Accutane, A Cure and a Problem

Every day a young person opens their eyes to another blemish or a fiery breakout and wishes there was a magical cure to the most hated disease by teenagers and some adults,acne. There are face washes,wonder creams and complete systems on the market such as Proctive or Clear or Aveeno. People with the most severe cases of acne have tried every one ,spent hundreds of dollars and found they do not work. People are visiting Dermotologists more frequently to find answers to the perplexing problems of acne and the question of,"Why me?" The truth of the matter is the gene pool is a complex system and everyone's DNA ladder is completely different. Some people escape the horrors of acne completely, others have the typical two year horror story and then it clears up. There are a select amount of people that have occasional flare ups which subside on their own. Then there are the unfortunate people that are diagnosed with cyclic acne. For these people the treatment of course turns out to be accutane. Accutane is a cure but is it over prescribed and is this being done haphazardly without real consideration for the consequences? Acne vulgaris, the medical term for typical acne, is the most common skin disease. It is so common that nearly eighty-five percent of the population will develop some form of acne at some time between the ages of twelve and twenty-five years. Although there are several theories about what causes acne, medical doctors generally agree that acne is a by-product of hormonal changes in the body. At puberty (that period of life when a child develops secondary sex characteristics), increased levels of androgens (normally referred to as the male hormone) cause the sebaceous glands to produce to much sebum. The sebaceous glands lie just beneath the skin's surface. They produce an oily substance called sebum, the skin's natural moisturizer. These glands and the hair follicles (the tube like structures from which hair develops) within which they are found are called sebaceous follicles. These follicles open into the skin through pores. When excess sebum combines with dead sticky skin cells a hard plug, or comedo is formed. If comedones are open to the surface, they are called blackheads. Comedones that are closed at the surface are called white heads. Plugged follicles can rupture internally, resulting in a discharge of their contents into the surrounding tissues. A comedo is the mildest type of acne.
Moderate and severe inflammatory types of acne are the result of plugged follicles being invaded by the bacteria that normally lives on the skin. The role of the bacteria is unclear. Bacteria may act by causing chemical reactions in the sebaceous fluid, leading to the release of very irritating compounds called fatty acids. These in turn cause inflammation that increases susceptibility to infection. A pimple forms when the damaged follicle weakens and bursts open, releasing a substance (sebum, bacteria, and skin) into the surrounding tissues. Pimples that are near the skin's surface and are inflamed are called papules. When pimples are deeper they are called pustules. This process begins an inflammatory response that sets the stage for the development of acne.
Specialists are unable to detect the exact cause of acne, but there are many risk factors that have been identified with the contribution of developing acne. Diet does not cause acne, but certain foods can cause flare-ups. However, eliminating certain foods, particularly chocolates and fats, appear to improve some cases of acne. Teenagers are more likely to develop acne, due to hormonal changes they experience. Boys tend to develop more severe acne than girls, as well as more often. Acne can also be a side effect of drugs including antibiotics, tranquilizers, oral contraceptives, and antidepressants. Hormonal changes during pregnancy and menopause can also contribute to flare-ups of acne. In addition, emotional stress seems to contribute to acne.
Acne causes raised swellings, most frequently on the face, neck, shoulders, and back. Acne is not usually conspicuous, although the inflamed lesions may cause pain, tenderness, itching, or swelling. The most troubling aspects of these lesions are the negative cosmetic effects and potential for scarring. Some people, especially teenagers, become emotionally upset about their condition. For persistent acne, a doctor may prescribe an oral antibiotic or an antibiotic that can be applied directly to the skin. These drugs include tetracycline, enthromycin, and doxycycline. These antibiotics act to decrease inflammation and bacterial growth to prevent new comedone formation. Another drug, isotretinion, is used to treat severe cystic acne. It is usually not prescribed, however, unless all other acne treatments have failed. This drug works temporarily suppressing the production of secretions by the secretion glands. It is important to note that this drug can have very serious side effects and should never be used without the knowledge and supervision of an experienced medical doctor. Acne is not curable, although long-term control is achieved in a high percentage of patients treated with isotretinion. It can be controlled with the proper treatment, with improvement taking two or more months. Acne tends to reappear when treatment stops, but spontaneously improves over time. Acne is caused by an accumulation of dry skin and oil that stops up the pores of the skin. This substance try's to move towards the surface of the skin and the irritation that ensues is followed by infection due to the blockage. 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. " (I-Pledge)
There are less serious side effects, such as 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 conditions (Kirin). 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. 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. Doctors are hoping with education and fear the I -Pledge program will be successful. If it fails Accutane will fail in the FDA marketplace. 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 drugs to prove they work. Pharmaceutical companies and doctors work hand in hand with each other, so it is no surprise that they are constantly prescribing medications. According to a doctor who practices Traditional Chinese Medicine (TCM) Shaobai Wang, M.D., "We consider that everything is related. The weather, diet, and season and other such factors can have pathological effects on human functioning. For TCM science, everybody is different; every problem is different We treat disease according to the method of differentiation." (Taylor). It is no surprise that people and dermatologists alike speak about breaking out during times of stress, when the weather changes, or how women break out before their period. Every single person is made different, and every person's body reacts differently to various forms of therapy. Who is to say that Accutane, which is large doses of a synthetic form of vitamin A, is the only cure for acne while it could be that the person is just deficient in another vitamin or mineral?
Originally, essential fatty acids (EFAs) were believed to store energy in the form of fat. But now we know that is not true. Now we know they are used in the body for numerous biological functions, such a the manufacture of hormones and prostaglandins. Prostaglandins work similarly to hormones. In a study published in the American Academy of Dermatology it shows that people who suffer from acne have a deficiency of linoleic acid, an EFA, in their skin. This deficiency is accredited to an overabundance of hydrogenated fats according to researchers (Taylor). Dr. Haines Ely sometimes uses pantothenic acid, more commonly known as vitamin B-5, for her patients who claim they do not wish to go on antibiotics or Accutane, or who are allergic to certain topical medications. Research published in the Journal of Orthomolecular Medicine by Dr. Lit-Hung Leung has shown that large doses of B-5 have dried up most patients skin the same way Accutane does (Palkhivala). The toxicity level for B-5 is very high, and there are only a few minor symptoms such as diarrhea, water retention, and sensitive teeth. This seems like a much more pleasant alternative to Accutane.
A mineral that is crucial for maintaining clear skin is zinc. Organisms invading the skin's surface are destroyed when antibodies are triggered by zinc. The American population has an extensive deficiency of this mineral. As the result of minimal deficiencies, teens often develop acne, according to Dr. Carl Pfeiffer. A study published in Pediatric Clinics of North America, "Twenty-seven patients with severe acne were given a placebo, while 29 received zinc sulfate daily. After 12 weeks, none of the placebo patients showed improvement, while 58 percent of the zinc-treated patients experienced marked improvement on their acne." (Taylor).
There are a couple other vitamins and minerals in which scientists believe people who suffer from acne are deficient: chromium and vitamin A. The skin is part of the epithelial system in the body. Skin cells divide at a very rapid pace, and vitamin A is crucial for new cell growth. Levels of vitamin A in the blood are significantly lower in patients with severe acne, according to a study published in the British Journal of Dermatology. About ninety percent of Americans are deficient in chromium. Research has shown that, "The more insulin the body uses to process sugars following meals, the more chromium the body uses." A study printed in Medical Hypotheses shows that people with irregular blood glucose levels also experience irregular acne (Palkhivala).
Anthony Chu, F.R.C.P.C has done research on the belief that acne is an immunological disease. Immunology is the study of the immune system in all organisms. Studies have shown that acne has been successfully treated using a low fluence pulsed-dye laser (PDL). Research published in the Lancet of 41 adults with mild to moderate acne showed that 53 percent of acne lesions had disappeared when given PDL treatment for 12 weeks (Palkhivala).
Everyone has the right to make their own decision about which method they think is best to fight acne. What people don't realize is that there are alternatives to what a doctor may prescribe. While one man may believe there is a certain path to follow when it comes to medicine, there may be another man who takes a different but equally effective path. Taking supplements and taking a more natural approach may require more self motivation than seeing a doctor and getting a pill. But thanks to the iPLEDGE program it may not be so easy to get Accutane anymore. Some people may think this is a nuisance, but in the long run it may help to open peoples' eyes to let them see what a potentially dangerous drug it is, and what can alternatively be done to treat acne.

Works Cited
"Brain Imaging Studies Suggest a Link Between Accutane and Depression." The Brown University Child and Adolescent Psychopharmacology Update 7 (2005): 1 - 7.
Cuzzell, Janice Zeigler. "FDA Approves Mandatory Risk Management Program for Isotretinoin." Dermatology Nursing 17 (2005): 383.
Kirn, Timothy F. "Isotretinoin Rx Plan Delayed." Family Practice News. 35.24 (2005): 32
Miller, Michael C. "Questions and Answers." The Harvard Mental Health Letter. 22 (2005): 8
Palkhivala, Alison. "Looking Outside Box' for Acne Treatment: Some Psysicians Report Success with Vitamins, Herbs, Lasers, Acupuncture." Dermatology Times. 25.12
(2004): 20.
Taylor, Deborah Seymour. "Zinc and EFAs Fight Acne; Essential Fatty Acids, Along with the Trace Mineral Zinc, are Vital for Acne Treatment." Today's Living. 21.3 (1990): 10.
Walsh, Nancy. "iPLEDGE Registry Back on Track Despite Delays: Patients Not Registered and Activated in the System by March 1 Will Not be Able to be Prescribed Isotretinoin." Family Practice News. 36.3 (2006): 33.

Accutane A Cure and A Problem