EM INGLÊS .
RETIREI ESTE TEXTO DE UMA LISTA DE DISCUSSÃO AMERICANA, UM DOS LOCAIS MAIS INTERESSANTES PARA ATUALIZAÇÃO E DISCUSSÃO DE CASOS DIFÍCEIS.
ACHO BEM APROPRIADO, DESMISTIFICANDO O MEDO DA RELAÇÃO ROACUTAN X DEPRESSÃO.
SINTO QUE ESTEJA EM INGLÊS, MAS VAI BEM DE ENCONTRO COM MINHA OPINIÃO.
DR CLAUDIO WULKAN
” If there’s one thing that breaks my heart, it’s seeing people who
are suffering needlessly. The teenager who walks with his head down.
The middle aged man who never goes to the beach. Or, the patient who
specifically seeks work that will not require much contact with
other people. Acne is to blame in all of these cases.
If you’ve never had acne, it’s easy to downplay the significance of
this common skin problem. Zits aren’t the end of the world, right?
No, but the social effects can be devastating, as acne can sap one’s
self-confidence and possibly cost somebody a job he or she might be
well qualified for.
Acne is most common among adolescents, but it can be a lifelong
malady as well.
And although it is a treatable condition, many people still struggle
with it. Part of the reason for that may be that the treatments they
tried when they were younger were ineffective.
In my experience as a dermatologist, I have noticed that the single
most effective medicine for acne is being significantly underused.
Isotretinoin, a derivative of Vitamin A, is an incredible drug,
albeit expensive, that has been around since the 1980. Chances are
you’ve heard of it by its more common name, Accutane.
When this medicine was first approved, it was reserved for only the
most severe forms of acne. But over the years, we have found how
effective it is at clearing varying degrees of acne to the point of
actually curing some patients once and for all.
One of the good reasons for why it was not prescribed widely was
that Isotretinoin, like other medications, does cause side effects.
One of the most serious ones is that it can cause terrible effects
on a developing fetus. Therefore, any woman contemplating pregnancy
cannot be on this medication. Period.
It’s my opinion that some physicians avoided prescribing this
medication for fear their young patients might ignore their
warnings. Other potential effects are that the drug may cause brain
swelling or depression, although this is very unlikely. However, it
should be noted that commonly prescribed antibiotics used to control
acne also pose a small risk of brain swelling.
Much more likely side effects from Isotretinoin are extremely dry
lips during the duration of treatment and an increase of fat in
one’s blood. But in both instances, vigilant patients can deal with
those problems by adjusting their diet and using lip balm.
In responsible patients, Isotretinoin is the gold standard for
treatment of acne. It seems to work by affecting the DNA in the
cells of our oil glands. It acts to normalize the cells, reprogram
them, if you will, to the time before adolescence. It’s interesting
to note that Vitamin A derivatives are used to treat and prevent
cancer because they tend to normalize abnormally growing cells.
The dosage and duration of Isotretinoin treatment depends on the
severity of the acne and the patient’s weight. And the cure rates
vary, according to the patient’s age. The problem may actually
worsen, initially. But that’s only temporary. Recurrence of acne is
quite possible after the treatment ends, but another round can
always be given. The amount of Isotretinoin given is the amount each
patient needs to clear his or her acne. However, the physician who
administers this drug should be very familiar with it, and I highly
recommend patients seek treatment directly from a dermatologist.
When appropriately prescribed, this medicine is so effective, it can
eliminate the awful grease, and make the patient’s skin as smooth as
a baby’s bottom. (Unfortunately, if scarring already has occurred,
even this medicine can’t reverse that situation.)
We can do this. We can do it now. It is a shame that the fear of
side effects often prevents many of my colleagues from prescribing
this medicine. Properly managed, Isotretinoin can be the medicine
many acne sufferers have dreamed about. Isotretinoin is not
necessary, nor appropriate for every acne case, but it certainly
deserves consideration when other medicines fail or barely improve
the patient’s complexion.
Unfortunately, too many people are unaware of how well Isotretinoin
works or have been mislead about whom is a good candidate for it. So
unfortunately, because their acne remains essentially untreated,
they continue to suffer quietly and avoid social situations whenever possible.
I believe their suffering is the legacy of a phenomenally effective
medicine that has simply gotten a bad rap.
Dr. Diane Thaler, of the State Medical Society of Wisconsin, is a
Madison dermatologist. She has no financial ties to Isotretinoin or its maker. “