Acne is a skin condition presenting with swellings due to an inflammatory response to bacteria. Roacutane is a treatment for severe acne that is highly effective but can result in a high number of side-effects.
Acne results from increased testosterone levels that cause excessive oil production by glandular cells in the skin and shedding of skin outer layers. This provides a suitable environment for the replication of Propionibacterium acnes, a usually harmless bacterium found on the skin. The symptoms of acne such as blackheads, pustules and swellings develop as the skin becomes inflamed due to the bacterial replication.
Roacutane was introduced to the market to treat severe acne under the name of Accutane in 1982. An article written by Aamir Haider and James Shaw published in "The Journal of the American Medical Association," reports that roacutane is the gold standard with which new acne treatments are compared. A trial in 1998 involving 900 patients, found that the total acne lesion count was reduced by 53 percent in patients treated with roacutane.
The Mechanism of Roacutane
Roacutane is an oral treatment that inhibits the proliferation of glandular cells in the skin that produce oil and reduces the sizes of existing glands. It is derived from vitamin A and naturally occurs in the body. Recent research suggests roacutane causes increased production of the antimicrobial protein neutrophil-gelatinase. A paper published in "The Journal of Clinical Investigation" in 2008 by Nelson, et al, explains how neutrophil-gelatinase reduces oil production and reduces the size of oil glands by causing spontaneous death of glandular cells.
Haider and Shaw write that treatment with roacutane is only suggested when acne is severe and other therapies have failed to be effective. Roacutane is absorbed best when ingested with food, and treatment lasts between 4 to 6 months. A study in 1984 found that there was a greater failure rate when roacutane was prescribed at a lower dosage of 0.1 mg per kg of body weight per day. Far fewer patients required repeated treatment when prescribed at 1mg/kg per day. A study published in 1993 found that after following the progress of 88 patients for 10 years, 23 percent needed a second treatment of roacutane within three years after the treatment when it was prescribed at 0.5 or 1mg/kg per day. It became apparent that a key factor determining the success of roacutane was the cumulative level of roacutane that built up in the body. Patients with more than 120 mg/kg of cumulative roacutane have fewer relapses than patients with less.
Roacutane causes cell surfaces to produce less fluid. Consequently, possible side-effects of roacutane treatment include drying out of surfaces such as lips, skin and eyes. A review by James Leyden in 1997 published in "The New England Journal of Medicine" claims that roacutane would be the drug of choice for most people with acne if it were not for side effects including joint stiffness. Patients may also experience headaches, nose bleeding and backaches. Headaches may be an indication of raised intracranial pressure and patient’s triglyceride count may also rise. Roacutane treatment is extremely harmful for developing embryos, and so contraception must be used during treatment and for six weeks after treatment has finished. A commentary by Koren, Avner and Shear in 2004 published in the Canadian Medical Association journal stated that 40 percent of embryos exposed to roacutane in early pregnancy are born with severe malformations. It has been suggested that treatment with roacutane can cause Crohn’s disease and ulcerative colitis.
- "The Journal of American Medical Association"; Treatment of Acne Vulgaris; Aamir Haider, James C. Shaw; Aug. 11, 2004
- "New England Journal of Medicine"; Therapy for Acne Vulgaris; James L. Leyden; Apr. 17, 1997
- "The Journal of Clinical Investigation"; Neutrophil gelatinase–associated lipocalin mediates 13-cis retinoic acid–induced apoptosis of human sebaceous gland cells; Amanda M. Nelson et al; April 2008
- "Canadian Medical Association Journal"; Generic Isotretinoin...; G. Koren, et al.; May 11, 2004