The dead sea salt is the best but any other sea salt will still work. The difference is that dead sea salt contains more minerals than sea water. The minerals in dead sea salt works as a cleansing agent, detoxifies the skin and improves the state of the skin.

Many people who used dead sea salt claims to have better complexion, where their skin becomes evenly toned and gives out a radiant glow. It purifies the skin and kills bacteria that are around the pimples.

To effectively cure acne, you don’t need to travel all the way to the Dead Sea because it can be bought at your local pharmacy. Dissolve the dead sea salt into lukewarm water and wash your face or any acne affected area of your skin with it.

Not only does it work for acne on the face, it can be use in a bath to help clean our body skin. Acne does not only appear on the face but at times, on parts of the body as well. The bath is great to clean your body as well as a way of relaxation.

As dead sea salt is completely natural, rarely people suffers from side-effects or allergies. In case it happens, then it is recommended to stop using it and consult a dermatologist for a better option. Dead sea salt can effectively cure acne as well as being a safe option. Due to its nature, it is completely safe and will not pose any risk of cancer-causing like the chemical acne treatments.

-
About the Author:
Natural treatments for acne are a safe and effective approach. Learn more about the benefits of natural treatment for acne here.
For more information, guide and tips on natural skin care, visit skin care label.
 
 
Article Source

1. Drink more water.
The absolute best way to treat acne is to drink more water. It is a little known fact that dehydration is one of the #1 causes of acne breakouts.  The more water you drink, the less chance you have of annoying breakouts.  Try to drink at least 2 quarts of water each and every day!  The more the better!

2.  Wash your face twice daily with a natural cleanser.
Make sure that you don’t use a harsh cleanser that dries out your skin.  Cleansers that are too harsh will dry out your skin and actually make your acne worse in the long-run!  Use organic, all natural cleansers, they can sometimes be more expensive but they are definitely worth every penny.

3.  Treat acne from the inside out.
The absolute best way to treat acne is to cure it from the inside out.  Acne is a symptom that something is wrong within the body, so in order to clear your acne you must fix the in-balance going on within your body.  The best way to do this is through herbal supplements.  For the best herbal acne clearing supplement, see the link at the end of this article.

4.  Have a positive attitude.
I know it seems impossible, but you will never be able to achieve clear skin without having a positive attitude.  Your mental state effects more than 50% of how your skin looks.  It is scientifically proven that a positive attitude, whether through real medicine or through the placebo effect, makes outcomes of specific situations turn out better than they would have with a negative attitude.  Being positive will change your entire perspective on your acne situation, will make you feel more optimistic, and will ultimately lead to clear skin.  People with clear skin are confident that they will wake up each day with a clear complexion, are you?

Acne is an easily treatable condition, you just have to know what is causing your acne and how to treat it in the most efficient way.  You don’t have to have your acne forever!

-
About the Author:
If you would like to know the simple and natural 3-step solution to permanently clear skin, visit YourClearSkinSolution.com for an easy, cheap, and 100% reliable treatment for acne.
Article Source

Microdermabrasion - this treatment for acne scarring removes the dead surface of the skin by light abrasion.  What this means is tiny crystals (or diamonds in powder form) are blasted onto the skin to perform the exfoliating process.  Once the wound is healed, a smooth pink layer of new skin will appear.  Multiple treatments are often necessary, and you can expect to pay at least $750 a session.

Laser Therapy - Using lasers is one of the most prevalent options for severe acne scars. The lasers remove the scarred skin,and promote growth of new skin in its place.  After treatment, the skin will be a little pink and swollen. During this time, you may want to cover the treated area to prevent infection.  It takes time for the skin to return to normal.  Most people will notice less scars and smoother, softer skin. A laser treatment for acne scarring procedure can last up to 3 hours and cost around $350 per hour.

Scar Creams and Gels - There are many topical treatments that profess to reduce the appearance of acne scars. Many contain Vitamin E and other nutrients.  The brand Zenmed offers a number of popular products.  A number of people claim that it can improve new scars in as little as 4 weeks, or up to 3 months for older, deeper scars.  Results with acne scar creams will differ from person to person.

Collagen Injections - This is not a permanent solution.  Here, body fat or collagen is injected directly into the scar area.  This treatment for acne scarring works well for some people with deep pitted scars.  The substance injected serves to raise the skin, and reduce the pitted appearance, and wrinkling from the scar.  However, this procedure needs to be repeated every 6 months and can be expensive. 

-
About the Author:
Dan Buckner has researched the treatment for acne scarring and has discovered a website dedicated to acne scars remedies that you may find helpful.
Article Source

Following are the most common causes of acne. If you happen to be suffering from one of the top two, consider yourself lucky because once you eliminate the cause, your acne may never return.

Most common acne cause #1. Cosmetic allergies

The absolute most common and easily overlooked cause of superficial acne is from cosmetic allergies. Mild allergies are so common and at times silent, that many people often dismiss the symptoms as ‘nothing’. The most common acne contributing allergies are to preservatives, additives and fragrance found in makeup, lotions, creams, hair products, soaps, laundry detergent, nail polish and other cosmetic products.

Tips to overcome cosmetic allergies:

Only use products which are

Nonacnegenic, or noncomedogenic
Perfume free
Formulated for sensitive skin
Dermatologist recommended

Also..

Keep hair products off of your skin
Rinse hair conditioner thoroughly
Be mindful of what you put on your skin

Most common acne cause #2. Hard water and over treated water

My family doctor actually mentioned this acne tip to me. He explained that some water is so over treated to protect us from harmful contents, that in fact, the chemicals which treat the water to be safe, could at times cause a skin reaction.  Your skin may appear dry or itchy at first, followed by red or white body acne formation.

Tips to overcome hard water causing acne:

Use a water filter in your entire house or insert a shower head water filter

Most common acne cause #3. Hormonal acne

Hormonal acne, at times associated with hereditary acne, is the most difficult to treat and is unfortunately, not yet well understood.  From personal experience, I can tell you that successful treatment is possible by a well balanced blend of medical and holistic treatments.  By treating your skin topically, and cleansing your body from within, you can eliminate the internal and external acne causing bacteria and toxic acne breakouts.

Tips to overcome hormonal and hereditary acne:

Use a prescription strength or OTC Benzoyl Peroxide acne treatment daily
Use a mild facial wash specifically formulated for acne skin
Cleanse and detoxify your body - a mild and natural method is best
Take a multi vitamin specifically formulated for your age and gender or a multi vitamin formulated to treat acne prone skin

-
About the Author:
Would you like a step by step acne treatment guide to show you exactly what you need to do to heal your skin condition safely and effectively, today? The Acne Treatment Info Guide is a free publication which will show you exactly what you need to do to get rid of your acne, without purchasing any special products or services, guaranteed.
 
To download your free Acne Treatment Info Guide, please visit: http://www.acnetreatmentinfoguide.com/complimentaryacneguide.html

 
Article Source

The first thing that you will need to know on how to treat acne vulgaris is to know what is the exact cause of it. There is a misconception about the cause of acne vulgaris. Many people spend money on costly products that treat the commonly known causes of acne such as excess sebum production. But these are just surface problems. You can keep on treating the surface problem but acne will keep on occurring until you get to the root of the problem.

Acne treatment depends on whether you have a mild, moderate, or severe form. Sometimes your doctor will combine treatments to get the best results and to avoid developing drug-resistant bacteria. Acne vulgaris treatment comes in many forms. Pharmacies and supermarkets are literally inundated with new products for fighting acne. It’s important to remember that acne products work differently for different people. Some topical acne treatments work well for some, but irritate the skin of others. Some ingested treatments work well for some but cause complications in others.

Gentle washing - This is the first line of attack in terms of acne vulgaris treatment. Acne is caused primarily by bacteria on the skin that in turn clog up your pores, so if you can get rid of the bacteria your skin is much more likely to stay clear. Gently washing your skin each morning and each evening can have a tremendous effect in reducing acne problems.

Topical medication is probably the most popular acne vulgaris treatment method. Topical medication can contain natural or synthetic ingredients (or both), and are used to kill the P. Acnes bacteria, clear oil from the skin, and generate healthier skin. Some topical medications are prescription based, and can only be obtained by a physician. Examples include topical steroids and antibiotics, and the chemical compound isotretinoin (retinoids) which is common for sever or chronic acne treatment.

Natural acne treatment. Within the last decade, natural medicine has made a significant comeback. Naturopaths are available for consultation in every town, as people begin to lose faith in ‘chemical’ products and their outlandish guarantees. Some natural products that have been used for decades to clear acne are rose water, milk of magnesia, lemon juice, tea tree oil and ginger root.

-
About the Author:
Author is an online medical researcher on acne treatment and skin care. Click read more on natural acne treatment, acne vulgaris treatment.
Article Source

Acne is a historical problem that has likely been plaguing people for centuries. But there are many treatment methods available for this bothersome condition. Read on to learn more about acne, and what you can do to treat it.

How should I treat my acne?

About ninety percent of acne patients respond to treatment, although treatment may need to be continued for months or even years. Here are some common treatment methods that can be used for acne.

Cleaning the intestinal tract:  Acne can be a byproduct of an area and colon intestinal disgusting. In most cases when the colon is clean the acne will go away.

Remedies: Herbs such as chamomile, lavender, juniper, bergamot, dandelion root, and burdock root can be used to reduce toxicity and improve the overall condition of the skin. The root of Echinacea and the push is often used for its anti-inflammatory properties and red clover may be beneficial for its estrogenic action.

Conventional Treatment
Medication: Conventional acne medications may be topical applied directly to the skin or taken internally can be systemic.

BONUS TRICK YOU WON’T MISS IT: Ask yourself this question now “Did you want free from acne and have a beautiful and healthy skin” then I strongly recommended you to try this FREE NATURAL ACNE TREATMENT.

Never underestimating the Acne that can make huge damage on your skin!

-
About the Author:
Found yourself the True Secret of how to get rid of acne, conquering back your beautiful skin and have a balance inside that you should have it in the first place.
Article Source

You’ll discover 4 distinctive kinds of rosacea, and those who have the ailment could possibly get one of these four. The incredibly initial sort of Rosacea is known as erythematotelangiectatic rosacea. It’s characterized by flushing and persistent skin redness. Dilated blood vessels that causes visible red lines within the face, known as telangiectasia, may possibly be present too even though it’s not essential for the diagnosis of this sort of rosacea. It may perhaps also consist of other symptoms for example central facial edema, roughness, and stinging and burning sensations. Those people today who only have a history of flushing is regularly diagnosed with erythematotelangiectatic rosacea.

The subsequent variety of rosacea is papulopustular rosacea. This kind of problem is truly marked by central face inflammation paired along with reddish humps (papules) together with various pus loaded (pustules) which lasts for about four days. This situation is frequently confused with acne breakouts, except that you’ll find commonly no blackheads (comedones). Burning together with stinging feelings may also be existing in this ailment. Papulopustular rosacea is regularly recognized additionally with erythematotelangiectatic rosacea. The distinct presence of telangiectasia may well be overlooked as a result in the chronic redness from the pores and skin and papules and pustules.

Phymatous rosacea is the subsequent kind of rosacea and is typically linked with rhinophyma or the swelling within the nasal area. This specific situation is designated by the thickening from the epidermis and irregular surface nodularities. Aside from the nose, it might additionally affect the chin (gnatophyma), cheeks, eye-lids (blepharophyma), forehead (metophyma), and ears (otophyma).

-
About the Author:
Jodi has been writing articles for the past 2 years. Check her latest website over at http://www.acnecareproductreviews.com/ which is a one-stop resource site for people looking for anything about Loreal Revitalift
.
Article Source

1. An important tip to reduce acne is to always wash your face. If you do no wash your face regularly, then you have a high chance of getting acne all the time. However, always wash your face gently. Use mild soap as opposed to strong-scented soaps. To those who may not know what a mild soap is or what brands are mild soaps, talk to your dermatologist. Its is highly recommended to unclog your pores by using warm boiled water. Non-boiled water has exfoliating effects on the skin, and it can remove certain elements from the body from within the skin.

2. Try applying benzyl peroxide in your skin for at least a week. This scrapes dead skin layers to show up the new, healthier skin underneath. This solution also removes oil and bacteria that may otherwise end up as acne. When buying benzyl peroxide, it can come in many formats, such as a cleanser, so watch for the form you are looking for.

3. Always try to keep your hands off of your face, especially during the day. You most likely had activities that occurred in different locations, and you got germs and bacteria from that location as well. Always take your hand cleanser or alcohol with you to constantly keep your face clean. Also, don’t pick at your acne. Your body naturally removes dirt over time, so there is no use doing it in a forcible manner. It will only cause scarred skin, which is worse because it will stay with you for as long as you live.

4. It is recommended not to use oil-based products. Any products that have oil content, such as some makeups, can worsen your condition. The oil content from the product can cause bacteria to grow in the skin, which can stimulate more acne as well. When you eat something oily, gently wipe off your mouth with tissue or towel, making sure it does not spread to your face.

5. Always drink water because your body will then get ris of all unnecessary materials in the body. Also, eat plenty of fruits because they contain nutrients that help your skin texture.

-
About the Author:
So you wish to discover how to get rid of acne scars? Do you want it done fast and efficiently? Then go here www.adult-acne-cure.org to discover how to deal with this problem as soon possible.
Article Source

Anyway the acne is really troublesome, right? Once, my 16-year-old daughter was always spending a few minutes before mirror and complaining about it, and my hard-earned salary was constantly flowing into the doctor’s pocket due to it. Both of them drive me mad.

The nightmare finally will be finished by a product-Acne No More. It’s really out of our expectation that it’s an e-book instead of a medicine or a cleansing milk or a set of tools used to remove acne. The author is Mike Walden, a nutritionist. His idea is not only focus on the acne, but a general adjustment to the inner body environment. He believes that when the inner environment reaches harmony, the acne will disappear naturally. The book mainly includes what is acne and why it comes, how to cure it and some other helpful topics such as internal body cleansing, appropriate diet, food we should try to avoid and we can eat, keeping a natural hormonal balance, and so on. My daughter and I sometimes throw ourselves into sofa, reading together and discussing. Most of time I take it with me and read when I take subway. A detailed summary of Acne No More shows five treatment programs. A mini program for mild acne is my daughters favorite -after all she is a young girl without too much patience to read all. Other topics covered are how to alleviate stress, sleep improvement, exercise and skin care. This is a step by step program, not a once and away one. We have overcomed our laziness, casual desires to the rich food and have been reminding each other of following its instructions. Recently the acne becomes faded. Our fight with acne likes a seesaw battle, fortunately we almost win.

I like Acne No More not only because it cures my daughter’s acne, saves my money, but also because it gives us many useful tips for our health. The idea I appreciate most in this book is that food affects our health. Everybody knows the truth that curing disease with food is more delicious and cheaper than the medicine.

I do hope more and more acne sufferers or other people without acne to own Acne No Moreand benefit from it. Download

-
About the Author:
Acne No More Review
Article Source

The possibility of introducing prescribing options for New Zealand psychologists is currently being considered. Clinicians have been invited to offer opinions on the advisability of such a move and to make suggestions on additional training requirements. Certainly, an extensive understanding of the possible side effects of such medications likely to be prescribed would be required.

 In fact, an understanding of the possible short- and long-term side effects of medications in general is already an area that warrants considerably more attention from all those working in mental health. The possible, very serious mental health consequences of ingesting certain prescription medicines are currently outlined in a number of medication inserts. In addition, agencies such as the US Food and Drug Administration (FDA) have published warnings cautioning against the use of some prescription medicines, which they state may cause serious psychiatric disturbance. There are also currently proposals in Britain to give every new drug licensed a ‘suicide rating’.

This reform, based on a system adopted recently in the United States, has been fuelled by a growing body of evidence that drugs that affect the brain can heavily influence behaviour through seemingly innocuous changes in body chemistry. Medicines to treat acne, swelling, heartburn, pain, obesity, high blood pressure and cholesterol, bacterial infections, smoking and insomnia have all been associated recently with psychiatric problems. (Mostrous, 2008).

 One such medication is isotretinoin (also known as Accutane or Roaccutane), prescribed for the treatment of acne. This vitamin A derivative, manufactured by Hoffman-La Roche, is one of that company’s most popular and controversial medications. In its most recent warnings the FDA (FDA, 2005), stated:

FDA ALERT [7/2005]: Suicidal Thoughts or Actions: In addition to the strengthened risk management program, FDA continues to assess reports of suicide or suicide attempts associated with the use of isotretinoin. All patients treated with isotretinoin should be observed closely for symptoms of depression or suicidal thoughts, such as sad mood, irritability, acting on dangerous impulses, anger, loss of pleasure or interest in social or sports activities, sleeping too much or too little, changes in weight or appetite, school or work performance going down, or trouble concentrating, or for mood disturbance, psychosis, or aggression. Patients should stop isotretinoin and they or their caregiver should contact their healthcare professional right away if the patient has any of the previously mentioned symptoms. Discontinuation of treatment may be insufficient and further evaluation may be necessary. 

The ‘Patient Information Sheet’ for this medication also reads:

Serious mental health problems: Isotretinoin may cause:

- Depression

- Psychosis (seeing or hearing things that are not real)

- Suicidal thoughts or actions

-Aggressive and violent behavior

 Although approved for the treatment of “the most severe form of acne (nodular acne) that cannot be cleared up by any other acne treatments” (FDA, 2005), isotretinoin has been used increasingly for the treatment of more mild and moderate forms of acne. “In 1995, doctors calculated that only sixteen percent of prescriptions were for severe disease” (Girling, 2002). As a consequence, it is now estimated that many millions have been treated with isotretinoin worldwide. Unfortunately, the numbers of those who have reported suffering serious mental health side effects has also continued to grow. A research documentary, which screened in November 2006, quoted over 6000 reported cases of psychiatric consequences of isotretinoin use, with “US Health Authorities” estimating this was around one percent of those actually affected (Tinari, 2006). Consistent with this claim, Carleton, Smith, Gelin, and Heathcote (2007) identified ADRs (adverse drug reactions) as an important cause of childhood morbidity and mortality and stated that as many as 95% of ADRs are not reported. In a New Zealand survey of secondary school students (Purvis, Robinson, & Watson, 2004), 14.1% reported having problem acne. It has been estimated that 5000 young New Zealanders take isotretinoin (Lawrence, 2006). By 2006, the Centre for Adverse Reactions Monitoring (CARM) had received 93 notifications of adverse reactions to this medication (MARC, 2006). If US Health Authority estimates are correct (Tinari & Häner, 2006), then around 930 New Zealanders have been significantly affected.

Isotretinoin was introduced on the market, as a treatment for acne, in 1982. By 1983 Hazen, Carney, and Walker had already published details of 24 cases of depression related to its use. These findings reinforced those reported earlier by Myskens (1982), who had been using isotretinoin as a treatment for patients with advanced cancer. Around 25 percent of those patients suffered “psychological changes”. These included 18 cases of depression. Four patients had attempted suicide. Subsequent years have witnessed much debate over the strength of the causal link between isotretinoin and mental health problems. The media have feasted on this debate and the medication “has made the kind of headlines normally reserved for mass murderers or airline disasters” (Girling, 2002). In 2007, Carleton et al. conducted a retrospective analysis of 1193 suspected ADRs in Canadian children (including 58.6% adolescents). The drug most cited was isotretinoin and the most frequent reaction descriptor was psychiatric disorders. In his overview of existing research linking isotretinoin to depression, psychosis, and suicide, O’Donnell (2003), having discussed the well-known birth defects caused by ingestion of isotretinoin during pregnancy, also concluded:

Less well known is the risk of this lipid-soluble chemical to affect the central nervous system. Reports of intracranial hypertension, depression and suicide ideation with accutane use, have prompted an examination of its serious life threatening potential…the public must be informed of the proper limited indication for its use, because depression and suicide can follow in patients with no prior history of psychiatric symptoms or suicide attempts.

Contrary to this conclusion, however, were the findings of Cohen, Adams, and Patten (2007), who used depression scales to assess signs of mental health disturbance at baseline and after two months of isotreinoin treatment. They found no correlation between isotretinoin use and the development of depression on their measures. This study has subsequently faced criticism since “most complaints about depression (following isotretinoin) come about four months after treatment begins” (”Study”, 2005). However, researcher Siegfried (who had made this comment) and her colleagues (Chia, Lane, Chibnall, Allen, & Siegfried, 2005) assessing levels of depression four months into isotretinoin treatment, also found that signs of this disorder were no more prevalent in these patients than in the conservative therapy group. Both studies measured depression using either the Centre for Epidemiological Studies Depression Scale (CES-D) or the Zung Self-Rating Depression Scale. Finally, consistent with both of these findings, Bremner et al. (2005) reported that, amongst their sample, there were no significant increases in depression scores (Hamilton Depression Scale) following four months of Isotretinoin treatment. However, the Bremner study is much better renowned for the other discoveries made during this research. In a world first, Bremner measured brain functioning in his subjects using [18F]fluorodeoxyglucose positron emission tomography, before and after four months of treatment with either isotretinoin or an antibiotic. Results showed clearly that the isotretinoin treatment, but not the antibiotic treatment, was associated with decreased brain metabolism in the orbitofrontal cortex (–21% change versus 2% change for antibiotic). This is a brain area known to mediate symptoms of depression. It seems that these observable brain function changes may produce symptoms (e.g. anger, aggression, paranoia) not well measured when depression screening tools are used in isolation. Depression scales “cannot take the place of a comprehensive clinical interview for confirming a diagnosis of depression” (WHO, 2008).

In recent research conducted at the Universities of Bath and Texas, researchers were able to monitor the effect of isotretinoin on the chemistry of the cells that produce serotonin. They found that the cultured cells significantly increased the production of proteins and cell metabolites that are known to reduce the availability of serotonin (O’Reilly, Trent, Bailey, & Lane, 2007). Researcher Sarah Bailey commented: “Serotonin is an important chemical that relays signals from nerve cells to other cells in the body…. In the brain it is thought to play an important role in the regulation of a range of behaviours, such as aggression, anger and sleep. Low levels of serotonin have been linked to depression as well as bipolar and anxiety disorders” (”Mechanism”, 2007). Previous research by some of the same scientists (O’Reilly, Shumake, Gonzalez-Lima, Lane, & Bailey, 2006) concluded that isotretinoin caused depressive behaviour in mice. These findings were supported by those of Crandall et al. (2004) who showed that a “clinical dose of 13-cis-RA (the active component of isotretinoin) in mice significantly reduced cell proliferation in the hippocampus and subventricular zone, suppressed hippocampal neurogenesis and severely disrupted capacity to learn a …maze task.” In a more recent review article, Strahan and Raimer (2006), taking such findings into account, have concluded: “It is clear that isotretinoin can stunt hormonal development and influence neurotransmitter receptors, including systems known to be involved in psychopathology”. This conclusion is similar to that of Bremner and McCaffery (2008) in their very recent review report, which describes several systems that may be targets of retinoic acid (isotretinoin component) and which contribute to the pathophysiology of depression.

Finally, numerous published case studies have documented the development of psychiatric symptoms following isotretinoin use. Barak et al. (2005) described a “series of cases of manic psychosis that developed in a one year period in association with isotretinoin treatment and resulted in suicidality and progression to long standing psychosis. Cases were drawn from 500 soldiers who had been evaluated in a military specialists’ dermatology clinic for severe acne.” Following on from this, Friedman et al. (2006) carried out a five year analysis and reported a significantly greater use of mental health services by those 1419 soldiers in the Israeli Defence Forces who had a history of isotretinoin use than by those in the control group. There are many singular case studies reporting symptom presentations similar to those described by Barak et al. (2005). Bachmann, Grabarkiewicz, Thiesen, and Remschmidt (2007), for example, presented the case of a 16-year-old boy who experienced two depressive episodes “strongly associated” with isotretinoin treatment and requiring “closed ward care”. They concluded, “The current case report strongly indicates that isotretinoin may induce depression in idiosyncratic patients. Hence prescribers of isotretinoin should be aware of the adverse drug reaction and, if necessary, refer patients to psychiatric institutions”.

Consistent with this recommendation for a referral to a “psychiatric institution”, the FDA (2005), having evaluated all available research findings on isotretinoin, followed their warning with the recommendation that: “A referral to a mental health professional may be necessary.” There is an assumption, then, that those mental health practitioners receiving such referrals will have the knowledge and skills to manage an individual suffering the psychiatric side effects of isotretinoin exposure.  Unfortunately, however, there has been a serious failure to educate practitioners in this regard. Many have little, if any, knowledge of the implications of the isotretinoin research and how these translate to effective client/patient management. Criticisms of the support offered to those who attribute their psychiatric symptoms to isotretinoin exposure abound. Numerous media and coroners’ reports of isotretinoin-related suicides make reference to slow or inadequate responses by mental health professionals and a lack of knowledge of the isotretinoin – mental illness link. (Acne Drug, 2004; Girling, 2002; Sims, 2005; Tinari & Häner, 2006). Without a thorough understanding of isotretinoin’s potential side effects, clinicians are failing to make an accurate assessment of the causal factors of presenting problems, failing to assist clients/patients in their understanding of these factors contributing to their disorders, failing to make notifications of adverse drug reactions and failing to refer clients/patients to those health professionals most likely to offer successful intervention.

It seems a significant communication gap exists between those approving the distribution of medications such as isotretinoin and the health practitioners who become responsible for the treatment of side effects. In 2006, the minutes of New Zealand’sMedicines Adverse Reactions Committee stated:

The Committee considered that dermatologists were well aware of the potential association between isotretinoin and depression or other mood changes, and they were well aware of the need to counsel patients on a possible effect on mood and when to discontinue treatment. The Committee discussed whether GPs who prescribed these products need to be reminded of the possible association between isotretinoin and effect on mood. (MARC, 2006)

So it seems that while dermatologists and (possibly) GPs have been made aware of the potential psychiatric side effects of isotretinoin, these warnings have not reached those responsible for the treatment of isotretinoin-activated disorders. To date, there are no specific treatment guidelines or published case studies outlining successful treatment strategies. Failure to recognise clients’ symptoms as isotretinoin-related has resulted in subsequent failure to share information on treatment successes and failures.

Whilst psychologists in New Zealand contemplate the pros and cons of adding prescribing rights to their professional responsibilities, it is timely to consider improving our knowledge base and assessment strategies relating to clients’ previous use of other medications, which may be causing or influencing their presenting problems, and should affect treatment choices. Good clinical practice should incorporate:

Specific questions on current and historic use of all medications;
Specific enquiries about the use of isotretinoin, by those working with acne-prone populations (e.g. adolescents);
A check of known side effects of all medications mentioned by clients.
Reporting any possible medication side effects to the Centre for Adverse Reactions Monitoring (CARM);
Educating clients on possible medication side-effect contributions to their presenting problems;
Taking recent research discoveries into consideration when contemplating treatment options (e.g. serotonin depletion in isotretinoin users);
Formal documentation and discussion of these cases with colleagues. A healthy exchange of information will facilitate growth in knowledge of the most successful treatment strategies.

References

Acne drug may have contributed to teens depression, (2004, October 28). ABC New South Wales. (Online). Retrieved February 8, 2008, from http://www.accutaneaction.com/press/28.10.04htm

Bachmann, C., Grabarkiewicz, J., Thiesen, F. M., & Remschmidt, H. (2007). Isotretinoin, depression and suicide in ideation in an adolescent boy. Pharmacopsychiatry, 40, 128-131.

Barak, Y., Wohl, Y., Greenberg, Y., Dayan, Y. B., Friedman, T., Shoval,.G., & Knobler, H. Y. (2005). Affective psychosis following accutane (isotretinoin) treatment. International Clinical Psychpharmacology, 20, 39-41.

Bremner, J. D., Fani, N., Ashraf, A., Votaw J. R., Brummer, M. E., Cummins,T., Vaccarino, V., Goodman, M. M., Reed, L., Siddiq, S., & Nemeroff, C. B. (2005). Functional brain imaging alterations in acne patients treated with isotretinoin. American Journal of Psychiatry, 162, 983-991.

Bremner, J. D., & McCaffery, P. (2008). The neurobiology of retinoic acid in affective disorders. Progress in Neoropsychopharmacology and Biological Psychiatry, 32, 315-331.

Carleton, B. C., Smith M. A., Gelin, M. N., & Heathcote, S. C. (2007). Paediatric adverse drug reaction reporting: understanding and future directions. Canadian Journal of Clinical Pharmacology, 14, 45-57.

Chanson, A, N., Cardinault, N., Rock, E., Martin, J. F., Souteyrand, P., D’Incan, M., & Brachet P. (2008). Decreased plasma folate concentration in young and elderly healthy subjects after a short-term supplementation with isotretinoin. Journal of the European Academy of Dermatology and Venereology, 22, 94–100.

Chia, C. Y., Lane, W., Chibnall, J., Allen, A., & Siegfried, E. (2005). Isotretinoin therapy and mood changes in adolescents with moderate to severe acne : A cohort study. Archives of Dermatology, 141. 557-560.

Cohen, J., Adams, S., & Patten, S. (2007). No association found between patients receiving isotretinoin for acne and the development of depression in a Canadian prospective cohort. Canadian Journal of Clinical Pharmacology, 14, 227-233.

Crandall, J., Sakai, Y., Zhang, J., Koul, O., Mineur, Y., Crusio, W. E., & McCaffery, P.(2004). 13-cis-retinoic acid suppresses hippocampal-dependent learning in mice. (Online).

Friedman, T., Wohl, Y., Knobler, H. Y., Lubin, G., Brenner, S., Levi, Y., & Barak, Y. (2006). Increased use of mental health services related to isotretinoin treatment: A 5-year analysis. European Neuropsychopharmacology, 16,413-416.

Girling, R. (2002). Scarred for life: Does the drug that cures acne have devastating side effects? (2002, June 30). Sunday Times (Online).

Hazen, P. G., Carney, J. F., & Walker, A. E. (1983). Depression – a side effect of13-cis-retinoic acid therapy. Journal of the American Academy of Dermatology, 9, 278-279.

Jofre, J. (2008, February 7). Accutane, depression, suicide and degenerative disorders. Legal News (Online). Retrieved February 24, 2008, from http://www.lawyersandsettlements.com/articles/accutane-depression-lawsuit.html

Lawrence, J. (2006, September 20) Acne treatment could be trigger factor in suicide, say researchers. New Zealand Herald (Online). Retrieved February 10, 2008, from http://www.nzherald.co.nz/section/1/story.cfm?c_id=1&objectid=10402011

Medicines Adverse Reactions Committee (MARC; 2006, December 14). Isotretinoin and suicide. Adverse Reaction Reporting and IMMP minutes. (Online).

Mechanism for acne drug’s link to depression suggested by new research.(2007, November 12.)ScienceDaily. (Online) Retrieved February 13, 2008, from http://www.sciencedaily.com­ /releases/2007/11/071112092800.htm

Mostrous, A., & Rose, D. (2008, February 9). ‘Suicide rating’ could be given to every new drug licensed in UK. Timesonline. (Online). Retrieved February 13, 2008, from http://www.timesonline.co.uk/tol/life_and_style/health/article3337966.ece

Meyskens, F. L. (1982). Short clinical reports. Journal of the American Academy of Dermatology, 6, 732.

O’Donnell, J. (2003). Overview of existing research and information linking isotretinoin (accutane), depression, psychosis and suicide. American Journal of Therapy, 10, 148-159.

O’Reilly, K. C., Shumake, J., Gonzalez-Lima, F., Lane, M. A. and Bailey, S. J. (2006). Chronic administration of 13-cis-retinoic acid increases depression-related behaviour in mice. Neuropsychopharmacology, 31, 1919-1927.

O’Reilly, K. C., Trent, S., Bailey, S. J., & Lane, M. A. (2007). 13-cis-retinoic acid alters intracellular serotonin, increases 5-HT1A receptor and serotonin reuptake transporter levels in vitro. Experimental Biology and Medicine, 232, 1195-1203.

Purvis, D., Robinson, E., & Watson, P. (2004). Acne prevalence in secondary school students and their perceived difficulty in accessing acne treatment. The New Zealand Medical Journal, 117.-

Sims, S. (2005, April) Wonder drug or deadly weapon? Real World. (Online).

Strahan, J. E., & Raimer, S. (2006). Isotretinoin and the controversy of psychiatric adverse effects. International Journal of Dermatology, 45, 789-799.

Study: No Link Between Accutane and Teen Depression (2005, May 17). Health News. (Online). Retrieved February 10, 2008, from http://health.dailynewscentral.com/content/view/780/63

Tinari, S., and Häner, H. (2006, November) To die for the skin.  Switzerland National TV. (Online). Retrieved January 10, 2008, from U.S. Food and Drug Administration (FDA; 2005, May) Isotretinoin (marketed as Accutane capsule information. Food and Drug Administration (FDA) Homepage.Retrieved February 10, 2008, from http://www.fda.gov/cder/drug/infopage/accutane/

World Health Organisation (WHO; 2008). The Zung Self-Rating Depression Scale (Online)

-
About the Author:
Annette Fea, Clinical Psychologist, Queenstown, New Zealand
Article Source