I am a strong supporter of Accutane.
It can be life changing and prevents severe scarring and a lifetime of pain and stigma.
Please read this article. Those Lawyer ads you see on TV labeling Accutane "A Bad Drug" are not based on science. Reports of Depression and IBD are wildly exaggerated and are associated with severe Acne itself and not with Accutane.I have personally treated hundreds of patients with accutane since 1999. It is not the first drug I prescribe and I do monitor my patients regularly. Having said that; it is a great drug for severe inflammatory and scarring acne:
Dermatologist evaluates latest isotretinoin developments for treatment of severe acne
DENVER, Colo. (March 21, 2014) —
Recent studies cast new light on reported side effects while new dosing and formulation could improve treatment outcomes
OVERVIEW:
Since
its introduction in the early 1980s, isotretinoin has been the
treatment of choice among dermatologists for patients with severe acne
that has not improved with other acne therapies. This painful form of
acne produces deep cysts, inflammation, and scarring, which can wreak
havoc on the skin and severely impact a person’s emotional well-being
and overall quality of life.
It's not for
everyone, but isotretinoin has proved to be the only therapy that can
clear severe acne and provide long-lasting results. However, its
reputation has been marred over the years by reported side effects and
misconceptions about this potent drug. Now, new research disputes the
link between isotretinoin use and inflammatory bowel disease (IBD), and
provides evidence that suggests other medical conditions may be to blame
for the drug’s association with psychiatric conditions. In addition,
high-dose isotretinoin therapy and a new formulation could help some
patients achieve even better results.
AMERICAN ACADEMY OF DERMATOLOGY EXPERT
Information
provided by board-certified dermatologist William D. James, MD, FAAD,
professor of dermatology at the University of Pennsylvania School of
Medicine in Philadelphia.
ASSOCIATIONS WITH IBD, PSYCHIATRIC CONDITIONS EXAMINED
New studies dispute IBD link
After
isotretinoin was first introduced, there were some reports of IBD
(which encompasses both Crohn’s disease and ulcerative colitis)
occurring or getting worse in patients using isotretinoin. Dr. James
explained that by the mid-2000s, papers published in gastrointestinal
journals reported that isotretinoin could cause IBD — resulting in
several lawsuits stemming from this relationship. Interestingly, 88
percent of IBD-related cases reported on the Food and Drug
Administration’s (FDA) Adverse Event System were determined to be
entered by attorneys rather than patients or physicians.1
Two new studies published in 2013 closely examined the relationship between isotretinoin use and IBD.
- The
most recent and statistically significant studies deny an association
between isotretinoin and IBD, and instead implicate a possible link
between acne severity and IBD.2,3
- Severe acne is
seen in inflammatory diseases such as SAPHO syndrome (which includes a
variety of inflammatory bone disorders that may be associated with skin
changes) and PAPA syndrome (a rare genetic disorder characterized by its
effect on the skin and joints), which were both found to be associated
with IBD.4
- On average, IBD begins at age 19,
which is close to the same age when a patient might develop severe acne
and be treated with isotretinoin.
Based on these new
findings, Dr. James and other dermatologists believe severe acne itself
might predispose a person to IBD, regardless of whether acne is treated
with isotretinoin. Dr. James educates his patients about the scientific
research concerning the possible association with IBD and monitors for
it in patients taking isotretinoin. He recommends his colleagues follow
this same course of action.
Acne, attention deficit hyperactivity disorder (ADHD) and depression
Psychiatric
side effects in patients taking isotretinoin — mainly depression — have
been reported and studied for several years. A new observation includes
an increased risk of Attention Deficit Hyperactivity Disorder (ADHD) in
some patients with acne.5 Dr. James stressed that this
association is not related to isotretinoin use, even though acne
patients with ADHD may be taking this drug. Because ADHD is associated
with an increased risk of suicide, Dr. James noted that a number of acne
patients with ADHD may already be at a higher risk of depression
regardless of whether they are taking isotretinoin.
- One
recent study examining mood changes in a small group of patients taking
isotretinoin found a marked improvement of psychiatric symptoms in
conjunction with improved acne.6
- In a study that
examined a large number of acne patients taking isotretinoin, Dr. James
explained that there was a reported negative effect on mood in a small
number of patients — likely about four per 1,000 in his estimates.
Despite
the low risk of depression with isotretinoin use, Dr. James always
checks for pre-existing mood disorders before prescribing isotretinoin
and educates all patients taking this drug thoroughly about this
controversy. He also insists that someone close to the patient — a
roommate, parents, spouse — is made aware that the patient is taking
isotretinoin so he or she can help monitor for any unexplained mood
changes during the course of treatment.
NEW HIGHER DOSAGES, NEW FORMULATION
Benefits, Risks of High Dose Isotretinoin Examined
One
of the key benefits of isotretinoin in patients with severe acne is
that use of the drug has been shown to successfully treat acne and lead
to long-term remission of the condition. About half of all patients
taking isotretinoin may relapse following treatment and require
additional use of isotretinoin or a milder topical or oral acne therapy,
but new research suggests that using a higher dose of isotretinoin
could provide longer-lasting results.7,8
- Dr.
James cautioned that higher doses can increase the chance of side
effects — primarily severely dry skin, nosebleeds, inflammation of the
lips, triglyceride elevations, and psychiatric or mood disorders.
- In some cases where a high dose has been prescribed, a temporary worsening acne flare has been reported.
- Benefits
of standard-dose isotretinoin use include milder side effects and an
increased likelihood that patients will take their medication as
directed.
New formulation increases absorption
A
new isotretinoin formulation allows the medication to be better
absorbed and circulated within the body — even without being taken with a
fatty meal, a requirement in isotretinoin use that poses a challenge
for some patients. Based on initial studies with this new formulation,
Dr. James believes it is likely to enhance results as patients are
absorbing more of the dosage.
- If a patient does
not eat a fatty meal with isotretinoin, the patient only absorbs about
40 percent of the prescribed dose. With the new formulation, a patient
will absorb about 70 percent of the prescribed dose even if the patient
does not eat a fatty meal.9
- The higher cost of the new formulation could limit its use initially.
- Patients
who are not responding to isotretinoin or eating fatty meals with the
medication may be good candidates for the new formulation.
AMERICAN ACADEMY OF DERMATOLOGY EXPERT ADVICE:
“Isotretinoin
remains the gold standard for treating severe acne, but there are many
aspects that must be taken into consideration before it is prescribed,”
said Dr. James. “It is important that dermatologists and patients who
are good candidates for isotretinoin — along with friends or family and,
in some cases, other physicians — work together to ensure the safest
and most effective treatment outcome. It is encouraging that new studies
continue to be conducted on the use of isotretinoin, and I expect more
studies will further expand our knowledge of this powerful and effective
medication in the future.”
Headquartered
in Schaumburg, Ill., the American Academy of Dermatology (Academy),
founded in 1938, is the largest, most influential, and most
representative of all dermatologic associations. With a membership of
more than 17,000 physicians worldwide, the Academy is committed to:
advancing the diagnosis and medical, surgical and cosmetic treatment of
the skin, hair and nails; advocating high standards in clinical
practice, education, and research in dermatology; and supporting and
enhancing patient care for a lifetime of healthier skin, hair and nails.
For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org. Follow the Academy on Facebook (American Academy of Dermatology) or Twitter (@AADskin).
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