In cases of severe acne, there is a very effective medication. This may however present serious side effects, hence the importance of a rigorous medical monitoring and to be well informed.
As with any medication that can induce serious adverse effects, the authorities set up a monitoring pharmacovigilance, whose results are regularly released.
What is the treatment?
This is isotretinoin, sold under the name of Roaccutane ® until September 2008. This medication is no longer marketed under the name of Roaccutane ®, but is replaced by 4 Generic Drugs Curacné ® (Pierre Fabre), Procut ® (Expanscience) Contracné ® (Bailleul Biorga) and Isotretinoin Teva ® (Teva) .
Isotretinoin is reserved for treatment of severe acne resistant to conventional treatment. Each year, 100,000 people receive treatment, 45% are aged 14 to 19 years.
This molecule is very effective against acne, but can also have serious side effects. What are they?
Risk of psychiatric disorders
Depression, suicide attempts and suicide are psychiatric disorders with the risk of occurrence is increased as isotretinoin.
Between 1986 and April 2009, one hundred cases of psychiatric adverse events were reported (52 cases of depression, 10 suicide attempts and 10 suicides). Note that cases of depression and suicide attempts were associated with a history of depression, a trigger (failure, attempted suicide of a loved one) or personality disorders.
People with psychiatric history and who wish to pursue this treatment must therefore be given very careful monitoring.
If signs suggestive of depression or other psychological disorders, discontinuation of treatment should be advocated.
Overall, the mental condition of the patient throughout the treatment should be evaluated with increased surveillance and screening of subjects at risk. The doctor may use such a questionnaire to assess the potential of a depressed teenager before the first prescription and throughout the treatment.
Risk of fetal malformations
Another side effect of isotretinoin is a serious risk of fetal malformations in pregnancy during treatment or within one month following his arrest. This treatment is strictly cons-indicated for pregnant women. It can be issued only to girls and women who are using contraception, and ideally both. A pregnancy test is required before starting treatment, then monthly during treatment and again 5 weeks after the treatment.
The prescription is limited to 1 months and the drug may be issued within 7 days of the prescription.
Any person taking isotretinoin should be thoroughly knowledgeable of the risk. Even the boys, to be sure they will not lend their treatment to a girlfriend for example.
Despite all these precautions, there was an increase in the number of pregnancies among women taking isotretinoin, including pregnancies starting during treatment. This phenomenon is due to contraceptive failure: lack of adherence (forgetting Pill) or inadequate contraception.
It is therefore once again emphasize the effectiveness of contraception and the risks involved in pregnancy.