HISTORY OF ACCUTANE
Accutane is the U.S. brand name for the drug isotretinoin, patented by drug manufacturer Roche Pharmaceuticals. In Europe, Canada, and the United Kingdom, it is known as Roaccutane. Roche's patent for isotretinoin expired in 2001, opening the way for competing drug companies to offer generic versions. The first of these rival medicines earned FDA approval in late 2002; versions are now available to the public under the names Amnesteem, Claravis, and Sotret.
Like Retin-A and other topical retinoids used to treat acne, isotretinoin is derived from vitamin A. The difference is that isotretinoin is an oral retinoid, one that is taken by mouth rather than applied to the skin.
Scientists have known for decades about vitamin As therapeutic effects on the skin. Sometimes called the "anti-infective" vitamin, it plays a key role in maintaining the health of skin cells. However, the body does not readily excrete vitamin A, and taken in large doses it can build up to toxic levels. That is why retinoids used to treat disease often have serious side effects.
In the 1970s, Swiss-based drug giant Hoffmann-La Roche (parent company of the U.S. firm) synthesized a number of different retinoids, trying to come up with safe versions for use on a variety of skin conditions. Among the experimental compounds was one known as 13 cis-retinoic acid. Dermatologist Gary L. Peck, leading a group of researchers at the National Institutes of I Iealth, tried it on fourteen patients (eight men and six women) who had an exceptionally severe and disfiguring form of acne called acne conglobata. Acne con-globata is acne at its most extreme and uncontrollable; at the time it was regarded by dermatologists as truly hopeless. There was literally no effective means of treating it.
Astoundingly, after four months of taking the new drug, thirteen of the fourteen patients were completely free of the monstrous cysts and nodules that had covered their backs and faces; the remaining patient was not totally clear, but had improved dramatically.
When Peck and his colleagues published their results in 1979, in the New England Journal of Medicine, the report caused a sensation among dermatologists. Potential patients who got wind of the new discovery from press accounts of an "acne cure" went wild with hope. Reportedly, one young man was so desperate to obtain Accutane for his girlfriend that he attempted to acquire a supply by holding up the NIH pharmacy at gunpoint.
WHAT IT DOES
Isotretinoin is so dramatically effective against acne because it is the only medicine that effectively fights breakouts on all major fronts. It reduces the size of sebaceous glands, which dramatically curtails sebum production; it decreases the cellular buildup that leads to comedones in sebaceous follicles; it massacres the population of P. acnes bacteria; and it quells inflammation.
Most remarkably, the drug's therapeutic effects typically last long after a patient has stopped taking it. Alone among acne medicines, isotretinoin produces lasting beneficial changes in the skin, making it a virtual cure for many acne patients and dramatically lessening symptoms over the long term for almost all others.
The most common side effects of isotretinoin are similar to those produced by overdosing on vitamin A, a condition called "hypervitaminosis A," or vitamin A toxicity. For most people, the symptoms show up in the mucous membranes and the skin. Accutane makes the skin very dry and easily irritated. The single most common side effect—affecting up to 95 percent of all Accutane patients—is excessively dry, cracked lips. Some patients also get dry, irritated eyes (which can be a particular problem for contact lens wearers).
Others may develop thinning hair or intermittent headaches. Muscular aches or joint pain may become a problem, particularly for people who tend to be very active or athletic.
More serious side effects are uncommon.
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