Accutane. Say it loud and there’s legal briefs building…
So – it’s the scourge of hyperactive oil glands, the salvation of many a cyst-ridden teenager, and currently being lined in the crosshairs of many a lawyer with a lecherous eye on big pharma’s deep, deep pockets. Accutane is becoming quite a contentious, pot-boiler of a subject. But let’s start at the very beginning:
First came the oil gland. Stimulated by hormones, the oil gushes, mixing with skin cells to form a glue that seals pores shut. Pimples propagate of all varieties, occassionally building to Grade 5 acne – threat level red for sufferers. Grade 5 requires immediate and drastic steps because this type of acne – defined by deeper, nodular, painful lesions -- can lead to scarring (both physical and mental, as any teenager who has suffered from it will tell you).
Enter Accutane. Doctors prescribe Accutane for Grade 5 acne, especially when it’s proven to be impervious to other treatments. Accutane is ‘isotretinoin’ a retinoid similar in respects to those we discussed in this article.One main difference is it’s a systemic treatment, not a topical one. Accutane is a pill, and taken twice daily over four to six months will actually decrease the amount of oil your skin produces. It usually comes with side effects – chapped lips, dry skin and itchiness, and sometimes mild nosebleeds (after all, it’s messing with the body’s lubrication system), but work in a dermatologists for a while, or just talk to someone who took it in their teens and you will inevitably hear the word ‘miracle’. It’s rare that anything lives up to its promise as thoroughly and consistently as Accutane.
One thing that needs emphasis up front, especially if this is a route you’re considering: Accutane is tetragenic – it causes fetal damage. So it’s imperative that any woman of child-bearing age not get pregnant during or right after a course of Accutane – in fact there’s a federally mandated program that requires women get two pregnancy tests before starting and monthly pregnancy tests while on the treatment.
Now there’s a second problem with Accutane that’s more alleged than proven and has whipped up a lot of legal frenzy: depression. There have been some suicides committed by patients taking Accutane, and grieving parents have sought counsel. No one knows whether these patients would have done so whether or not they were on Accutane – although one study contends there was no greater percentage of suicide for acne patients taking Accutane than acne patients taking antibiotics. As there is no way to say definitively whether it can or cannot affect moods – the research and science just isn’t there - we must consider it a possibility.
But I wonder, given the demoralizing effect acne has on many teenagers – how many suicides has it prevented? One early study noted that treatment with Accutane brought ‘significant reductions in anxiety… with mitigation of anxiety and depression most robust in those patients with the greatest… improvement’. Food for thought, anyway.
Many of us who have seen lives literally turn around because of Accutane are concerned that the current litigious environment will sink it even deeper in a swamp of ass-covering paperwork. It’s never been a big ticket item for dermatologists and if anything, now it’s going to offer negligible profit with the administrative costs involved… at some point they will just throw up their hands and stop prescribing it. Many have already.
