Term Paper on "Should Acne Be Treated"

Term Paper 11 pages (3256 words) Sources: 1+

[EXCERPT] . . . .

Acne Be Treated?

Treating Acne: the Methods, Advantages and Dangers Entailed

What is acne, why does it appear on the skin, and can it be prevented?

According to the National Health Service (NHS) Direct Online Health Encyclopaedia, acne affects a person's hair follicles and the sebaceous glands in the skin, "which secrete an oily substance called sebum" (a fatty lubricant material). The places on the body which most commonly are afflicted with acne are the face, arms, back and chest.

Acne usually begins to attack a person's skin about the time of puberty, the NHS explains, but acne can also begin around adulthood in other people. Only 20% of the people in the UK go through life acne-free, the NHS explains, but for those not so fortunate to avoid the plague of pimples, the onslaught can happen generally between the ages of 11 and 30.

Why does acne appear on the skin at around the time a person reaches puberty? The NHS Direct Online Health Encyclopaedia "Acne Introduction" section explains that changes to a person's "hormone levels" create a condition in the sebaceous glands that produces excess amounts of sebum; the sebum, together with dead skin cells, "blocks the hair follicles, which enables the formation of spots ranging from blackheads to painful red nodules," the NHS reports.

When going into the NHL Direct Online Health Encyclopaedia "Acne Causes" page, however, one learns that the increased "hormone level" is actually the presence of the hormone testosterone, which, some may not realize, is present in boys and girls. Testosterone triggers the rapid division of skin cells, the "Acne Causes" page explains, resulting in a blocking of the hair follicles. That is a little different explanation from the "Acne Introduction" page, which didn't mention the production of testosterone as a contributing factor to the blockage of the hair follicles. The "Acne Causes" page continues, with the information that changes in skin acid levels during puberty also "encourages the growth of bacterium," which also becomes trapped in hair follicles.

When the acid is trapped in hair follicles, the pimple is more severe, in fact it becomes a "deeper infection" in the form of pustules and nodules. The "Acne Introduction" Web page explains that "acne usually corrects itself over time," so a person could technically not treat the acne - "in most cases it should get better without treatment" the NHS reports - however, for some individuals, letting the acne go on without treatment "may take years" and "can potentially cause permanent scarring." Hence, the NHS recommends treatment.

The "Acne Causes" page offers addition information on causes of acne: 1) it may be genetically passed on through family trees; 2) stress causes existing acne to become worse; 3) girls may have increased acne breakouts during menstruation; 4) some drugs (corticosteroids, anti-epileptic medicines, and oral contraceptives) may aggravate acne; 5) exposure to "dangerous chemicals called dioxins" may cause a rare kind of acne called chloracne.

Heavy intake of chocolate and greasy fried foods does not cause acne, the NHS states, but failure to wash one's face, especially during puberty and teen age years, can indeed aid acne blemishes to get their start on the face. In the NHS Web page "Acne Prevention," the only suggestions not previously offered is that acne "is not infectious" and is not caused "by poor hygiene," albeit, washing one's face and removing make-up prior to going to bed are helpful preventative measures.

Various traditional treatments for acne

In the NHS Web site there is a link to "Wellingborough LHG Acne Treatment Advice," which gives treatment information for mild, moderate, and severe acne. In the case of "mild acne" ("open and closed comedones," several small papules and pustules), "Topical Adapalene (Differin) gel/cream or Isotrexin/Retin A gels and/or Benzoyl peroxide 2.5-5% gel" is recommended. For "moderate acne" ("numerous comedones and small inflammatory papules; numerous pustules") oral and topical remedies are recommended: topical (Zineryt, Zindaclin, Benzamycin); antibiotics (Oxytetracycline; Lymecycline; Erythromycin; Minocycline; Doxycycline; Trimethoprim).

In the case of "severe acne" ("numerous comedones, deeper papules and pustules; deep & large lesions; Nodules/cysts and abscesses"), the Wellingborough LHC advice is to use "systemic and topical treatment" similar to "moderate acne" treatment plus "immediate referral for Roaccutane" (blood test at the time of referral). The "severe acne" cases also require "systemic antibiotic therapy" for 3-36 months.

Meanwhile, the Acne-Rosacea.co.uk Web site takes acne severity to another level, "very severe acne": "requires urgent referral to a hospital specialist for mega dose antibiotics and possibly oral isotretinoin."

When is acne treatment not a good idea? When is acne treatment deadly?

On the subject of isotretinoin, an oral medication for severe acne sometimes prescribed by the brand name Accutane, it should never be prescribed for a pregnant woman: "istretinoin can cause severe birth defects in unborn fetuses," and has been linked to severe depression, behavioral changes and in some cases suicide" (Acne Resource Center, 2004). Moreover, isotretinoin can cause "headaches...nausea, vomiting and blurred vision," the Acne Resource Center advises on their Web site: (http://www.acne-resource.org).Additional negative symptoms include a decrease in the production of tears (causing red, itchy eyes, and even "ulcerations of the cornea, especially with contact lens wearers"); a decrease in the ability to distinguish between shades of black and white (causing "night blindness"); and, also, liver enzymes "can be elevated causing jaundice, hepatitis, and abdominal pain."

The deadly legacy of people with acne who used Accutane

As an indication of just how far individuals will go to attempt to rid themselves of acne, the story of the drug Accutane is very revealing. There could likely never be a more relevant instance in which a decision should be made against treatment of acne than that involving the drug Accutane.

Indeed, the Acne Resource Center is either lagging behind on their Web site updates, or they have chosen to ignore the latest medical news regarding the suicide deaths of individuals who used Accutane (isotretinoin), and whose use allegedly resulted in first depression, then suicide. According to the Web site www.the-accutane-lawyer.comWeb site (one of the sites where users get information about class actions suits being brought against the manufacturer), "there have been 142 suicides involving Accutane" since 1982.

FDA scientist David Graham testified before Congress last year that Accutane was one of the five dangerous drugs that should be restricted or removed from the market" (Canada.com News, 2005), a news source reported. On the Web site, which is sponsored by Ennis & Ennis, a Washington D.C.-based law firm, the attorneys claim that Accutane has the following side effects: "Inflammatory Bowel Disease"; "Crohn's Disease"; "Ulcerative Colitis"; "Kidney Transplant"; "Liver Transplant"; "Birth Defects"; "Suicide"; and "Intra cranial Hypertension."

Hoffman-LaRoche, Inc., a subsidiary of Swiss drug-maker Roche, has been dispensing Accutane in the U.S. since 1982. In October, 2001, Congressman Bart Stupak "expressed his concerns about Accutane following the suicide of his son," who was taking Accutane for an acute case of acne at the time.

A more widely publicized case of suicide involving Accutane is that of the son of Liam Grant, who believes his son's suicide was caused by Accutane. Grant's son, also named Liam, was a 19-year-old engineering student at University College Dublin, who played guitar and drums, but was an acne sufferer. He was given a prescription for Accutane in February, 1997.

His father says he should have noticed the potential warning signs that ensued" (McCoy, 2005), according to an article in USA Today. The younger Liam, "previously outgoing and enthusiastic about his plans, increasingly spent time alone in his bedroom," the article pointed out. "When his friends called, he asked one of his brothers to tell them he was unavailable."

And, tragically, Liam Junior was found dead in June 1997, "hanging from a tree outside Dublin. A jury...ruled the death a suicide and called for more research on Accutane and its side effects." The father, Liam Senior, has spent "roughly $1 million of his retirement nest egg on scientific research examining the effects of Accutane."

As to the manufacturer's response, according to McCoy's article: "Roche feels a great deal of sympathy for Liam Grant regarding the loss of his son, but according to a significant body of scientific evidence, there is no cause-and-effect relationship between Accutane and psychiatric events." That may be the company's position, but nonetheless: Roche changed the package insert four years after Accutane went on the market to say that "some users had reported depression"; in 1997 French regulators forced Roche to list suicide as a "potential side effect"; in February 1998, the U.S. Food & Drug Administration required Accutane packaging to include the statement that adverse reactions, besides depression and psychosis, could include "suicidal ideation, suicide attempts and suicide."

In March, 1998, England and Irish health officials required Accutane to post warnings on the drug's label regarding "risk of psychiatric disorders." And in June, 2002, Roche puts the following warning on all its Accutane labels: "[this drug may lead to] depression, psychosis and, rarely, suicidal ideation, suicide attempts, suicide, and aggressive and/or violent behaviors."… READ MORE

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