Complicated acne issues and safety concerns.

Dr. Irwin
October 17, 2012
Two questions: 1)Im 41 years of age. Is it safe to continue using Renova for longer than a year? I read the safety information and it stated that studies had not established its safety beyond 52 weeks. 2) My 16 year old daughter has struggled with acne for over 4 years, and up until recently has been on antibiotics (several kinds) for 3 years. We've used many topicals including Epiduo; a topical tretinoin with antibacterial that I cant remember the name of; and at least one to two other topicals that I can't remember; and most recently uses Tazorac. Her acne consists of probably 5-10 facial acne spots at a time which range from whiteheads to blackheads to some boil like. She has had some minimal scarring. Last month we tried Accutane generic (Claravis) for a period of two weeks - but then my daughter started having very bad back pain, so we stopped the medication. Now 3 weeks later her back pain is getting better. We have seen a orthopedic specialist and no cause effect has been established but the timing is clearly higly suspect. What would you recommend if this was your daughter? The safety information for Claravis is scary - possible side effects appear to match a serious Vitamin A overdose. For now my daughter is off all antibiotics and using cetaphil face wash and Tazorac. Her acne has not come back terribly but it is still is there. This is a very emotional thing for my daughter and truly for me also. Thank you! I've been utlizing the information on your site now for over a year now and respect your opinions. Any input you could give would be greatly appreciated!

Okay……..  I really hear your concern for her and it is frightening to have a teen with the more severe version of acne which often effects their self esteem at a time when that self esteem already seems fragile some days.  I’m going to answer your second question first.

In your situation, it’s too complicated to even attempt thoughts about a solution but I think I can help you with the process.   Usually drugs like Accutane are reserved for patients with cystic, scarring acne, acne grade III  or IV that doesn’t respond to other medications so trying that sounds reasonable to me.  However, she hit a snag.  It’s impossible to know if her back was caused by the Accutane generic or unrelated except in time.   Also, it’s difficult to know if Accutane itself would be better for her than the generic.  The pharmaceutical industry’s position is that they are equivalent but every doctor has had experiences that make us wonder otherwise.  Hard to know.  I would really recommend that you get a second opinion and perhaps even a third opinion in your area or the nearest larger city.   Look carefully for a board certified dermatologist and see this link about finding a good doctor.  Many of the doctors on this list also see medical patients and are excellent dermatologists.    I hope this helps.

On your first question, there is no safety issue, in my opinion, with using Renova/Retin A/tretinoin  for many years as long as you are sunscreening effectively every morning.   I, most other dermatologists, and thousands of patients have been using it for 10-25 years with very positive effects.  It not only helps to prevent skin cancers, helps to normalize sun damaged skin cells but it also helps to reduce wrinkles and lentigines (brown spots).   It’s still the gold standard for creams that treat sun damage.     Dr. I

 

Dr. Brandith Irwin, MD

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Hi, I’m Dr. Irwin. I believe that consumers deserve a medically trained and unbiased skin care advocate.

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