One of the most effective acne treatments for patients who suffer from severe acne scarring is Isotretinoin AKA Accutane. In general, it takes 4 to 5 months for the medication to eliminate cases of acne severe enough to warrant the use of Accutane after all other treatment options have failed. It is also useful in treating acne that has not shown a complete response to creams or antibiotics. Accutane was approved by the FDA in 1982 for use as an acne medication. The American Academy of Dermatology has reported that 85% of patients who use Accutane have results that range from long-lasting to a complete reduction of acne.
How It Works
Accutane belongs to the retinoid medication class which includes drugs that are used in cancer treatments. In fact, the drug was originally marketed as a chemotherapy drug. Accutane works by controlling the oil located in the sebaceous gland and is most often used to treat acne with nodules that are 5-mm or larger in diameter. The dosage of Accutane taken by a patient depends on his or her body weight. As mentioned above, it can take up to 4 or 5 months for the treatment to eliminate the acne.
As effective as Accutane is for treating severe acne, it is also known to cause side effects that range from mild to severe.
Some of the milder, and most common, side effects include:
- Dry eyes
- Cracked/Peeling skin
- Pain in the back, joints and muscles
- Swollen or Bleeding gums
There are also a number of serious side effects associated with Accutane and they include:
- Psychiatric disorders such as depression, aggressive behavior and suicidal thoughts
- Inflamed bowels
- Pancreas inflammation
- Pseudotumor cerebri (a buildup of pressure in the skull that mimics a brain tumor)
- Bone loss
Accutane has been known to cause birth defects in women. As far back as 1985, the FDA added a black box warning telling pregnant women (or women who hope to become pregnant) not to use Accutane because of possible birth defects including fetal deformities and potential fetal death. These potential birth defects can happen even if Accutane is only taken for a short period of time by a woman who is pregnant. Some of the serious birth defects that can occur include:
- Eye and ear abnormalities
- Cleft palate
- Problems with the heart and brain
- Facial dysmorphia
- Central nervous system malformations
- Fetus death
Interactions with Other Drugs
Anyone who uses Accutane should be aware of how it interacts with other drugs. Patients need to consult with a board-certified physician before making the decision to actively use Accutane. While the label on the medication informs patients of the lengthy list of interactions, here are some of the most common interactions associated with Accutane:
- Vitamin A – Toxicity can be the result if used with Accutane
- John’s Wort – Taking this product while also using Accutane can decrease birth control effectiveness and lead to pregnancy
- Tetracycline – When combined with Accutane, the risk of pseudotumor cerebri increases
- Phenytoin – Since this drug can cause low mineral density in bones and Accutane can cause bone loss, the two should not be taken at the same time
The role of scar revision is to restore self-esteem and improve the quality of life. The skin is actually the largest organ of the body and vital to not only our physical health but also it’s health and beauty important to our emotional well-being. Scars have a natural process or progression towards a mature scar. This represents the completion of the healing process.
There are individuals who heal with very little scars and others who scar from the slightest of skin injury. Any injury to the the skin, that is a rupture to the integrity of its’ surface or that results in an opening or damage to the dermis, will heal with a scar.
Life changes that effect our hormones can effect the way our skin heals. Childhood to puberty, adulthood and finally to old age can represent significant changes in how our skin heals. Predicting how a person heals cannot be done with medical certainty. It is a persons observation of their own healing history and familial history that provides the best indicators.
However through observation of certain skin types that we understand their tendencies to produce abnormal scarring and formation:
Pigmented skin and Celtic skin have a higher risk of Hypertrophic and Keloid scarring
the chest and shoulders, eyelids, lips or labia heal with inconspicuous scarring
The goal of scar revision surgery is to make the scar to blend or making it inconspicous. Scars that result from injuries, burns or cancer excision can have a major psychological impact. This impact from the scarring can be profound adversely effecting self-esteem, self-confidence and social interaction. If you suffer from such issues a cosmetic surgeon can often help.
Quality of Life and Scarring
Scars are an inevitable part of most peoples’ lives. There is nearly a person on earth who does not have some type of scarring. Severe scarring though affects individual’s quality of life and often decreases their self image. Self image is so much a part of person’s happiness and success that medical science has gone a long way to reduce the adverse effects of scarring no matter how the scar occurred.
Uniqueness of Burn Scars
Burn scars are often very traumatic, disfiguring and they are the hardest to treat through revision. When a person has significant scarring from burns there is often associated trauma that takes priority prior to addressing the issue of scarring. Life saving measures, infections and other complications take persistent over issues that will arise from burn scars.
Pain management is very vital because the pain from burn is one of the most excruciating types of pain one can bear. Where healthy skin and burned skin intersect pain can be a life time issue. Psychological issues such as severe depression are a compounding factor for people disfigured from burns. Scar tissue does not maintain the suppleness or laxity of healthy skin. As scars mature the fibrotic tissue composing it shrink and becomes more rigid. The location of such scars near joints of the hands, feet, limbs and neck can adversely affect the mobility of the joints.
Another issue with burn scarring is the need for skin grafting and the associated healing and scarring with those procedures. In addition burn scars because of the severity often are comprised of a combination of types of scars. This includes:
• Hypertrophic scarring
• Hypotrophic scarring
• Hyper-pigmentation scarring
• Keloid scarring
Traumatic burn scars necessarily are to be treated in absolute sterile clinical conditions, usually in specialty “burn centers”. Pain management is one of the important reasons as well as reducing the risk of infection to a minimum. Topical numbing creams do not penetrate burn scar tissue sufficiently and medical needling must be done under general anesthetic in most cases. Treatment for burns is a long process that can easily reach up to one year and intervals of specialized care are scheduled through a close monitoring process. It is during these interval medical treatments that the patient and doctor can discuss the possibility or revisioning scars.
How Scars Make Us Feel
There is unlikely an adult human on the planet without a scar. Most scars are not of consequence to cause severe emotional or physiological issues. Wound research has proven that the age of the person, gender and location of the scar are factors on how it will affect a person. In addition how the scar occurred can make it more of a problem. Facial scars cause more duress and scars that may be disfiguring or near around intimate areas of the body. Society premium appearance contributes to the anxiety associated with scarring. Stereotypes in moving show scarred people to be unpleasant, sadistic and mean.
However in some cultures consider scars desirable and are intentional and deliberate. Some tribes identify their clan and families by scar markings this was very common in Nigeria though the custom is no fading. Traumatic scarring is often very different. I greatly distress the person suffering from the scar and detract from their quality of life. Some anthropological studies indicate that facial symmetry seems to be innate attraction within humans; clearly facial scarring moves a person further away from what maybe a pre-programmed ideal. People who have adverse reaction to the scars can experience embarrassment and loss of self-image. Over long term this can lead to isolation, anger and self-loathing. In worse case scenarios psychological conditions that need to be treated can develop.
Today’s modern surgical techniques in the field of cosmetic surgery now provides many options in scar revision. Birth Marks, skin anomalies as well as scars can be treated with much success.
Read Part II of the Evolution of Scars