co.uk 2001). Of those 1,795 reactions, "23 were fatal, 14 being actual suicides," the pressbox Web site reported. More than 200 of the "adverse reactions were psychiatric with 20 reports of suicidal thoughts of suicide attempts." Additionally, 80 reports of "depression" were logged and 13 reports of "mood swings."
The pressbox article stated that surprisingly, 74% of UK patients who had used Accutane "had mild or moderate acne according to a study among UK dermatologists." The MCA, through the article in pressbox, stated that Accutane "should only be used for severe recalcitrant cystic acne as a treatment of last resort."
Not all Accutane patients wind up depressed, psychotic or dead from suicide, of course, and Brandi Jones is one example of an Accutane success story. At least, she made it through six months of Accutane treatment, and now her skin is "mostly pimple-free" (Setoodeh, 2005), according to an article in Newsweek. At the age of 16, the cysts on her chin were so painful her face "throbbed like someone had punched me," she is quoted as saying in the article.
She spent her nights "tossing and turning" and her days she spend "popping Tylenol and Aleve." When all over-the-counter acne remedies failed to clear up her face, she got a prescription for Accutane from her dermatologist, knowing the drug could cause depression "and that it sometimes made acne worse before improving it." She said she "felt pretty suicidal at times," and "isn't sure she'd go through with the treatment again," but her face is not clear, and she sleeps all night.
Other problems to be aware of in treating acne
When using topical antibiotics that contain erythromycin, clindamycin or tetracycline, one should be aware that these antibiotics may "fluoresce under ultraviolet light" - and therefore should not be used to fight acne when dancing at a disco, according to Acne-Rosacea.co.uk. Also, the same Web site warns that there are serious side effects connected with the long-term use of antibiotics in the battle against acne; long-term use "affects bacterial balances in the intestinal tract and can lead to oral thrus, nausea, abdominal pain or diarrhoea." These symptoms may be serious in about 5% of the patients who are on long-term antibiotics for acne, the Acne-Rosacea.co.uk page asserts.
Meanwhile, for acne sufferers with darker skin pigment, Dr. Pearl E. Grimes (University of California, Los Angeles) warns that some acne treatments, such as benzoyl peroxide, tretinoin, glycolic and salicylic acids, Adapalene and tazarotene "can actually exacerbate post-inflammatory hyperpigmentation" (www.Acne-Rosacea.co.uk,2004).
Dr. Lawrence Charles Parish, a clinical professor of Dermatology and Cutaneous Biology at Jefferson Medical College in Philadelphia, Pennsylvania, in his "Myths About Acne" report, explains to teenagers that scrubbing one's face can "worsen the condition." By using a scrub cloth, loufa, or "abrasive cleansers," one simply "aggravates the skin," he reports. "It's best for teens to wash their faces with their hands," he continues, noting that the temperature of the water "has no affect on acne or pustule formation."
Additionally, "drinking lots of water, taking numerous vitamins" will do "nothing" for the teen but "increase bathroom time" and "waste money." Adding lotions and moisturizers to the face "will just aggravate the condition and create more zits," Dr. Parish warns. "The skin is not dry!" he emphasizes; "the skin is actually oily."
Various alternative treatments for acne
An up-and-coming treatment for acne, according to Dermatology Nursing journal (2004), is "nonablative laser technology." This laser treatment "can clear acne without producing a notable injury to the outer layer of the skin," the article reports. "The laser emits a wavelength of light that is strongly absorbed by water within the skin." This then generates heat, "in and around the sebaceous glands," hence, the structure and function of the sebaceous glands are altered, "leading to prolonged acne clearance."
About three to five treatments - which take between five and twenty minutes each - are prescribed at "monthly intervals" to help reduce or remove the acne from a face. There is a "slight snapping or stinging sensation" associated with the treatment, but the article states that applying ice after the treatment, and pretreatment with "topical anesthetic" can reduce any irritation dramatically.
Meanwhile, the Acne Resource Center lists 87 "alternative therapy" links for the treatment of acne, ranging from "Thought Field Therapy 4 U," "Craniosacral therapy," "Hypnosis,' "Hair Replacement," "Inner solutions" to "Energy Psychology," "Spinaloptions," "Psychotherapy" and "The Anxiety and Depression Help Site." Some sound so bizarre the one wonders how an acne-challenged person would even be helped, but perhaps it speaks to the frustration that grows when pimples mar an otherwise attractive face.
An "Industry-independent, randomized" study of antibiotic therapy for acne carefully-controlled study of the effectiveness of antibiotic therapy on 649 community participants was conducted through Queen's Medical Centre, Nottingham, UK, and was reported in The Lancet (Ozolins, et al., 2004). The study utilized the "efficacy and cost-effectiveness of five antimicrobial regimens for mild to moderate facial acne," and also looked into whether "propionibacterial antibiotic resistance affects treatment response."
The article's "Introduction" asserts that, unlike earlier reports which indicated that around 80% of people between 11 and 30 will have acne to some degree, "Acne vulgaris [has] a point prevalence reaching 100% among adolescents." The article goes on to report that "antibiotic therapy has been an important part of acne management worldwide for the past 40 years"; however, acne is not an infection in the classic sense" because "direct anti-inflammatory activity could be as important as inhibition of propionibacteria growth, or even more important."
Important points that the research set out to examine include: a) whether "Minocycline is more cost-effective than Oxytetracycline" (the former is far more costly than the latter); b) whether "a leading topical treatment (a combined formulation of erythromycin and benzoyl peroxide) is more effective than oral treatment"; c) whether topical erythromycin and benzoyl peroxide "prescribed separately are as effective as the combined formulation" (the combined formulation is more expensive); d) "how well a cheap over-the-counter treatment (5% benzoyl peroxide) compares with prescription antibiotics."
Thirteen percent of the participants were recruited from UK colleges, all of whom had at least "15 inflamed and 15 non-inflamed lesions on the face."
The outcomes - which were determined at 18 weeks - were gleaned through "patients' self-assessed improvement and reduction in inflamed lesions." In the final report, which is most pertinent to young people suffering from acne, the "cheapest treatment (benzoyl peroxide) was 12 times more cost-effective than Minocycline." Moreover, "topical benzoyl peroxide and benzoyl peroxide/erythromycin combinations are similar in efficacy to oral Oxytetracycline and Minocycline and are not affected by propionibacterial antibiotic resistance."
Improvements / Modernization in England's National Health Service (NHS)
In order to serve British citizens more effectively and efficiently, the NHS first needed to determine what improvements were needed in terms of primary care management. And hence, a study was conducted by the Health Development Agency (HDA) (www.hda.nhs.uk)- which is the national authority and information resource on the issue of improving health care delivery in England. According to the report, improving patient access to health services is a top priority; and the "problems associated with patient access to health services, especially in rural areas, were identified by 49% of the local authority transport departments (LTPs) (Harner, 2004). In order to meet the demands for better access to health care facilities, the HAD reports that "people who are socially excluded may be experiencing a number of factors that in themselves have a negative impact on gaining access to health services."
In fact, the "socially excluded people" include low income individuals, people on disability and older citizens; indeed, 14% of adults "have a physical disability or long-standing health problem" that makes it challenging to get to health care services. Seventy percent of people over 85 years old fall into the category expressed in the preceding sentence. Transportation is vital when people need health care, and though 89% of visits to local hospitals are made by car "from the least deprived areas," just 56% of journeys from the "most deprived areas" are made by car.
Clearly, many people who need health services would prefer public transportation - in fact, the report shows that in North Cornwall Primary Care Trust's transport survey of six hospitals in Plymouth and Cornwall shows 80% of respondents to the survey "found it difficult to access healthcare other than by private car," and a survey of Royal United Hospital Bath showed that 41% of respondents "reported some difficulty, either due to parking [their cars] or with access to public transport."
The other upgrade as to the quality of health care delivered by NHS is the Web site (www.nhs.uk/England.aspx),which now offers a blue search engine with access to over 600,000 Web pages that provide NHS and health information. Additionally, the red search engine helps citizens locate specific health care facilities and organizations.