I read the scoping review of acne clinical practice guidelines, which aims to establish a global consensus for isotretinoin prescribing competencies, with great interest.1 The competencies identified (dermatology, pregnancy prevention, mental health assessment, and blood testing) provide a valuable foundation for broader consideration of isotretinoin prescribing requirements.
From an etymological perspective, the prefix ‘iso’ derives from the Greek ‘isos’ meaning equal, in reference to isotretinoin as an isomer of tretinoin. The irony of this nomenclature will not be lost on those who also consider the evidence of inequality that exists with regards to access to this treatment.
The key skills of psychiatric risk assessment, contraception care, and blood testing for high-risk drug monitoring are domains that would seem to sit well within the remit of core general practice. In view of such enabling factors, I agree that adequately resourcing primary care to deliver an isotretinoin prescribing service might go some way to tackling the multifactorial causes for inequality of access, especially in remote geographical areas or in healthcare systems with limitations to dermatologist-led care.
It is the dermatological knowledge domain that may present the greatest hurdle. I was reminded of the UK Commission on Human Medicines and Isotretinoin Expert Working Group report — delivered in response to growing concerns — which among its many recommendations highlighted current issues related to possible psychiatric and sexual side effects. With respect to knowledge, the report concluded that further research is required to fully understand the risks associated with isotretinoin.2 This example suggests that there is more to be done in this arena for us to safely realise ambitions for primary care prescribing.
What can we as GPs do now? Recognition and early referral practices can undoubtedly support the patient journey and access to prompt treatment. We can continue to advocate for the advancement of primary care dermatology with a focus on safety and adequate resourcing to support this. Above all, we must remain mindful not to underestimate the impact of skin disease, which despite its low mortality rate can have an often-overlooked significant psychosocial impact.
- © British Journal of General Practice 2025
