How far would you go for a flawless complexion? Would you risk your mental well-being, physical health, or even your life, for a picture-perfect reflection? Today, more and more Americans seem willing to take that chance. The most common skin disorder in America is one called acne vulgaris, a chronic condition caused by excess oil production from sebaceous glands which causethe skin’s hair follicles to become plugged, inflamed, and infected. Affecting an estimated 17 million people in the United States, acne usually begins during the teenage years, when hormonal changes start and stimulate the sebaceous glands.
However, an unlucky percentage cannot seem to outgrow the stubborn breakouts and suffer from this physically and emotionally scarring disease well into adulthood. Astoundingly, about 25% of adult men and up to 50% of adult women have had acne during their adult lives, and women who have bypassed the acne portion of adolescence may develop persistent adult-onset acne once they reach their twenties.
A powerful drug called Accutane, the biggest breakthrough in acne treatment over the last 20 years, is the only treatment that has the potential to permanently clear severe or persistent acne after only five months of treatment. It is the drug of “last resort,” turned to when all other options,such as prescription creams and antibiotic therapy, have failed.
Accutane is the closest the medical field has come to finding a “cure” for this disfiguring condition, and although it is highly effective, it also has the potential to be extremely dangerous. With side effects ranging from liver failure to loss of vision, depression to suicide, bowel diseases to bone disease, an acne patient may be left anxious and on the fence about jumping on the “Accu-train,” despite the fact that their condition is deeply affecting their quality of life.
Daniel Kern, long-time acne sufferer and founder of Acne.org, an online community composed of those dealing with the disorder, started getting acne at age 11 or 12, and was prescribed many topical creams, oral antibiotics, and countless other treatments. and was still unable to curehis acne. And while Accutane has been accused of causing serious psychiatric problems including depression and suicidal behavior, it is the acne in and of itself that has been revealed to have the most profound social and psychological impacts.
“My skin plummeted to levels I had never seen. I didn’t want to leave my room,” explains Daniel on his site. “By this point, I also had acne on my back that was bad enough that I would never consider removing my shirt for anyone, even in front of my roommate. I had severe cystic lesionson my back and many pustules. At my low point, I would not look at myself in the mirror. I just kept the light off in the bathroom.”
The feelings that Daniel experienced – those of embarrassment, unworthiness, frustration, hopelessness, negative body image, etc.- are severe symptoms of low-self esteem which, if left untreated, can lead to depression and even thoughts of suicide. For people with severe acne, Accutane can be a godsend.
It is actually a vitamin A derivative that works through drying out the sebaceous glands and decreasing sebum production, while simultaneously and indirectly reducing colonization of the bacteria that contributes to acne, Propionibacterium acnes, or P. acnes. Basically, it creates anundesirable environment for acne to exist, and as a result, those painful, red lumps beneath the skin that can cause permanent scarring diminish and can no longer form. The drug typically takes between two to three months before significant improvement is seen, but once it kicks in, the results can be both dramatic and incredible. For Daniel, the transformation occurred even sooner and within a month his face was absolutely, completely clear.
“My skin became perfect, and that is not an exaggeration. It was a beautiful experience. I became ‘popular’ for the first time since my acne erupted in middle school,” said Daniel. “I had a great time going out with friends, speaking to people without averting my eyes, and confidently livingmy new life.”That is not to say that the drug is for everyone, as an unlucky 10% of people do not respond to it and 15% have their acne come back, as Daniel did, requiring a second or third course. And along with its great benefits, there are many risks involved with taking it. The FDA has recently made it more difficult to obtain the drug, since it could potentially cause significant birth defects, miscarriage, and premature births. The strict regulations known as “iPledge”, require that women of childbearing age pledge to use two separate, approved forms of birth control for one month before, while taking, and for one month after stopping Accutane, in order to prevent pregnancies during treatment. A monthly blood pregnancy test is taken throughout the duration of treatment, along with tests to check the liver, kidneys, blood count and blood fats, as Accutane can increase the level of triglycerides in the blood, affecting cholesterol levels.
Other common side effects of the medication include dry eyes, mouth, lips, nose or skin, itching, nosebleeds, joint and muscle pain, sun sensitivity and poor night vision. In some people, Accutane can also have negative effects on the nervous system, intestines, eyes and skeletal system. However, for those suffering with severe acne, the risks seem to be entirely worth the outcome.
A St. John’s University student, who wishes to remain anonymous, accredits Accutane for turning his life around. “Having suffered from acne most of my teenage years, this was a miracle cure for me,” he explained. “I had tried everything before and nothing worked. Then I was finally prescribed Accutane and the changes seemed to take effect almost immediately. This medication saved my life, because I wasn’t living life at all but avoiding people and opportunities. My only regret is that I wasn’t prescribed it sooner.”
If the potential side effects are preventing you from considering Accutane, remember that the majority of them go away after the drug is discontinued, and the beneficial effects exist long after treatment has stopped-the reduction of acne lesions and improvement of scarring can beseen for months after finishing. All in all, when used in a prudent manner with careful monitoring by a dermatologist, Accutane can be a very safe and effective way to permanently knock out acne.