Teenager’s death ruled suicide by coroner

A coroner has ruled out a direct link between a 15-year-old girl’s suicide and the teenager being prescribed a drug to treat her acne.

Jonathan Leach said the evidence from experts on a potential link between Isotretinoin and self-harm was that there was “no settled and agreed view”.

Annabel Wright was found in her bedroom by family members at her home near Ripon North Yorkshire in May 2019 after being prescribed the drug six months previously.

Mr Leach recorded a conclusion of suicide after hearing that the teenager had sent messages to friends on Snapchat saying she was in a low mood and “life is not worth living”.

After her death, police also found a picture Annabel had drawn of Kermit the Frog hanging from a noose.

She had also “scratched” her wrists with a razor in January 2019, shortly after she had been heard laughing on the phone to her friends in her bedroom.

The teenager’s parents believe their daughter’s death was linked to the medication, which is also known as Roaccutane.

The inquest in Northallerton had heard conflicting evidence from two expert dermatologists, Professor Anthony Chu and Dr Sarah Wakelin, on whether the Isotretinoin had contributed to Annabel’s death.

Mr Leach, the assistant coroner for North Yorkshire, said Prof Chu’s assertion that Annabel’s death was linked to taking the Isotretinoin “was clearly outside his level of expertise”.

“Overall, he lacked the objectivity I look for in an expert,” he said.

“In contrast, I find Dr Wakelin to be measured and be prepared to qualify her view and evidence and to say when a question was outside her area of expertise.

“For these reasons where there is a conflict, I prefer the evidence of Dr Wakelin.”

Recording his findings, Mr Leach said: “There is no evidence the balance of Annabel’s mind was disturbed and the fact she took her own life does not in itself mean the balance of her mind was disturbed and, if it was, there is no evidence that this was caused or contributed to by Isotretinoin.

“The only evidence was from Annabel’s parents, who could not concede of any other reason why she would take her own life, and that of Prof Chu, and that part of his evidence was outside of his area of expertise.”

The inquest heard that Annabel saw her GP about her acne at the age of 12 and was later referred to Harrogate District Hospital when she was 14.

Her mother, Helen Wright, told the inquest her daughter had shown no signs of depression and her death “just didn’t make any sense”.

Mrs Wright added: “I wasn’t made aware that suicidal impulses could overcome a perfectly normal person.”

Annabel’s father, Simon Wright, told the inquest: “There was no precursor of depression, mood change, being morose or anything like that.

“Annabel was Annabel and that’s why I believe it was linked.”

The inquest heard that Annabel was seen by two different dermatologists, Dr Ibtessam El-Mansori and Dr Alison Layton, before she was prescribed Isotretinoin.

Dr Layton said she explained “all adverse effects” of the treatment to patients and their parents, including the small risk associated with depression and suicide.

In his findings, Mr Leach said the decision to prescribe Isotretinoin was reasonable and the formal consent process was followed.

“I am satisfied on the question of suicide and a link with Isotretinoin was raised and Dr El-Mansori advised that no causal relationship had been established, and where a suicide occurs there would be other contributory factors.

“I am satisfied the Dermatology Association leaflet was given and she wanted Annabel and Mrs Wright to consider her advice and in the interim period prescribed a different antibiotic.

“I do not accept that Annabel and Mrs Wright were not properly advised about the risks of taking Isotretinoin at all and I find the treatment options discussed and recommended were correct and proportionate.”