A Cure Can Cause More Problems

Almost every day it seems like there is a new treatment out to cure one of America’s most hated disease: acne. Whether it is a new face wash, a miracle cream, or a skin care system such as Proactive, the sufferers with the most severe cases have no use for these products. They are turning to their dermatologists for help, and are usually being prescribed Accutane. Is Accutane the one and only cure, or are doctors over-prescribing this drug while acne could be more safely treated before utilizing this as a last resort?

Acne is caused by an excess of dry skin and oil which plugs the skin’s pores. As oil continues to try to reach the surface of the skin the pore becomes infected because it is blocked. This results in a blemish and is often red and swollen. For many years, dermatologists have known that the hormonal differences at puberty trigger an overproduction of sebum. This overproduction is also a result of an over-production of androgens (male hormones) in women over the age of twenty. (Taylor). Some people may only have a few blemishes at a time while there are other people who have a more severe form of acne, which can cover the face and cause scarring. For this form of acne, many dermatologists will prescribe Isotretinoin, more commonly known as Accutane. This is supposed to be used as a last resort drug.

Accutane does not come without any serious side effects. In the package insert for the drug it states

Birth defects which have been documented following Accutane exposure include abnormalities in the face, eyes, ears, skull, central nervous system, cardiovascular system, and thymus and parathyroid glands. Cases of IQ scored less than 85 with or without abnormalities have been reported. There is an increased risk for spontaneous abortion and premature births have been reported.

There are less serious side effects, such has dried skin and nasal passages, peeling skin, thinning hair, brittle nails, joint pain, high blood lipid levels, weakened night vision, headache, and liver inflammation (Miller). These side effects are both a nuisance and dangerous.

Isotretinoin is a synthetic form of vitamin A. As attested by Dr. Michael Miller, “High doses of vitamin A can cause headache, depression, fatigue, irritability, aggression, even personality change and psychosis -- a syndrome called hypervitaminosis.” According to FDA case reports, Isotretinoin has a high occurrence of reports of depression and suicide (Miller 1). A part of the brain known as the orbitolfrontal cortex, which is presumed to control symptoms of depression, has shown a decrease in brain metabolism as a result of Isotretinoin (“Brain Imaging“ 1). An article in the Brown University Child and Adolescent Psychopharmacology Update says, “The association is still controversial, however, because up to 5.6 percent of patients with moderate cases of acne may have pre- existing suicidal ideations (6). If patients are suffering from depression before going on Accutane, why are doctors prescribing this drug that allegedly can lead to depression, possibly making it worse?

In order to decrease the number of women who have become pregnant while on Accutane, the Food and Drug Administration (FDA) approved a system that would require patients, pharmacies, and doctors to use a program called iPLEDGE in order to control use of the drug (Cuzzell). According to the iPLEDGE website, the system is used to ensure that women do not use Isotretinoin if they are pregnant and that no woman becomes pregnant while on Isotretinoin. It requires patients to meet specific criteria and to verify that it is continuously met on a monthly basis before receiving their prescription every month. This program is a result of the failure of the SMART (System to Manage Accutane-gelated Teratogenicity) which was used prior to iPLEDGE on a completely voluntary basis. Much of the time prescribers were not receiving any kind of communication or reminders to really keep the SMART program in place. In order to ensure that iPLEDGE did not fail like the SMART program, it was delayed 1 to 2 months from its original launch date (Walsh). A source from the FDA stated, “We need time to iron things out--it’s a very complicated task.” (Kirn). One of the major reasons the program was implemented was for patients to assume more responsibility if pregnancy does occur, and for doctors to be less liable (Walsh). Doctors cannot control what their patients do outside their office, but the iPLEDGE program is there to ensure that the patients know what the repercussions are if they do get pregnant. This program seems a lot stronger than SMART, and hopefully it will not fail. If it does, doctors are going to have to find alternatives to Accutane.

There are a number of natural approaches for treating acne which a lot of doctors fail to try. There has been extensive testing on pharmaceutical