Acne drug Accutane has major side-effects
Dear Dr. Roach: Our 31-year-old daughter has fought a losing battle with acne since adolescence. Accutane has been suggested many times, and now she is about to begin treatment. We have always been too afraid of this powerful drug to try it. Are we right to be afraid?
L.E.M. Isotretoin (Accutane) is indeed a powerful medication, and although it clearly is beneficial for acne, its side-effects are sufficiently important that a thorough discussion is appropriate before starting this medication, especially in a woman of childbearing age.
Isotretoin is a powerful teratogen, meaning it causes birth defects. These sometimes are severe enough to cause a stillbirth, but a child born to a woman taking Accutane has a high risk of a serious congenital malformation. Even babies who appear normal at birth are more likely to have developmental problems in the brain. For this reason, any woman of childbearing potential must commit to effective birth control (abstinence from heterosexual intercourse or two effective methods, such as oral contraceptive plus a barrier method). Women also need monthly pregnancy tests and counselling visits, and prescribers require extra training to be able to prescribe this medication. The manufacturer recommends against getting pregnant in the cycle following cessation of treatment; however, at least one case report noted a birth defect consistent with isotretoin in the second month, so I think waiting an additional month, with extra precautions, is prudent.
Both men and women are at risk for additional side-effects of Accutane. Depression and other mental-health issues, including psychosis, are possible, and people should be screened for depression and thoughts of suicide. Dry skin and inflammation around the lips are common, and often require lotions to treat. A connection with bowel disease is controversial. Elevations in cholesterol and triglyceride levels also are common, but seldom require stopping medication. I don’t have space to cover all of the less-common possible sideeffects.
On the other hand, isotretoin is the most effective treatment for severe nodular acne that has not responded to other treatments. Severe acne is associated with its own problems, including risk of depression. Despite its risk of side effects, isotretoin is a reasonable choice in carefully selected patients who agree to the necessary conditions of treatment. At 31, your daughter certainly can make her own choice about this. Dear Dr. Roach: Could you find out what the success rate of laser treatment for vaginal rejuvenation for incontinence is? I find the wearing of adult diapers unattractive and unsatisfactory, but I would rather not waste my money on a procedure that has not been proven successful.
B.M. There are several types of incontinence (the most common are urge incontinence, the sense that you need to get to the bathroom RIGHT AWAY or else will have an accident, and stress incontinence, when urine leaks with a stressful manoeuvre, such as a cough or a sneeze). The best treatment depends on the type of incontinence, and before considering a treatment such as laser, it’s important to look carefully at common causes, including medications, underlying medical conditions, urine infection and vaginal atrophy. These may have effective treatments. Even if no cause can be identified, pelvic floor muscle exercises and bladder training still might be effective. Medications and pessaries are helpful for some women.
If you have been through all of these and are still having incontinence, then it is worthwhile to consider options, including surgery in some cases. Laser vaginal treatment is a potential new treatment. Several preliminary studies have been done, showing 60 to 80 per cent effectiveness, but I still think it is too early to recommend this treatment.