking is not safe on isotretinoin. Bloods are checked monthly and dose is adjusted if lipids or LFTs drift.
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Can I exercise normally?
Light and moderate exercise is fine. Heavy weightlifting and long-distance running often cause muscle and joint aches; some patients notice raised creatine kinase on bloods. Warm up longer, hydrate more, and back off if you develop unusual muscle pain.
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Will my hair fall out?
A minority notice transient hair thinning during the course, usually mild and reversible within a few months of finishing. Persistent hair loss is uncommon. Flag it early so we can rule out other causes and, where appropriate, adjust dose.
Book your consultation
Consultant-led isotretinoin, done properly.
Send a short brief. We match you to a UK consultant dermatologist within one working day, with a firm quote and an honest view on whether isotretinoin is the right next step.