March 1997
Pediatricians should consider the degree of inflammation and status of comedones and nodules when deciding which acne treatment to prescribe to an adolescent. The degree of oiliness, dryness and the patient's washing habits should be taken into account, as well.
With all those concerns about the physical, it could be easy to ignore the emotional. However, Patricia Treadwell, MD, said it was important not to overlook the patient's emotional state. Treadwell is associate professor of dermatology and pediatrics at Indiana University and chief of pediatric dermatology at Riley Children's Hospital in Indianapolis.
"Certainly the emotional aspects that are involved with having acne, especially on the face because it is such a visible area, come into play when you are deciding how to treat," she said at the 32nd Annual Pediatric Postgraduate Course sponsored by Miami Children's Hospital here. Treadwell says she has seen a range of reactions from patients over the years, so she always recommends that physicians take the patient's psychological standing into account when deciding just how aggressive the course of treatment should be.
Several issues come into play with the use of the oral preparation isotretinoin (Accutane, Roche Pharmaceuticals), which Treadwell recommends for severe cases of adolescent acne when other therapies have failed. "This is an effective medication for acne, but the patients need to be chosen carefully," she said.
One concern is that candidates for isotretinoin will see it as a cure rather than a treatment and that they will be in an unrealistic hurry for results. "I always point out to patients that the initial improvement is to not have new lesions," Treadwell said.
Treadwell says it is key to emphasize to patients that they may have some scarring. "I try to counsel them that what they are going to see [initially] is fewer active lesions," said Treadwell, "because they are usually hoping that their face will clear up by the next day."
Another concern is that it should be used with extreme caution in females of childbearing age. "We have to be so careful prescribing this," she said, "because we're all too familiar with how adolescents don't think about the issue of pregnancy." A pregnancy prevention program supplied by the product's manufacturer is provided along with the prescription.
Isotretinoin is given for a course of 20 weeks. Initially it was prescribed for 16 to 20 weeks, but Treadwell says the lengthier treatment regimen has decreased the number of relapses that have occurred.
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