For teens with severe, disfiguring acne, sometimes there’s only one answer: Accutane, a popular drug that can dramatically reduce scarring and boost self-esteem.
Yet the suicide Monday of a 14-year-old Palo Alto boy who jumped in front of a train has many parents and kids wondering if the medication is worth it.
The Santa Clara County medical examiner said the high school freshman had a prescription for the drug, and his office is trying to determine whether it was in the boy’s system when he died Monday morning. There is no conclusive evidence the drug had anything to do with the boy’s death, but it does carry a label warning doctors and patients about depression and the possibility of suicide.
Doctors stress it would be premature for patients to give up on the drug out of fear that they might become suicidal. And the manufacturer points out the suicide rate among patients on the medication is lower than for the general population.
But parents and teens do need to educate themselves about the potent medication, experts said, and take any changes in mental health very seriously.
Q What are the common risks associated with Accutane?
A “Everybody gets dry skin, dry lips, dry eyes,” said Dr. Sandhya Yadav, chief of dermatology at Kaiser-Santa Clara hospital. Accutane hair loss and peeling palms are also not uncommon, Yadav said.
Less frequently, Accutane may cause depression, psychosis and, even more rarely, suicide attempts, according to the Food and Drug Administration. Doctors also recommend regular liver tests to ensure that it isn’t promoting liver problems in patients. And because the medication causes birth defects, it should never be taken by pregnant women.
Since 2001, the Food and Drug Administration has required doctors to have patients sign a lengthy consent form alerting them of these dangers before they can write a prescription for the drug.
Q How can I tell if my teen’s mood swings or irritability might be due to the drug, rather than just normal teen behavior?
A Doctors recommend that patients report any behavior that is not normal for them. If teens suddenly begin to feel sad or overwhelmed, have difficulty sleeping or concentrating, or have significant changes in appetite, the physician should be notified immediately. Yadav said the patient should stop taking the drug until meeting with a doctor.
Q Why would anyone want to take Accutane if it has such side effect warnings?
A “It’s a marvelous drug for people who have acne,” said Dr. Richard Glogau, a clinical professor of dermatology at the University of California-San Francisco.
Usually, dermatologists will start patients off on a topical therapy such as benzoyl peroxide or retin A. Or they will try antibiotics such as tetracycline or erythromycin. But if those don’t work and a teen’s acne is severe enough, “Accutane fills a niche,” Yadav said. “There is no other substitute.”
The drug works by shrinking glands that produce sebum, an oily substance that clogs pores and produces pimples. And in patients with severe cystic acne, which can cause facial scarring, it can bring about dramatic results.
In fact, Glogau said he worries more about the mental health of kids with a serious pimple problem who don’t receive any medical help at all.
“By actually treating acne and boosting self-esteem” Glogau said, it “probably lowers their suicide risk.”
Q What are the drug’s limitations?
A It isn’t a cure. Normally they take the drug for five months. But some patients may have to try a second course of treatment. And the dry skin teens experience while on the medication is no fun either, doctors said.
Also, it shouldn’t be given willy-nilly to any teen suffering from just a few pimples.
Q Are there alternatives?
A “There are a few parents who say that they’re uncomfortable exposing their child to such a strong medication. For those people, we will try three, four or five different antibiotics,” Yadav said. But if all of them fail, patients can be left with a tough, personal decision: Go on Accutane, or continue to struggle with severe acne.
Q Where can I learn more about Accutane?
A The Food and Drug Administration has a wealth of information on its Web site. Go to www.fda.gov/cder/drug/infopage/accutane. Dermatologists can also hand out informational brochures on the drug and answer questions about it.