One of the reasons I originally agreed to develop a weekly column on women's health is my commitment to giving women the information they need to make informed decisions about their own health. And because of their unique ability to conceive and create life, women's decisions are often intrinsically more complicated than men's.
The acne medicine Accutane is an extremely effective medication, but for women in particular it also has potentially serious side effects. The decision about whether to use this drug provides an excellent example of the kinds of decisions women must make and the kind of responsibility they must take.
I asked my colleague in dermatology, Dr. Elizabeth Whitmore, to help me understand the benefits and risks of Accutane clearly.
Q: Is acne a serious problem for women?
A: In the United States, acne is the most common skin disease, affecting up to 85 percent of women between 12 and 25. When it is very severe, as in cystic acne, it is not only a problem when it occurs, but may leave lifelong scars.
Acne can contribute to depression, anxiety, self-imposed isolation and a negative body image.
Q: What is the best treatment for severe acne?
A: A drug that has now been on the market for almost 10 years, isotretinoin (its trade name is Accutane) can be a miracle drug -- it results in a permanent cure in more than 60 percent of patients and a dramatic improvement in almost all the rest. It is not clear exactly how Accutane works, but, during treatment, patients have a greater than 90 percent reduction in their normal oil production.
Treatment usually lasts about 20 weeks and most patients can expect to be "cured" from their acne after this course.
Q: What are the risks of using isotretinoin?
A: This extremely effective drug comes with a very serious risk: It may cause severe brain, heart and bony malformations in forming fetuses. It is not mutagenic, meaning that it toes not affect a woman's unfertilized eggs and thus has no effect on future developing fetuses conceived after Accutane is out of a woman's system. Other, lesser side effects include dry skin, lips and eyes, and, infrequently, an effect on the fats in the blood that resolves after therapy ends.
Q: How can the risks be managed if I use isotretinoin?
A: If a woman is to be put on Accutane therapy, the physician conducts a pregnancy test and instructs the patient not to begin treatment until the third day of her next menstrual cycle. There is a series of constant forms and checklists for the patient to read and complete to ensure that she fully understands the drug's potential and is willing to use two forms of contraception throughout treatment and knows that if she should become pregnant, an abortion would be recommended. The makers of Accutane will pay for an initial consultation with a gynecologist to discuss birth control with the patient.
Q: What if pregnancy should occur despite the use of contraceptives or if a woman does not want to use contraceptives at all?
A: If pregnancy should occur during Accutane therapy, the doctor would almost certainly recommend an abortion for medical reasons. In persons morally opposed to medically indicated abortions, two options exist; they may either remain celibate during the treatment and for one month before and after treatment, or forgo Accutane therapy. If a woman does not want to use contraceptives, she has the same two options.
Q: What are benefits to women of the therapy?
A: Although Accutane does have high potential risk, it is an extremely effective therapy which, when used in appropriate patients, can eliminate lifelong scarring from severe acne.
Accutane represents a clear opportunity for women to improve their health, but one that requires responsible decision-making, effective communication between a woman and her physician and a commitment to accepting the risks with the benefits.
For information about Accutane, consult with your physician or call the Center for Drugs, Food and Drug Administration at (301) 295-8012.
Dr. Matanoski is a physician and professor of epidemiology at the Johns Hopkins School of Hygiene and Public Health.