$Unique_ID{BRK00789} $Pretitle{} $Title{Accutane for Treating and Clearing Acne} $Subject{acne boils inflammatory disease skin hair growth isotretinoin Accutane pregnancy pregnancies pregnant Fertile women liver function tests serum cholesterol triglycerides acute pancreatitis folliculitis inflammation hair follicles antibiotic ointment infertile infertility Fertility sterility sterile} $Volume{R-20} $Log{ ACNE: Pimples and Pustules*0001102.scf} Copyright (c) 1991-92,1993 Tribune Media Services, Inc. Accutane for Treating and Clearing Acne ------------------------------------------------------------------------------ QUESTION: I have acne (boils) on my thighs, but mainly on my buttocks, yet my face is clear. I recently read an article that said that Accutane, a vitamin A derived prescription drug, proved successful for treating and clearing these lesions, but not without side effects. Can you tell me more about this medication and any concerns I should have by taking it? ------------------------------------------------------------------------------ ANSWER: My first problem is with your diagnosis of acne on the buttocks. Acne is an inflammatory disease that affects the skin in areas where there is hair growth, since the disease affects the glands at the base of each hair which form a waxlike substance called "sebum." Acne most always occurs on the face, but is also common on the neck, chest, shoulders, and upper back. I suppose it could occur on the buttocks, but it would have to be considered rare. The medication you referred to is called "isotretinoin" (Accutane) which is a synthetic derivative of vitamin A. It is specifically indicated for cystic acne that does not respond to other therapies such as antibiotics and local lotions or gels such as benzoyl peroxide. Isotretinoin is administered by the oral route and capsules are taken on a daily basis from 15 to 20 weeks. There are some important side effects with this medication, and it must never be given to women who are pregnant or who might become pregnant during the course of treatment. Fertile women must observe strict birth control measures during the period of time they are on the medication, for the danger of harming the fetus is a very real one, particularly in the first three months of gestation. The medication is also prohibited in lactating mothers. Constant laboratory testing is necessary during the course of treatment and must include liver function tests, as well as tests for serum cholesterol and triglycerides. Frequently, there is an increase of fatty substances in the blood during treatment and if they reach extremely high levels, then the medication must be stopped because of the risk of acute pancreatitis. Another possible consideration for the treatment of acne would be "tretinoin" (Retin-A) from the same chemical family. It is prepared as a gel, cream or lotion and is applied locally. Many adverse side effects are therefore avoided. However the medication can cause skin irritation in sensitive individuals. In your particular case, however, I think I'd have another physician take a look at your rash, as the possibility that it might be folliculitis is a very real one. This is also an inflammation of hair follicles and a small pustule or pimple containing pus may form around the opening of each affected hair. In this case, proper treatment will include a local antibiotic ointment, or, in the case of severe disease, an injection with either penicillin or erythromycin. In any case, you will really have to visit your physician again as either isotretinoin or tretinoin may only be prescribed by a physician and care should be closely monitored during the period you are using the medication. The good news is that if you do have acne, and if your physician does prescribe one of these medications for you, the hopes that you will have a positive outcome are very high. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.