The Roaccutane Debate

Date: 24/11/2016

Author: Ingrid Katz (Pure Aesthetics) - Published in A2 Magazine Issue 20

Considering the severity of the side effects associated with the acne treatment drug Roaccutane, it should ideally be prescribed as a last resort. INGRID KATZ takes an in-depth look at this treatment modality, while advising an alternative approach.

This subject is one that I could dedicate an endless amount of time towards, as I feel that Roaccutane is made too easily available to patients. Don’t get me wrong, I do believe there is a place for this drug in the market; however, there should be a support programme with advice on the possible side effects and care one should take to counter these.

Responsibility from the doctor as well as the patient should be at the forefront of every prescription given.

Roaccutane has been developed to treat severe cystic acne that is unresponsive to conventional therapies – so it’s ideally prescribed as a last resort. It is a derivative of vitamin A, which we know is the “skin vitamin”, yet in this form it is delivered at such a high volume that there are severe side effects that should not be overlooked. It has a quick result on the concerns, and patients are more often than not pleased with this seemingly instant positive change. Therefore, they are quick to forget or compromise on the side effects.

Acne formation

Let’s go back a step and discuss how acne is formed and comes to be in the skin. We have a few instigators of break outs, but acne (acne vulgaris) is a bacterial infection of the sebaceous gland. This infection breeds in an alkaline environment and is able to spread quickly between follicles if left untreated. The testosterone hormone plays a major role in our very common teenage acne – and that is why you will more often notice teenage males having a more severe form of acne or cystic acne when compared to teenage females. We also have hormonal influences to thank for most adult acne, which we see more commonly in our female patients. These particular hormonal influences may vary from pregnancy, menopause, stress and changes in contraceptive pills. So, to be exact, we have bacteria and hormones that are the major threats.

Roaccutane at work

Roaccutane will decrease the size and sebum output of the sebaceous glands by inducing apoptosis (death) in the sebaceous gland cells and various other cells in the body. In some cases, it may only be a temporary result. It will have an effect (and result) on the nodules forming in the skin, as well as the potential scarring these may cause. It works quickly within the body, so, from a psychological perspective, the patient is able to overcome any insecurity or discomfort in a short time period. This is important in the teenage years when puberty causes many different changes in the body that the patient needs to overcome. Having a severe acne breakout at this stage of life can affect the psyche very negatively. However, the decrease in sebum can be quite drastic in some patients, and some severe side effects can be experienced. These are mainly muco-cutaneous: dry lips and skin, and in some cases eyes, as well as fragility of the skin. Proper advice should be imparted from doctor to patient to ensure good care is taken when treating the skin at home.

A pH-balanced cleanser and moisturiser should be used twice daily. A sunblock should be used every day. No scrubbing, exfoliating or rough cloths should be used on the skin.

Cause and effect

When we understand the skin and its behaviour, we are in a better position to understand what will be best to treat it. Often the cause of a condition is not treated, but rather the effect on the skin. If we can treat the cause, we have a better chance of a long-term result. I mentioned alkalinity above for a very good reason. Our skin’s natural pH is an acidic one, and bacteria cannot breed in an acidic environment. By maintaining the skin’s natural pH, we remove the breeding ground for acne to develop. Using a pH-balanced cleanser is a great way to start the path to healthy skin. Sufferers of acne often feel oily, and are thus accustomed to feeling the need to dry their skin out.

This often leads to them reaching for the closest bar of soap or cleanser that leaves them with that squeaky-clean feel. This is wrong. In effect, one would be stripping the skin of its natural lipid (oil) barrier and taking the skin from an acidic pH to an alkaline one.

This would result in the skin becoming dehydrated (loss of water) and producing more oil to try to compensate – thus a vicious cycle begins. When pustules, nodules and/or cysts develop, there is a high level of inflammation within the skin, which will perpetuate the condition and make the skin appear red and rather angry-looking.

We would want to treat that inflammation first and foremost, providing a calmer environment in which to provide more balance to the skin. A moisturiser is a necessity to ensure barrier repair (our skin’s suit of armour), while hydration (water) is supplied to the skin’s deeper structural layers. This will also ensure the water and oil balance within the skin is maintained.

Roaccutane alternatives

Often parents will begin to notice the frequency of breakouts, and immediately require an appointment and a script for Roaccutane. Whereas, in our clinic, we believe in treating the cause. We would most likely perform very light peels to treat and regulate the cell turnover, and would then recommend the use of a topical form of vitamin A that will locally treat the irregularities and inflammation that lead to breakouts. This advice will not only treat the actual causes, but will teach the skin how to function in the long term as well. Added to that, an oil-free, non-comedogenic sunblock is a non-negotiable requirement. Our climate is harsh. Sun exposure will prematurely age the skin and cause pigmentation (especially over scarring), which in turn will irritate an already inflamed skin (where acne is present).

Acne is a horrible infliction on the skin and one that can cause long term damage due to scarring and short-term psychological damage. Care should be taken to try to prevent or stunt teenage breakouts by starting a good homecare routine at the appropriate age.

If breakouts start to appear, ascertain the severity before jumping on the Roaccutane wagon.

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