When 13-cis retinoic acid or isotretinoin first came out as an acne medicine, it was regarded as a wonderful new way of treating acne, especially severe acne. It appeared to be able to cure acne, especially the severe from known as cystic acne.
I have a friend who has very severe acne. She is actually quite pretty. Unfortunately, it is hard to notice that as the acne seems to take all the attention away from her features. It was so bad everyone could see the problem but nobody dared to talk about it for fear of upsetting her further. Her face was constantly looking red and inflammed. Scars had begun to form from the healing lesions. Her self-confidence was really low and she had tried everything to cure her acne.
One day, we noticed that she looked like she had a bad sunburn. Her face was dry and peeling and she looked quite uncomfortable. When one of us finally plucked up enough courage to ask her about it, she explained that she was on a new acne medicine.
This new acne medicine works by reducing the amount of the natural skin oils (called sebum) produced. It also works by having a peeling effect on the skin.
We asked if the drug had any side effects. She looked at us like we had asked her if elephants could fly. All medications have side effects, she said. Acne medicine is no exception.
I looked up the side effects of this wonder acne medicine. The list was quite shocking, to be honest. The first highlighted side effect was a warning that this drug can cause deformities in unborn babies. Under no circumstances should a patient who is pregnant or who has the possibility of getting pregnant take this drug. Effective contraception is a must.
Other side effects included dryness and soreness of lips, eyes, skin, liver and other major organs. Eyesight could be affected. Liver tests needed to be done to ensure there was no harm done to the liver. Even bloody diarrhoea was a potential side effect.
To add to the list of more side effects of this acne medicine, it could also increase blood fat and sugar levels. These too had to be monitored, especially in patients who had other problems such as high cholesterol and diabetes.
It could even cause depression, anxiety and mood changes.The list of warnings was longer than the paragraph on how this acne medicine worked !
Fortunately, the side effects were said to be short-lived and would be reversible if the medicine was stopped. However, we were worried as isotretinoin needed to be taken for at least 12 to 16 weeks.
This wonder acne medicine did not sound so wonderful to us. We did try to talk her out of it. She became unhappy, saying we did not understand how much she had gone through, suffering with her acne problem for years. She explained that with any acne medicine, one had to weigh the benefits and the risks. To her, the risks were worth the potential promise of a cure.
There are few lessons that can be learnt from this story. The first and most important is that while acne is not in any way a fatal disease, it can cause debilitating effects on its sufferers. It affects their self-confidence, the way they see themselves, the way others see them. It can control their lives. Acne has been known to cause depression in some, especially if it is severe.
Unfortunately, while there are acne medicines available, many have side effects. These medicines can cause problems in themselves.
However, in the end, it is the sufferer who must decide if the risks outweigh the benefits.