Dear Dr. Roach: Our 31 year old daughter has been fighting a losing battle with acne since she was a teenager. Accutane has been suggested many times, and now she’s about to start treatment. We have always been too scared of this powerful drug to try it.
Dear Dr. Roach: Our 31-year-old daughter has been fighting a losing battle with acne since she was a teenager. Accutane has been suggested many times, and now she’s about to start treatment. We have always been too scared of this powerful drug to try it. Are we right to be afraid?
Isotretoin (Accutane) is indeed a powerful drug, and while it is clearly beneficial for acne, its side effects are significant enough that a thorough discussion is appropriate before starting this drug, especially in a woman of childbearing age.
Isotretoin is a powerful teratogen, which means it causes birth defects. These are sometimes severe enough to cause stillbirth, but a child born to a woman taking Accutane is at high risk of a serious birth defect. Even babies who appear normal at birth are more likely to have developmental problems in the brain. For this reason, every woman of childbearing potential must commit to effective contraception (abstinence from heterosexual intercourse or two effective methods, such as an oral contraceptive plus a barrier method). Women also need monthly pregnancy tests and counseling visits, and prescribers need additional training to be able to prescribe this medicine. The manufacturer advises against becoming pregnant in the cycle following the discontinuation of treatment; however, at least one case report noted an isotretoin-compatible birth defect in the second month, so I think it is prudent to wait another month, with extra precautions.
Both men and women are at risk for additional side effects from Accutane. Depression and other mental health problems, including psychosis, are possible, and people should be screened for depression and suicidal thoughts. Dry skin and inflammation around the lips is common and often requires lotions to treat. A link to bowel disease is controversial. Elevations in cholesterol and triglyceride levels are also common, but rarely require stopping medication. I don’t have enough space to cover all possible less common side effects.
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 the risk of depression. Despite its risk of side effects, isotretoin is a reasonable choice in carefully selected patients who accept the necessary conditions of treatment. At 31, your daughter can certainly make her own choice about this.
Dear Dr. Roach: Could you know what is the success rate of laser treatment for incontinence vaginal rejuvenation? I find wearing adult diapers unappealing and unsatisfying, but I’d rather not waste my money on an untested procedure.
There are several types of incontinence (the most common are urge incontinence, the feeling of needing to go to the bathroom IMMEDIATELY or risk having an accident, and stress incontinence, when the urine leaks during a stressful maneuver, such as coughing or sneezing). The best treatment depends on the type of incontinence, and before considering treatment such as laser, it is important to carefully consider common causes, including medications, underlying medical conditions, UTI and vaginal atrophy. These may have effective treatments. Even if no cause can be identified, pelvic floor muscle exercises and bladder training can still be effective. Medications and pessaries are helpful for some women.
If you’ve been through all of this and still struggle with incontinence, it’s worth considering options, including surgery in some cases. Vaginal laser treatment is a potential new treatment. Several preliminary studies have been done, showing 60-80% effectiveness, but I still think it’s too early to recommend this treatment.
Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can send questions to [email protected]