Acne

Total words: 1734

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 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.

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