Intro
I had acne for 6 years before being prescribed Roaccutane aged 18. (Now nearly 20). It has been something that has troubled me for my entire teenage life, and I understand all too well the inhibiting effect it can have on a young person in social situations, and the damage that can be done to one’s self-confidence. As such the issue has become an area of medical interest for myself.
Most of you will agree that acne is an underrated issue of concern by both GPs and some dermatologists, who treat it as a ‘phase’ that everyone goes through, a ‘normal’ part of growing up, rather than the emotionally distressing condition it really is.
GPs and antibiotics … then Rocaccutane.
GPs tend to prescribe a series of antibiotics for acne, and it is only when these do not work that they (often reluctantly) make a dermatology referral. The grounds for this delay are often financial, though if one calculates the cost of a successful course of Roaccutane against the cost of 5 courses of different antibiotics over a period of years, the Roaccutane is much the cheaper option.
The second reason for its under-prescription is the link made to depression and suicide, which as far as I can see, is tenuous indeed. After all -how many teenagers, especially those distressed about their appearances, are depressed?
Thirdly, there are other health implications linked to the side-effects, but the emotional benefits of a successful treatment arguably outweigh the physical discomfort. Further, years spent on antibiotics can hardly be good for one’s health either.
I must stress that Roaccutane is not a direct cure for acne - it gets rid of the ‘medium’ in which the bacteria thrive and cause spots - the sebum, secreted by the sebaceous glands, which are shut down by Roaccutane. For many, these glands remain inhibited sufficiently to prevent further acne outbreaks, and the chances of this are increased after a second course. The hope is that by the time the effects of Roaccutane wear off, the patient will have reached the point/age where their hormones (the root cause of acne) will have stabilised sufficiently that acne will not return, at least not as severely as before.
Hormones
The reason for overproduction of sebum (leading to acne) is an excess of, or oversensitivity to, testosterone. This explains why many women experience outbreaks of spots at certain times in their monthly cycle, and why the teenage years are the most common for acne to occur. In women, acne can be sometimes successfully treated with Dianette - a contraceptive pill, but not in men, for obvious reasons. It must be stressed that Dianette carries hormone-related side effects linked to changes in body hair, mood, and libido, amongst others.
This raises the question of why acne is a question for dermatologists at all - surely it is a problem for endocrinologists (hormone specialists). If they could limit testosterone production, or solve sufferer’s oversensitivity to it, they could tackle the root of the problem, possibly with a long - term solution.
Acne is a problem which affects around 80% of Western-inhabiting youths at some point in their lives, so a cure would be lucrative, at least in the short-term. Cynics might argue that a long-term solution is prevented since it in the interests of the manufacturers of teen skin products, and perhaps indeed of Roche, the makers of Roaccutane, for acne to remain a problem.
Diet and Acne
Another area of interests is the link between acne and diet. It has been accepted by dermatologists that there is no established link, but studies between Western and other societies are showing massive differences in levels of acne. I have read journal articles noting the appearance of some grade of acne in around 80% of American or European youths, compared to around 30% in far-Eastern youths (specifically China and Japan). Western people ate roughly 3-4 times the amount of processed carbohydrate (bread, pasta, potatoes) as our far-Eastern cousins, as well as an abundance of dairy products and caffeine. These three food groups are all the subject of further research. Some studies of South American traditional communities showed acne appearance in as little as 2 to 5% of youths. A genetic link is also a consideration, but it is noted than among youths of far-Eastern origin living in the West, acne prevalence is as high as in youths of Western origin. It is suggested that certain hormones are released in the digestion of carbohydrates which trigger sebum production, and that the toxicity caused by over-consumption of caffeine has a similar effect.
I’m not suggesting cutting out carbs completely - that would not be healthy, but switch perhaps to brown bread, and less of it. Eat less potato, moderate your cheese consumption, etc, and keep an eye on the research.
My Roaccutane Experiences.
I’m on my second course in about 18 months. The first, 40 mg a day for 16 weeks worked wonders - I had normal skin for about 8 months having had acne for 6 years. I started to break out again in December, so went back to the dermatologist, who gave me 60 mg a day, which I’ve been on for a month.
As before, the effects have been quick to appear - spots going but side effects too. Last time I had the tiredness, dry lips, eyes, nose and fingers, but this time I seem to be losing weight. It says in the leaflet that muscle loss is a possible side-effect, I don’t know the reasons for this, but I was wondering if anyone else had experienced the same?
I would support any campaign for further research into acne, specifically hormonal research, in the hope of a long-term, or permanent solution.
Sam.