Isotretinoin is a very effective therapy for severe and persistent acne. It is not recommended for pilots, because of the possibility of mood changes and depression, and the association with photophobia and night blindness (nyctalopia) while on treatment. Additionally, dark adaptation may be affected permanently in some individuals. Animal models show that the effects of isotretinoin on retinal function reverse rapidly within several days after cessation of high dose treatment.
Medical certification (Class 1 and 2) is not possible whilst taking isotretinoin.
For all those with a history of isotretinoin use, a detailed history must be taken to include questions about low mood and night vision e.g. night driving.
In the last two weeks…
Psychological questions recommended by the British Association of Dermatologists include:
For most of the last 2 weeks….
If review is satisfactory, Class 1 certification can be considered through referral to the AMS and Class 2 certification can be considered in consultation with the AMS.
If there are any concerns about night vision, then further assessment will be necessary prior to making a certificatory decision. This should involve appropriate examination, such as electrophysiological testing and dark adaptatometry, to determine whether there is any detrimental impact on night vision. If the pilot is found to have a demonstrable nyctalopia, a medical flight or simulator test may be required, depending on the degree of severity. For pilots with demonstrated nyctalopia enough to cause concerns for night flying, a VCL limitation will be required.
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