Askanesthetician's Blog

An esthetician explores skincare issues and concerns

Rethinking Accutane? December 13, 2010

I’ve already written about Accutane (or isotretinoin as it known medically) twice in this blog (see my previous posts:  Why Was Accutane Taken Off the Market? and New Information about Accutane), but when I saw the following article online on Skin Inc. I knew that I wanted to address the issue once again. 

AADA Updates Position on Isotretinoin explains how The American Academy of Dermatology  reevaluated and issued a new position statement on the use of Accutane.  Basically the AADA says that isotretinoin is still the most effective treatment for severe acne, but it needs to be prescribed and used safely and responsibly.  Furthermore, AADA does address the link between isotretinoin and depression and inflammatory bowel disease and finds that there is no conclusive evidence that links taking isotretinoin to either of those ailments/diseases.

William D. James, MD, FAAD, president of the AADA and its sister organization, the American Academy of Dermatology (AAD) said:

Isotretinoin continues to be considered a critically important drug for treating patients with severe acne who fail other therapies.  Isotretinoin offers our patients with severe acne significant, life-changing benefits. Providing this medicine safely is our top priority.

 

I suspect that the controversy over isotretinoin will continue for some time, but it is important to be aware that, as stated above, it a medication that is prescribed when all other acne treatments fail.  Ultimately, it is the only product on the market that actually comes close to offering a cure for severe acne.  Used responsibly and correctly isotretinoin can change someone’s life.  Take it from someone who has been there.

Further reading:  American Academy of Dermatology’s position statement on isotretinoin

 

New Information about Accutane October 14, 2010

Filed under: Acne — askanesthetician @ 8:37 am
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One of the first posts I ever wrote for my blog was called Why was Accutane Taken Off the Market?  in which I explained that while generic versions of the anti-acne drug were still available the original, non-generic version of Accutane had been taken off the market by its manufacturer for “business reasons”.  Speculation was rife at the time that while it was true that the Swiss drug maker Roche could not compete with generics on the market they were also busy fighting off lawsuits from users who blamed their severe stomach problems or depression on Accutane.

Certainly Accutane has been controversial for a number of reasons including the fact that taking the drug while pregnant will cause terrible birth defects.  Another controversy about the drug has been that it can cause depression.  But Norwegian researchers have recently concluded that the depressive side effects long thought to be associated with Accutane are actually a side effect of having acne.  According to the research, which included 3,775 18 and 19 year olds in Oslo, young people with acne have levels of depression and suicidal thoughts that are two to three times higher than those without acne.  Subjects of the study had those thoughts regardless of what type of anti-acne medication they were on.  While not all researchers agree with the findings in the Norwegian study I think it is a very interesting bit of research to share.  I think it makes it abundantly clear that the psychological effects of acne should never be forgotten or dismissed. 

Source and further reading:  Is Accutane as Dangerous as Initially Believed?   Skin Inc. 

 

Why was Accutane Taken Off the Market? January 20, 2010

Filed under: Acne,beauty,Skincare products — askanesthetician @ 11:59 am
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I was very surprised to learn a few months ago that Accutane had been taken off the market.  As I wrote in the “about” section of this blog I suffered from terrible acne as a teenager; my acne was “cured” by a dose of Accutane.  At the time I took Accutane I knew nothing of the potentially terrible side effects, and I was ecstatic with the results.  Yes, I had some unpleasant side effects while I was using Accutane but only while I was using it.  My face turned very, very red and became extremely dry and flaky.  My lips were very dry as well.  Those conditions were embarrassing but no more embarrassing than my acne, and once I finished taking the Accutane my skin was blemish free and no longer dry.  Accutane is considered the last resort in acne treatments because it is so strong.  But Accutane is also the only known “cure” for acne making it, in my opinion, irreplaceable.   

 Additionally, it is important to point out that there are great emotional and psychological side effects of acne, especially severe acne.  Having acne takes a terrible toll on your self-esteem.  Everyone wants to have blemish free skin, yet not everyone seems to be able to achieve it.  I am not talking about getting a occassional pimple around your period but about acne that is wide spread, unattractive, and immediately apparent to everyone who looks at you.  When you have acne in some ways it feels like the whole world has beautiful, clear skin but you.  You become upset enough about how your skin looks that you begin to consider using just about any treatment, cream, dietary supplement, or lotion that is marketed at those suffering from acne.  And then when nothing works you get more depressed about how you look.  The great thing about Accutane is that it can  both help you achieve blemish free skin and help you regain confidence and self-esteem.

What is Accutane?

Accutane (generic name isotretinoin) was first introduced in 1982 and is an oral drug derived from vitamin A.  Essentially Accutane stops oil production in the sebaceous glands and then shrinks those glands.  After this happens sebum cannot clog the hair follicle which sets off the chain of events that eventually lead to breakouts.  Additionally, Accutane decreases cellular buildup in the follicles, kills the acne bacteria, and even controls inflammation.  Once treatment is complete normal oil production returns and sebaceous glands slowly grow larger again, but they never return to be as large as they were originally.  But what is remarkable is that after using Accutane most acne sufferers never experience the level of break-out that they did before taking the drug.  As such it is the closest thing that can be considered a “cure” for acne.  The Food and Drug Administration approves Accutane for the treatment of “severe recalcitrant nodular acne” – in other words acne that is characterized by many inflamed nodules and cysts that are found deep in the skin.  Doctors today may also prescribe Accutane to patients who have acne scars or have a tendency to scar. 

The most common side effect from taking Accutane is very dry and irritated skin.  The single most common side effect is excessively dry lips – up to 95% of Accutane patients have this problem. Other side effects include mild nosebleeds, hair loss, aches and pains, rash, increased sun sensitivity, and headaches.  And those are the temporary side effects.  More severe, though less common side effects, include nausea, depression, severe stomach pain, increased cholesterol levels, and yellowing of the skin.  Of course, the most disturbing problems associated with Accutane are very severe birth defects.  The risk of birth defects are extremely high if the mother was taking, even a small amount of Accutane, during her pregnancy.  Birth defects include heart, brain, and central nervous system defects, abnormally small or asymmetric heads, cleft palates, deformed eyes or ears including infants being born without ears.  Accutane babies generally have severe developmental difficulties or can be born mentally retarded.  Because of these severe birth defects doctors are cautious about prescribing Accutane to women of childbearing age.  If the doctor does decide to prescribe the drug the woman must undergo pregnancy prevention counseling and have two negative pregnancy tests before being given the prescription.  Prescriptions are only given on a month by month basis and are only reissued after a negative pregnancy test is obtained.  There has been much talk about a link between Accutane and depression, but the number of suicides of Accutane users and those hospitalized for depression are very small when compared to the millions of people in the US who have used Accutane without a problem since its introduction in 1982.

Despite the harsh side effects and the very upsetting birth defects that can occur because of Accutane this drug has provided lasting relief and help to millions of acne sufferers.  Though these side effects should not be dismissed lightly the benefits of Accutane must be highlighted.  Accutane has proved to be the cure many people have sought for their severe breakouts.   

Why was Accutane Taken Off the Market?

Accutane was manufactured by the drug company Hoffmann-La Roche Inc.  Hoffman-La Roche Inc. said in a statement that they pulled Accutane from the market because of “business reasons“.   Indeed Accutane, when it was pulled from the market, only made up 5% of the isotretinoin product sales.  But perhaps more tellingly Hoffman-La Roche has and continues to fight lawsuits brought by patients who suffered some of the more extreme and terrible side effects of Accutane.  The newest lawsuits against Hoffman-La Roche involve plaintiffs who developed Inflammatory Bowel Disease (IBD) after using Accutane.  A simple google search to  find out information about lawsuits involving Accutane turns up over 350,000 hits.  There seem to be plenty of law firms out there who are willing to take on such a case.

So now that it seems pretty clear why Hoffman-La Roche Inc. pulled Accutane from the market what is someone to do who suffers from severe acne and who has tried lots of different treatments to no avail?   Even though Accutane is no longer available generic versions of the drug are.  Three such generics are currently available:  Amnesteem™, Claravis™, and Sotret®.

Bottom Line:  Judging by my own experience with Accutane would I recommend its use?  Definitely, but only if you are under the direct and constant supervision of a doctor.  Your doctor should educate you on the side effects and risks of taking a version of Accutane, but you should be sure to educate yourself as well.

Here are two great resources for more information about Accutane and about acne in general:

http://www.acne.org/accutane.html

Breaking Out by Lydia Preston

For some new research about Accutane see my post:  New Information About Accuntane

 

 
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