Doctors Lounge - Dermatology Answers
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Forum Name: Dermatology Topics
|slc62 - Tue Mar 31, 2009 10:36 am||
My 12 year old daughter is struggling with acne. She's on her second dermatologist, previous treatments (including a variety of over the counter treatments) just have not brought the results she needs. I just took her in yesterday to a new dermatologist and asked about Accutane. I was informed of the prescribing restrictions, birth control pills, pregnancy tests, etc. and doc told me she felt that wouldn't be the best idea considering my daughter has not begun regular menstrual cycles. I don't feel comfortable with it either, but her father feels strongly that we need to get her going on accutane.
What are the down sides to birth control pills for a girl that isn't yet menstruating? Should I even consider this along with accutane for her? I want to do the right thing, when the dermatologist explained what was involved with accutane treatment in my gut I just didn't feel good about going that road. Doc didn't recommend that either. But her acne has proven to be very resistant to treatment and that runs in both my family and my husband's family. I am concerned every day for how she must be feeling at school. I've not seen one kid in her grade with acne even close to what she is experiencing.
Is there anything else we could be doing?
|Debbie Miller, RN - Fri Apr 17, 2009 10:52 pm||
I would not advise birth control pills. The warnings about Accutane apply to women of childbearing age. Your daughter is not there yet so It seems that the requirement for a woman to use birth control while on the drug would not apply to a girl who has not reached menarche. The trick would be to make absolutely certain she did not become sexually active (or abused) while taking the drug and in the month following its discontinuation.
On another note, drugs are not tested for safety and efficacy in children, unless they are targeted to that population so I'm not sure if she is young enough for this to be a concern.
Is your daughter's acne the cystic or nodular type? Is it scarring? I assume she has tried antibiotics and topical treatment with benzoyl peroxide and salicylic acid, using these religiously for at least two consecutive months. Accutane is considered the last resort in acne treatment and at your daughter's age, hormones may be at play which may vary with the start of her periods. If it were me, I would wait a while and diligently pursue every other treatment (wash daily with mild cleanser - not soap and not scrubbing or abrasive cleansers). You don't want to overdo and the goal is management at a tolerable level; not cure at this point.
My reasoning is based on my gut feeling that this is a powerful drug with potentially strong and unpleasant side effects, even apart from pregnancy, and every other treatment should be tried first. I realize you have said you have done much, but time alone may help her a little or at least get her to an age where taking the pill might be more acceptable.
Blood testing is required throughout treatment and other precautions must also be taken such as care in the sun and dry skin and mucus membrane issues which sometimes make the wearing of contact lenses impossible.
You are wise to consider this carefully and while it might be the right time for your daughter, it also might be best for you to wait a while.
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