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Accutane concerns

 
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jezzabell1787



Joined: 08 Jun 2007
Posts: 6

PostPosted: Sat Jun 09, 2007 2:12 pm    Post subject: Accutane concerns Reply with quote

I have heard that accutane can cause sever depression. Although it stops oil production im not sure if i want to risk depression. Any other suggestions for oily skin and how to control it?
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drtodorov
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Joined: 10 Dec 2004
Posts: 3177

PostPosted: Sat Jun 09, 2007 10:59 pm    Post subject: Reply with quote

Topical retinoids; topical azelaic acid reduce sebum secretion.
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orangehrzn



Joined: 23 Feb 2005
Posts: 1005

PostPosted: Sun Jun 10, 2007 3:45 pm    Post subject: Reply with quote

Accutane at the doses necessary to halt oil production, 10mg/day, does not cause any side effects except dry lips. I've been taken it for months.

I've never taken high doses accutane but I'm quite suspicious the claims of 'depression' are based on a few isolated cases with unclear derivation. Someone took aspirin and commited a suicide, does that mean aspirin causes depression? Acne patients have enough depression even without accutane so it would be really hard to prove accutane caused it.

Retin A is the topical form of retinoid. If you skin is sensitive or doesn't tolerate acids, it is going to make you look like sunburnt and even cause broken capillaries. Also I've never observed it reducted oil production. Another user said she used it for years and no it doesn't stop oil production.

Retin A irritates skin and puts it in state of flaking which may look like reduced oil but once your skin normalizes the oil is there.

I've heard similar claims that Salycilic acid reduces oiliness. The effect is again putting the skin in a state of chronically irritated flaking that looks like 'drier skin'.
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drtodorov
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Joined: 10 Dec 2004
Posts: 3177

PostPosted: Sun Jun 10, 2007 4:06 pm    Post subject: Reply with quote

One can avoid irritation from topical retinoids by measures like very low initial strength and slow buildup, using every other day, antiirritants (e.g zinc oxide) and so forth.

The idea of low dose Accutaine is interesting. I wonder if there were any studies done the its risks and benefits of low doses.

Also, antiandrogens would often reduce sebum production, especially when there's relative androgenic excess, but there are various issues with this option too...
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orangehrzn



Joined: 23 Feb 2005
Posts: 1005

PostPosted: Mon Jun 25, 2007 10:31 pm    Post subject: Reply with quote

The best study I know about low doses accutane is below. During the treatment they say the blood tests for liver enzimes and triglicerides remained normal, something I can attest myself cause I do those tests regularly. The study was 6 months. The article is in english on blackwell-synergy site.
-----------------------------------------------------------------------------------
Sabine E. Geißler, Silke Michelsen, Gerd Plewig (2003)
Very low dose isotretinoin is effective in controlling seborrhea. Niedrig dosierte Isotretinoin-Therapie ist wirksam bei Seborrhö
Journal der Deutschen Dermatologischen Gesellschaft 1 (12), 952–958.
doi:10.1046/j.1439-0353.2003.03738.x

Abstract:

Background: Excessive seborrhea, coarse-pored skin, minimal acne and oily scalp hair comprise a well-known clinical entity. It causes considerable concern, has social impact, and affects the quality of life in some individuals. Some patients seek treatment for seborrhea. No effective topical sebosuppressive medication is available. Oral isotretinoin is the only remedy for men. In women, oral isotretinoin is the most effective remedy, followed by antiandrogens.

Patients and methods: Eleven patients in three groups were treated for 6 months with very low dose isotretinoin. The influence on seborrhea was measured during oral treatment with 5 mg/d, 2.5 mg/d, or 2.5 mg 3× weekly.

Results: Sebum production, measured with Sebutape®, was reduced by up to 64 %. Acne lesions regressed by as much as 84 %. Follicular filaments were reduced by 66 %. Microcomedones were reduced on average up to 86 %. Quantitative bacteriology showed a reduction of Propionibacterium acnes but no increase of Staphylococcus epidermidis. Biopsies revealed a 51 % reduction in sebaceous gland size. With Bentonite™, a reduction of lipids was demonstrated with 2.5 and 5 mg isotretinoin/d but not with 2.5 mg 3× weekly. There was a shift within the lipid fractions: triglycerides dominated, followed by squalenes and free fatty acids.

Conclusions: Good results were achieved in all patients. The small number of patients did not permit a statistical analysis of the three isotretinoin doses studied, but there was a tendency toward better results with the two higher doses.
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orangehrzn



Joined: 23 Feb 2005
Posts: 1005

PostPosted: Tue Jun 26, 2007 8:18 pm    Post subject: Reply with quote

Another study 10mg/day for 3 years. They found a slight increase in triglicerides blood levels for 10mg/day accutane group versus the placebo group. The placebo group triglicerides increased from 1.34 to 1.45 mmol/liter, for the accutane group from 1.33 to 1.63 at end of 3rd year. Both are considered normal and low risk levels. My favorite quote from that article is that 43% of the placebo group claimed 'adverse side effects' cause they were told they were on 'accutane' something I have known for years that anecdotal reports of 'side effects' or 'miraculous wrinkle erasure' are not to be trusted.

----------------------------------------------------------------------
Clinical and Laboratory Adverse Effects Associated with Long-
Term, Low-Dose lsotretinoin: Incidence and Risk Factors
Joseph A. Tangrea,’ Maria Elena Adrianza,
William E. Helsel, Philip R. Taylor, Anne M. Hartman,
Gary L Peck, and Brenda K. Edwards for the
Isotretinoin-Basal Cell Carcinoma Study Group2


Quote:
An important finding is the very small difference
between the incidence of musculoskeletal symptoms in
the treatment and control groups, as well as the lack of
significant changes in total cholesterol levels. Patients
included in our study were significantly olden than those
who normally receive isotretinoin therapy.


Quote:
Furthermore, the inclusion of a placebo
group in this double-blind clinical trial was key in further
delineating the true incidence of adverse reactions due
to isotretinoin (22). Indeed, the high incidence of putative
adverse effects (43%) among placebo group patients
emphasizes the need for caution when examining anecdotal
or isolated case report data
and underlines the
importance of incorporating both a control group and a
uniform system of adverse reaction detection and classification
when evaluating the toxicity of a drug.
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orangehrzn



Joined: 23 Feb 2005
Posts: 1005

PostPosted: Tue Jun 26, 2007 8:24 pm    Post subject: Reply with quote

Another study about the effects of low doses accutane on skeletal system:

T.C. Ling, G. Parkin, J. Islam, D.C. Seukeran, W.J. Cunliffe (2001)
What is the cumulative effect of long-term, low-dose isotretinoin on the development of DISH?
British Journal of Dermatology 144 (3), 630–632.
doi:10.1046/j.1365-2133.2001.04103.x

Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a relatively common disorder in adults over 40 years of age, and the reported prevalence increases with age. 1 The diagnostic criteria for DISH, as described by Utsinger, 1 are continuous ossification along the anterolateral aspect of at least four contiguous vertebral bodies, primarily in the thoracolumbar spine; and symmetrical and peripheral enthesopathy involving the heel, patella or ulnar olecranon. Clinical manifestations include spinal rigidity and pain (especially thoracic spine), peripheral joint and bone pains in the heel, elbow, knee and shoulder. A DISH-like syndrome is known to occur in patients who have received high doses of oral vitamin A and its compounds, including etretinate and isotretinoin. This raises the question of a need for radiological survey for patients on such treatment, either as baseline or during therapy. We report our experience in acne patients who had received long-term and/or multiple courses of isotretinoin for troublesome acne.

Sixteen patients (nine males and seven females, mean age 32 years) had attended our clinic for many years with acne vulgaris resistant to oral antibiotics, Dianette® and topical agents. They were subsequently prescribed repeated or prolonged courses of isotretinoin, with a cumulative dose of at least 360 mg kg-1, i.e. equivalent to three standard 4-month courses of isotretinoin at 1 mg kg-1 daily. The cumulative dose of isotretinoin was obtained retrospectively from patients' hospital records. Three of the patients were maintained on intermittent small doses of isotretinoin, e.g. 20 mg two or three times a week for many months. Radiographic lateral views of both calcanea, dorsal and lumbar spines were taken. The cervical spine was omitted to minimize radiation exposure, as early skeletal changes are least likely to appear here. 1 The radiographs were reported by one radiologist (GP). Pre-therapy radiographs were not available.

Table 1 summarizes the treatment details and radiographic findings for the 16 patients. The daily dosage of isotretinoin ranged from 0·15 to 1·5 mg kg-1 daily. The median cumulative duration of treatment is 28 months, range 18–50 months. The range of total cumulative dose was 373–1075 mg kg-1, median 535 mg kg-1 (95% CI, 492–734). The median daily dose was 0.7 mg kg-1daily (95% CI, 0·7–0·8). The interval between each course of isotretinoin ranged from 0·5 to 10 years, median 2 years (99% CI, 1·8–3·4). One patient, aged 52 years, developed moderate spinal hyperostoses involving T7–L1 and a tiny spur at the insertion of Achilles tendon, after a total of 50 months of treatment and cumulative dose of 637 mg kg-1( Fig. 1). Seven other patients (44%), aged between 28 and 37 years, developed very mild radiological changes: three had spinal hyperostoses, and four had calcaneal hyperostoses. None of the patients had any symptoms or had suffered any backache whilst on or off therapy.

Pittsley and Yoder 2 were the first to recognize 'retinoid hyperostosis' as a side-effect of retinoid therapy in 1983. Several other studies 3-5 found a high incidence of skeletal effects in isotretinoin therapy. This may be explained by a higher dosage per day and cumulatively than used in our patients. The dosages used were 1·0–3·0 mg kg-1 daily. A large randomized controlled trial 6 of 139 patients with basal cell carcinoma who received chronic low dose isotretinoin developed progression of radiological changes. These patients received 10 mg of isotretinoin (0·14 mg kg-1) daily for 3 years. The median age was 63 years. All the patients had skeletal changes at baseline; more than twice the treated group showed progression of cervical and/or thoracic hyperostoses compared to the placebo group. Thus, the presence of pre-existing age-related DISH increases the risk of progressive change.

Several other studies on standard short-term courses of isotretinoin for acne7,8 confirm that a 4 months' course at 0·5 mg kg-1 daily does not cause significant long-term radiological abnormalities.

Our data, like other reports, supports the view that most hyperostoses were asymptomatic 3-8 unless there were gross radiological changes. 2 In Ellis' report, 75% of symptomatic sites did not show hyperostoses, suggesting that perhaps the symptoms were unrelated to the DISH syndrome; furthermore, most of the observed hyperostoses were asymptomatic.

We conclude that the long-term use of isotretinoin in acne patients does not usually cause clinically significant radiological abnormalities. Long-term maintenance therapy of 20 mg two or three times a week also appears to be of a minimal risk, although this risk may be higher in older patients (> 60 years). Most hyperostoses are asymptomatic and clinically insignificant, particularly at low doses of 0·5–1·0 mg kg-1. We are not aware of any reports of serious skeletal abnormalities associated with long-term retinoid use in acne patients. Hence, routine radiological survey is not warranted in repeated or prolonged courses of isotretinoin therapy for acne unless symptomatic, especially in older patients. In particular, pretherapy X-rays are probably unnecessary, even after several courses.
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Wish



Joined: 01 Jul 2007
Posts: 12

PostPosted: Sun Jul 01, 2007 4:44 pm    Post subject: Reply with quote

Often the people who have problems with depression on accutane are people who had a history of depression prior to taking accutane. I didn't have any problem with depression on accutane. If anything, I was less depressed because my acne no longer affected my self-confidence and self-esteem.
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