Guidance on assessment
following completion of treatment
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
Medical certification (Class 1 and 2) is not
possible whilst taking isotretinoin.
o Existing certificate holders: shall be made unfit
until off treatment for 2 weeks or more followed by a fit assessment by the AME
– see below.
o Initial applicants: defer initial medical until has
been off treatment for 2 weeks or more followed by a fit assessment by the AME
– see below.
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…
o Do you have difficulty adapting from brightly lit
rooms to dark places?
o Do you suffer eye-strain at sudden bright lights?
o Do you have any difficulty seeing the stars on a
o Do you have stress, anxiety or fear of driving in
the evening or at night?
o Do you have difficulty seeing colours at night?
Psychological questions recommended by the British
Association of Dermatologists include:
For most of the last 2 weeks….
o Have you been feeling unusually sad or fed up?
o Have you lost interest in things that used to
interest you, or gave you pleasure?
More extensive screening using a validated
questionnaire may be helpful. The Beck questionnaire, the Baer HANDS
questionnaire, or the 6 question screening tool advocated in a BMJ review may
If review is satisfactory, Class 1 certification
can be considered through referral to a CAA Medical Assessor and Class 2
certification can be considered in consultation with a CAA Medical Assessor.
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 adaptometry, 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
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