Transcript Lauren Tran ACCUTANE dR. KARAN SRA M.D.

Lauren Tran
Acne and Accutane: My Journey
Dr. Karan K. Sra, MD
The Dermatological Association of Texas
ISM Health Science Fall 2014
Mrs. Click R.N
*Some information in this presentation comes from
outside sources.
Dr. Karan K. Sra, MD
 Dr. Sra completed her undergraduate
training at the University of Texas in
Austin and graduated with honors.
She attended medical school at the
University of Texas Medical Branch
at Galveston with an internship and a
Dermatology residency. Before
completing her training, she was a
part of the clinical trials at the
Department of Dermatology at the
University of Texas Medical branch
at Galveston and Center for Clinical
Studies in Houston.
"Karan K. Sra, MD, FAAD." dermtexas. Dermatological Association of Texas, n.d.
Web. 12 Oct. 2014. <http://dermtexas.com/about-us/
karan-k-sra-md-faad/>.
What is ISM?
 ISM is an abbreviation for Independent Study
Mentorship
Multi- Disciplinary
 Health Science

 Students are given the opportunity to choose a career
based on their interests
 Students also choose a mentor that fits into their
desired field in order to assist them on their project as
well as provide an introduction to their profession
 At the end of the semester, the students showcase their
knowledge of their project topic at the Career Fair
ISM Requirements
 Students must:
 Document a minimum of 2-3 hours of mentorship
activities each week
 Complete a Journal Entry each week documenting
mentorship experiences
 Complete an ISM Professional Portfolio showcasing all of
the assignments during the course and final project
My Project Topic
 My project is about acne, Accutane and my Accutane
journey
 Why did I choose this topic?
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I chose this topic because I want to educate others about acne,
Accutane, and to share my experience with Accutane.
What is Acne?
 Acne is a skin condition that is caused by:
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Hair follicles that are blocked due to oil (sebum: produced form
sebaceous glands) and dead skin cells
Overproduction of sebum (puberty/pregnancy due to hormones)
Buildup of bacteria
Collection of dead skin cells
Heredity
 Commonly appears on:
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Face, chest, back, neck, and shoulders
"Acne." Mayo Clinic. Mayo Foundation for Medical Education and Research, n.d. Web. 12 Oct. 2014. <http://www.mayoclinic.org/diseasesconditions/acne/ basics/treatment/con-20020580>.
The Different Types of Acne
 Non-inflammatory lesions
 Comedones
 Whiteheads-
pimples that stay under the surface of the skin
 Blackheads-
the pimples that rise to the surface of the skin
and looks black
 Inflammatory lesions
 Papules- raised bumps (signal of inflammation/infection)
 Pustules (pimples)- red and tender filled with pus at the tips
 Nodules- large and solid lumps beneath the surface of the skin
 Cysts-(the most painful) boil-like infections that cause scarring
"Acne." Mayo Clinic. Mayo Foundation for Medical Education and Research, n.d. Web. 12 Oct. 2014. <http://www.mayoclinic.org/diseasesconditions/acne/ basics/treatment/con-20020580>.
Nase, Geoffrey. "Rosacea Symptoms and Rosacea Triggers: Details and Rosacea Photos by Dr. Geoffrey
Nase." Rosacea Symptoms and Rosacea Triggers. Nase Publications, n.d. Web. 06 Dec. 2014.
"Acne: It's Not Just a Teen Problem." - WGEM.com: Quincy News, Weather, Sports, and Radio.
N.p., n.d. Web. 06 Dec. 2014.
Facts vs. Myths
 Factors that could worsen acne:
 Hormones (especially during puberty)
 Certain medications
 Diet
 Oil based cosmetics
 Sweat
 Myth factors
 Fried foods (greasy)
 Chocolate
 Dirty skin
"Acne." Mayo Clinic. Mayo Foundation for Medical Education and Research, n.d. Web. 12 Oct. 2014. <http://www.mayoclinic.org/diseasesconditions/acne/ basics/treatment/con-20020580>.
Treatments for Acne
 Topical medications
 Epiduo
 Differin
 Oral medications
 Antibiotics (Solodyn)
 Oral contraceptives (Ortho Tri-Cyclen)
 Laser and light therapy
 Cosmetic procedures (chemical peels or
microdermabrasion)
 Drainage and extraction procedure
"Var R_text = New Array (); R_text[0] = "Excellence in Dermatology™"; R_text[1] = "Excellence in Dermatologic
Surgery™"; R_text[2] = "Excellence in Medical Dermatology™"; R_text[3] = "Excellence in Dermatopathology™"; Var I =
Math.floor(4*Math.random()) Document.write(r_text[i]);." Acne: Diagnosis, Treatment, and Outcome. American Academy
of Dermatology, n.d. Web. 05 Dec. 2014.
Dehn, Elizabeth. Epiduo. Digital image. Beautybets.com. N.p., 30 July 2013. Web. 12 Oct. 2014
Why Did I Choose Accutane?
 I tried all sorts of medications and none of them were effective
Topical treatments (Epiduo and Differin)
 Oral medications (Solodyn- antibiotic)
 Birth control (Ortho Tri-Cyclen)
 My dermatologist Dr. Sra, introduced me to Accutane

"Solodyn Antitrust Class Action Lawsuits Consolidated into MDL." Top
Class Actions. N.p., n.d. Web. 06 Dec. 2014.
"10 Things to Know about Differin." Clear Clinic Acne Acne Scar
Treatment Centers. N.p., n.d. Web. 06 Dec. 2014.
What is Accutane?
 Isotretinoin
 “Last resort pill” (if other medications aren’t
effective)
 Powerful medication that is used to treat severe acne
How Does Accutane Work?
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Vitamin A derivative
Dramatically reduces size of the sebaceous glands (35%-58%) and the amount of oil
production (about 80%)
Reduces amount of bacteria
Slows down the process of skin cell production inside the pore (prevents clogged skin)
Anti-inflammatory properties
Accutane. Acne. Dan Kern, n.d. Web. 12 Oct. 2014.
<http://www.acne.org/ accutane.html>.
Temporary Side Effects
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Bone/joint pain
Burning and dryness of eyes
Nosebleeds
Dry nostrils
Extremely dry lips
Peeling skin
Rash (eczema)
Hair loss
Increased sunburn susceptibility
Diminished night vision
Blurred vision
Fatigue
Slow healing of cuts and sores
Hearing impairment
Headaches
"Accutane (isotretinoin)." - How It Works, Side Effects, and Reviews - Acne.org.
N.p., n.d. Web. 06 Dec. 2014.
Permanent Side Effects
Elevated liver enzymes
 Inflamed pancreas
 Respiratory symptoms
 Inflammatory bowel disease/ Chrohn’s disease

"Accutane (isotretinoin)." - How It Works, Side Effects, and
Reviews - Acne.org. N.p., n.d. Web. 06 Dec. 2014.
"Accutane (isotretinoin)." - How It Works, Side Effects, and Reviews Acne.org. N.p., n.d. Web. 06 Dec. 2014.
iPledge System
 Roche started a program SMART (System to Manage
Accutane Related Teratogenicity) in 2000 which
became iPledge
 Launched in March 2006
 Purpose of the program is to prevent females from
becoming pregnant
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Must use two forms of birth control while on Accutane
"Call Our Toll Free Number 1-866-495-0654 to Report Any of the
Following:." Public Home Page. N.p., n.d. Web. 06 Dec. 2014.
"IPLEDGE." Wikipedia. Wikimedia Foundation, 29 Nov. 2014. Web. 06 Dec. 2014.
Birth Defects
 Include:
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Skull
Ear
Eye
Facial
Central nervous system
Cardiovascular
Thymus
Parathyroid abnormalities
Death
 Effects and risks of Accutane on unborn children are so severe that
female patients at childbearing age are required to use two forms of
birth control while on Accutane.
"Acne Drug Accutane's Side Effect Is Death. So Why Is It Still on the
Market?" CBSNews. CBS Interactive, n.d. Web. 06 Dec. 2014.
Depression and Suicide
 Between 1982-2000, the FDA received reports of 431 cases of depression,
suicide attempts, or suicide.
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37 patients who committed suicide
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24 while using it and 13 after using it
84%, 31 were male between the ages of 13-32 years
110 patients were hospitalized
56%, 62 were female between the ages of 12-47 years
 2008- Journal of Clinical Psychiatry was the first controlled study to find a
correlation between Accutane, suicide, and depression were relatively minor
 More recent studies have led to more credibility that Accutane does not
negatively effect depression or mood
 “It showed significant improvements to depression, anxiety, and
obsessive thoughts due to the power of Accutane to clear acne and
thus increase the quality of life.”

"Depression and Suicide in Patients Treated with Isotretinoin — NEJM." New England
Journal of Medicine. N.p., 8 Feb. 2001. Web. 06 Dec. 2014.
Patient Protocol
 Required to sign papers accepting the terms and policies for
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the program
Required to take a monthly test on the iPledge program and
pass in order to obtain refills
Shouldn’t go out in the sunlight too much
Shouldn’t use any treatments to treat acne (salicylic acid)
Shouldn’t wax or thread eyebrows
Every month the patient must take a:
 Urine test to make sure the female patient is not pregnant
 Blood test to make sure the liver, vitamin, iron,
cholesterol, and blood platelet levels are stable enough to
continue using Accutane
Statistics on Accutane
 1997-2002: the Food and Drug Administration
received 83 cases of inflammatory bowel disease
among uses of Accutane
 Researchers found a relationship between dosage
and the risk of getting ulcerative colitis (higher
dose= greater risk of disease)
 Study based on 87 health insurance companies
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Out of 8,189 cases in the study population:
 3,664 had Crohn’s disease
 4,428 had ulcerative colitis
 97 had unspecified bowel disease
"Accutane® Statistics." Accutane Statistics. N.p., n.d. Web. 06 Dec. 2014.
Lawsuits Against Accutane
 Roche has been ordered to pay more than $53 million to
Accutane patients
 Cases:
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2008- Jury awarded a woman with inflammatory bowel disease 10.5
million in compensatory damages and $78,500 for medical
expenses
2010- Roche was forced to pay $25 million (largest award) to
Andrew McCarrell, who developed inflammatory bowel disease years
after he had taken Accutane. He had five surgeries and was forced to
have his colon removed. The judge who ruled the case, Carol E.
Higbee, said that McCarrell’s “testimony and that of his wife
and doctors presented a picture of probably the worst case
of pain, suffering and loss of quality of life I ever heard
described in my eighteen years on the bench.”
"Accutane Lawsuit." - Settlements, Claims & Compensation.
DrugWatch, 10 Oct. 2014. Web. 06 Dec. 2014.
My Accutane Journey
Before
May 2014
After
December 2014
Side Effects That I Had
 Dry lips
 Dry eyes (Restasis)
 Dry patches on hands
 Joint pain
 Fatigue
 Dry nostrils
Portfolio Binder
Weebly Website
 www.laurentran.weebly.com
Final Product
 www.laurentran28.weebly.com
Conclusion
 I chose this topic because it was something that I’ve wanted to share for
a while. I’ve had acne since I was 10 years old. It has affected me
emotionally and psychologically. I would be scared to walk out of the
house fearing that people would judge and laugh at my face. I would
also occasionally cry because I hated the fact that I was so selfconscious about myself even though at an early age I shouldn’t have
been. Even though having acne made me have a low self-esteem, I
wouldn’t say that I “suffered” from acne. Acne has made a grand and
positive impact on my life.
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Healthy lifestyle- only water, no rice, occasionally have baked and fried goods
Skincare- acne isn’t curable but my proper skincare routine helped me prevent/maintain my
skin from breaking out to its highest potential
Knowledge/passion- that I have gained from all of this. I know so much information about
acne, Accutane, and skin care as well as cosmetic products
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I share my knowledge because I desire to help others because I can understand what they have gone
through.
Conclusion Continued
 What I’ve learned from my mentorship:
 Nothing ever runs smoothly
 They deal with different kinds of patients
 There are definitely the fantasies vs. realities of being a doctor
 Having this mentorship has completely changed my
perspective of the medical field
The nurses working hard
Liquid Nitrogen to freeze
warts
Dr. Robare searching for
Scabies
Questions?
Part of the lab
Part of the lab
Thank You
 I would like to thank:
 My mentor: Dr. Sra
 Mrs. Tufano
 Dr. Robare
 My evaluators: Mrs. Deckert and Mrs. Cotton
 My teacher: Mrs. Click
 My parents: Nga Tieu and Long Tran
Work Cited
"10 Things to Know about Differin." Clear Clinic Acne Acne Scar Treatment Centers. N.p., n.d. Web. 06 Dec.
2014.
"Accutane (isotretinoin)." - How It Works, Side Effects, and Reviews - Acne.org. N.p., n.d. Web. 06 Dec. 2014.
"Accutane Lawsuit." - Settlements, Claims & Compensation. DrugWatch, 10 Oct. 2014. Web. 06 Dec. 2014.
"Accutane® Statistics." Accutane Statistics. N.p., n.d. Web. 06 Dec. 2014.
"Acne Center: Blackheads, Cystic Acne, Whiteheads, Scarring, and Acne Treatments." WebMD. WebMD, n.d.
Web. 07 Dec. 2014.
"Acne." Definition. Mayo Foundation, n.d. Web. 07 Dec. 2014.
"Acne: It's Not Just a Teen Problem." - WGEM.com: Quincy News, Weather, Sports, and Radio. N.p., n.d. Web.
06 Dec. 2014.
"Depression and Suicide in Patients Treated with Isotretinoin — NEJM." New England Journal of Medicine. N.p.,
8 Feb. 2001. Web. 06 Dec. 2014. "Var R_text = New Array (); R_text[0] = "Excellence in Dermatology™";
R_text[1] = "Excellence in Dermatologic Surgery™"; R_text[2] = "Excellence in Medical Dermatology™";
R_text[3] = "Excellence in Dermatopathology™"; Var I = Math.floor(4*Math.random())
Document.write(r_text[i]);." Acne: Diagnosis, Treatment, and Outcome. American Academy of Dermatology, n.d.
Web. 05 Dec. 2014.