November 29,
2000 Editor, Baltimore Sun PO Box 1377 Baltimore, MD
21278-0001
Dear Editor,
I am concerned about my patients. Over the
years, I have seen more than three thousand acne patients and have treated
approximately 15% of these patients with isotretinoin, also known as Accutane.
This key acne treatment has significantly improved my patients’ severe scarring
acne, and as a result, their emotional well being. If this treatment were not
available in our community, it would have a devastating effect on my patients’
lives. Recently, an advisory panel to the Food and Drug Administration (FDA)
recommended restricting access to isotretinoin to only registered physicians and
registered patients. This action stems from reports of depression and potential
birth defects in women who may become pregnant while taking this medication.
My foremost concern is the safety of my patients. While I share the FDA’s
concerns regarding the serious side effects of this powerful medication, it is
crucial that I be allowed to offer all treatment options to my patients so
together we can make an informed decision. In some cases, isotretinoin is the
only effective choice for my patients’ severe, disfiguring acne. I support
the American Academy of Dermatology’s position that education of physicians and
patients, rather than regulation, is the best way to ensure safe and effective
results when using isotretinoin. Limiting distribution of this important acne
medication would severely restrict access to the drug, making it difficult to
obtain, especially for patients in rural areas. This action would be an immense
disservice to patients everywhere. Millions of teenagers and adults have
acne, a chronic skin condition. Because of its visibility, acne often has a
devastating effect on a person’s self-confidence and self-esteem. When severe,
untreated acne can result in disfiguring scars. While over-the-counter
products can often control acne in its mildest forms, dermatolologists will
frequently prescribe topical medications and oral antibiotics for more difficult
cases. In severe cases, isotretinoin is the only medication proven to
effectively control resistant nodular cystic acne, the most serious form of this
skin disease. Studies have shown that over a 20-week period, up to 80 percent of
patients taking this medication will have a complete resolution of their acne,
and in most cases, permanent clearing. Everyone knows someone with acne,
whether it’s a neighbor, a co-worker, or a friend. Today, we are fortunate to
have access to an extremely valuable medication for the care of destructive
cystic acne. The decision whether or not to prescribe this treatment should be
made on an individual basis between the dermatologist and his or her patient. It
should not be influenced by government regulations. Sincerely, David F.
Jaffe, M.D.