Dr. Diane Thaler
If there’s one thing that breaks my heart, it’s seeing people who are suffering needlessly. The teenager who walks with his head down. The middle aged man who never goes to the beach. Or, the patient who specifically seeks work that will not require much contact with other people. Acne is to blame in all these cases.
If you’ve never had acne, it’s easy to downplay the significance of this common skin problem. Zits aren’t the end of the world, right? No, but the social effects can be devastating, as acne can sap one’s self confidence and possibly cost somebody a job he or she might be well qualified for.
Acne is most common among adolescents, but it can be a lifelong malady as well.
And although it is a treatable condition, many people still struggle with it. Part of the reason for that may be that the treatments they tried when they were younger were ineffective.
In my experience as a dermatologist, I have noticed that the single most effective medicine for acne is being significantly underused. Isotretinoin, a derivative of Vitamin A, is an incredible drug, albeit expensive, that has been around since the 1980’s. Chances are you’ve heard of it by its more common name, Accutane.
When this medicine was first approved, it was reserved for only the most severe forms of acne. But over the years, we have found how effective it is at clearing varying degrees of acne to the point of actually curing some patients once and for all.
One of the good reasons for why it was not prescribed widely was that Isotretinoin, like other medications, does cause side effects. One of the most serious ones is that it can cause terrible effects on a developing fetus. Therefore, any woman contemplating pregnancy cannot be on this medication. Period.
It’s my opinion that some physicians avoided prescribing this medication for fear their young patients might ignore their warnings. Other potential effects are that the drug may cause brain swelling or depression, although this is very unlikely. However, it should be noted that commonly prescribed antibiotics used to control acne also pose a small risk of brain swelling.
Much more likely side effects from Isotretinoin are extremely dry lips during the duration of treatment and an increase of fat in one’s blood. But in both instances, vigilant patients can deal with those problems by adjusting their diet and using lip balm.
In responsible patients, Isotretinoin is the gold standard for treatment of acne. It seems to work by affecting the DNA in the cells of our oil glands. It acts to normalize the cells, reprogram them, if you will, to the time before adolescence. It’s interesting to note that Vitamin A derivatives are used to treat and prevent cancer because they tend to normalize abnormally growing cells.
The dosage and duration of Isotretinoin treatment depends on the severity of the acne and the patient’s weight. And the cure rates vary, according to the patient’s age. The problem may actually worsen, initially. But that’s only temporary. Recurrence of acne is quite possible after the treatment ends, but another round can always be given. The amount of Isotretinoin given is the amount each patient needs to clear his or her acne. However, the physician who administers this drug should be very familiar with it, and I highly recommend patients seek treatment directly from a dermatologist.
When appropriately prescribed, this medicine is so effective, it can eliminate the awful grease, and make the patient’s skin as smooth as a baby’s bottom. (Unfortunately, if scarring already has occurred, even this medicine can’t reverse that situation.)
We can do this. We can do it now. It is a shame that the fear of side effects often prevents many of my colleagues from prescribing this medicine. Properly managed, Isotretinoin can be the medicine many acne sufferers have dreamed about. Isotretinoin is not necessary, nor appropriate for every acne case, but it certainly deserves consideration when other medicines fail or barely improve the patient’s complexion.
Unfortunately, too many people are unaware of how well Isotretinoin works or have been mislead about whom is a good candidate for it. So unfortunately, because their acne remains essentially untreated, they continue to suffer quietly and avoid social situations whenever possible.
I believe their suffering is the legacy of a phenomenally effective medicine that has simply gotten a bad rap.
By: Diane Thaler, MD
State Medical Society of Wisconsin
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Dr. Diane Thaler, of the State Medical Society of Wisconsin, is a Sturgeon Bay dermatologist. She has no financial ties to Isotretinoin or its maker.
