Oil glands that attach to hair follicles in the skin produce oil that normally travels up the follicle to lubricate the skin. When excess oil is produced, the oil may not make it up the follicle and may form a lump deep beneath the skin. This is exacerbated by an accumulation of dead skin cells inside the follicle. Bacteria buildup contributes to the formation of nodular acne as well. The hard lumps cannot be popped like normal pimples, and attempts to pop them can lead to scarring. Nodular acne tends to be painful.
Oil production is the skin is generally thought to be precipitating by hormones. This is why acne is common among teens, pregnant women and women just before their periods; hormones are fluctuating at these times. However, a consistent hormonal imbalance or hereditary factor can lead to persistent acne.
Nodular acne is particularly stubborn and often doesn't respond to regular treatments like topical creams or antibiotics. These, of course, should be tried before more aggressive and expensive treatments are considered. Many turn to Accutane for treatment because, according to WebMD.com, it has an 80% success rate. A round of treatment with the drug is usually 3-6 months. It is important to understand the many risks associated with Accutane. Its array of severe side effects make it a last resort treatment.
Accutane Side Effects
When reading a list of side effects for this medication, you might not believe it is an acne medication derived from vitamin A. The following is a partial list of side effects associated with the drug.
Psychosis
Depression
Suicide/Suicidal Ideation
Severe Skin Reaction
Pancreatitis
Liver Damage/Failure
Severe Back Pain (particularly among pediatric patients)
Bone Fractures
Impaired Healing
Seizure
Severe Birth Defects if Pregnant
Birth defects associated with the drug are prevalent enough that female patients must pledge to use two different forms of birth control while taking it.
For more side effects and contraindications, see http://www.rxlist.com/accutane-drug/warnings-precautions.htm.
Why would anyone risk these things for clear skin? It is important to recognize that acne can be painful emotionally as well as physically. For some people, the distress of persistent acne can be sufficient to warrant such risks. However, there are other treatments that should be tried first. Again, this drug should only be a last resort.
Alternatives
When nodular acne flares up, you can opt to receive "acne surgery," which consists of draining the nodules. This procedure can help prevent recurrent flares, as the bumps often reoccur in the same location. Many insurance companies cover this procedure.
Another option is an anti-inflammatory injection, which generally shrinks the nodule down within 5 days. This likely prevents any type of scarring. Insurance may cover this treatment as well.
Photodynamic therapy (PTD) is a new treatment for severe acne as well as superficial skin cancer. It is a form of light therapy that destroys bacteria that may cause inflammatory acne. PTD is a non-invasive treatment and may be covered by insurance. According to Cancer.org, it has no long-term risks and may be safely repeated a number of times. It can be used to precisely target acne sites. See customer reviews for this form of treatment at http://www.realself.com/Photodynamic-Therapy/reviews.
Whether or not to assume the risks of Accutane is a personal decision that should be based on a firm understanding of those risks. Every alternative should be tried before resorting to this medication.
Safe choices for pain management solutions exist. Educate yourself in alternative solutions for back pain management. Please ask questions, give comments or stories related to this article submission regarding back pain management.
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