I was surprised to read that Roche Pharmaceuticals, the makers of Accutane, decided to stop selling the name brand of the product in late June. The company cited declining sales as their reason. Since 2002, generic forms of Accutane (isotretinoin) have been available and it turns out over 95% of the time doctors prescribe a generic. Roche’s decision to stop selling also came shortly after a jury awarded $33 million in damages to people who claimed Accutane caused bowel disease.

What does this mean for us? Well, it gives me pause because yet again Accutane’s side effects are in the spotlight. While some people with recalcitrant, widespread, deeply scarring acne regard Accutane as a godsend, I would have to think twice before agreeing to have a loved one of mine take it for anything less than severe acne.

For people who choose to take it, isotretinoin, the active ingredient in Accutane, is still available in its generic form. However, that brings up another concern. Are generics reliable? This study performed in 2006 cast doubt over the quality of generic forms of isotretinoin. It is only one study, and more are needed, but I’d like to see further oversight and studies performed to ensure product efficacy. Let’s keep our eye closely on this issue.

My fabulous research assistant, Miriam, and I have been steeping ourselves in rosacea research for the past couple of weeks. It’s a mysterious topic, but some effective treatments exist. Also, the latest research is showing promise for hopeful rosacea eradication in the future. I distilled down what we learned onto the new rosacea pages, with Joel’s help of course :)

Let me know what you think!

I’ve been pouring over scar research for days now. It is pretty endless, but I’m making progress. I’ve read through the latest summaries of research as well as a bunch of your comments on the scar treatment ratings pages. I have a couple of initial strong feelings:

1. Prevention is key! Scar treatment is hardcore–bleeding, oozing, bruizing, pain, long recovery time, permanent change in pigmentation at times, and major expense. It is far easier to prevent acne than it is to attend to scars. I happen to not be prone to scarring, but if I were, I would be diligent on the regimen and I would also be serious about creating anti-inflammatory action in my body. I’d be all about fish oil, zinc, eating well, exercising, and if I was healing from a pretty hardcore zit, I’d take an advil or two during recovery to prevent over-inflammation in my body and the scar response (this is only theorized and not proven to work, but I’d try it). I’d also refuse to pick at my skin, knowing that picking can cause as much scarring as the acne itself.

2. Scar revision is more of an art than a science. I’ve researched 19 different procedures so far. These 19 different procedures often need to be combined for best results. If I were looking for a doctor to take care of my scarring, I would look specifically for a plastic surgeon who specializes in acne scarring. Furthermore, I would not just take their word for it. Lots of people seem to “specialize” in whatever you’re paying $4000 for. Rather, I’d feel more comfortable if they themselves had scar revision treatment performed and if this is what got them into plastic surgery to begin with. I’d also make sure they had lots of before and after pictures for me to look at of their own previous clients. To give you an idea of what I mean regarding combination of treatments, if you have some ice pick scars, some narrow and some wide boxcar scars, and several rolling scars here and there, your treatment might consist of one or two punch excisions, one or two punch elevations, a bunch of subcisions, and perhaps some 75% TCA applied directly to a few scars. Then, 6 weeks would pass and you might get CO2 laser revision, followed by Er:YAG, or alternately, 5 medium depth TCA peels, with a little needling should it be required. I think you catch my drift.

I’m angered and motivated from some of the reviews you guys have written about doctors with a laser just sitting you down in the chair with no prep work and just lasering away, taking your $3500 and being done with it, leaving you with less than desirable results. Let’s help educate one another so those of us who need scar revision can be better advocates for themselves and others. I’ll post what I’ve got on the updated scars pages soon.

Research was again spotty regarding drugs and acne. I found no published studies or trials specific to drugs and acne, so I took the next logical step and looked at how drugs affect hormone levels. I found information on marijuana, cocaine, and ecstacy (MDMA) but not methamphetamines or other drugs. A synopsis of what I found is on the new drugs and acne page.

If I had to sum it up in two sentences: Drugs may affect hormone levels, which may or may not in turn affect acne, but as of this point in time, more research is needed. Additionally, drugs can have negative effects on stress levels, picking, and regimen adherence which may prove detrimental to acne symptoms.

Rosacea: It’s not acne vulgaris, but it’s similar. I’d like to make a nice rosacea page to outline what it is, how it’s different, and appropriate approaches to therapy.

Free radicals: Questions I’d like to answer: Free radicals are necessary for bodily maintenance, but how much is too much? When are anti-oxidants best utilized?

Scarring: I have not looked into the latest scar revision techniques for a couple of years. It’s time! I’ll update the scars pages accordingly.

B5
: Despite the severe paucity of research on this topic, it keeps coming up, so I’ll delve as deeply as I can and make a page about it.

Hormones
: In particular, you guys keep asking me questions regarding masturbation and acne. As is often the case, there is zero research on this exact topic, but looking more widely at hormones may shed some light. I’ll see if I can’t make a hypothesis or two regarding this sensitive topic.

Today I’m doing some research into drugs and acne. Unfortunately, I found no clinical studies on the topic, so I am having to cast my net more widely. I’m going to look into the effects of drugs and alcohol on the endocrine (hormone) system. For instance, it seems that marijuana effects the hormone levels of rats and monkeys, but evidence in humans is less consistent.

This is going to require a trip to the medical library, but once I’ve got the evidence in my hands, I’ll distill it down for us and we’ll try to draw a hypothesis or two from the studies that have been performed.