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Accutane is the most well-known brand name of the oral medication known as isotretinoin. It is powerful, and for people with severe, widespread, deeply scarring acne, it can be a godsend. However, Accutane is like a nuclear option for acne. It affects the entire body and creates permanent changes to the body and the skin. Permanently changing your body is a huge decision and should not be entered into lightly.

Accutane (isotretinoin), or Roaccutane as it is known in parts of the world, was discovered in 1979 when it was first given to patients with severe acne, most of whom reacted with dramatic and permanent clearing of their acne symptoms. It is a vitamin A derivative (13-cis-retinoic acid) that is administered orally in pill form with a meal that contains an adequate amount of fat, 1 normally for 15-20 weeks (3.5-4.5 months), 2 although it is also sometimes prescribed at lower dosages for up to six months or longer. It was originally recommended for people with severe acne that did not respond to other treatments, 3 but has gained in popularity in the past 25 years and is prescribed more and more frequently for less severe acne. 4-6 This practice is controversial because Accutane is a systemic medication that affects every bodily system and can cause lifelong side effects to the user. Accutane need not be paired with other medications. 7

Exactly how Accutane works on a cellular level is unknown but we do know that it affects four ways that acne develops.

  1. It dramatically reduces the size of the skin's oil glands (35%-58%) and even more dramatically reduces the amount of oil these glands produce (around 80%). 8-11
  2. Acne bacteria (P. acnes) live in skin oil. Since oil is dramatically reduced, so is the amount of acne bacteria in the skin. 9
  3. It slows down how fast the skin produces skin cells inside the pore, which helps pores from becoming clogged in the first place. 11-12
  4. It has anti-inflammatory properties. 11-12

Although acne may get worse within the first month of Accutane use for about 30% of patients, the ultimate results are usually dramatic. 13 Accutane works to achieve partial or complete clearance of acne in about 95% of people who complete a cycle, regardless of whether they have inflammatory or non-inflammatory acne. 14 The majority of people who take it experience long-term remission of acne symptoms. Studies show relapse rates between 14.6% to 52%, with a real-world average of about 1/3 of people experiencing a relapse. In these cases sometimes a second course is given. 11,7,9,14-19

This relapse rate is dose-dependent. Patients who receive a cumulative dose of 100-120mg/kg see the best results and lowest relapse rates. Patients who receive a lower dose relapse more frequently. Daily dosage depends on how much the patient weighs; 0.5mg-2mg / kg is typical. 1,15,17

Other factors that increase the chance of relapse are:

  • male gender
  • severe acne
  • not taking isotretinoin with an adequate amount of dietary fat
  • hormonal imbalances like poly-cystic ovary syndrome (PCOS) in women

Low dosing: Traditionally, most doctors prescribe high doses of at least 1mg/kg / day for relatively short periods of time (15-20 weeks). However, because many people develop severe side effects from Accutane, more recently clinicians started testing lower doses of Accutane administered over a longer period of time. Initial data is showing that patients with mild to moderate acne may be able to achieve long-term remission with significantly lower dosages, and thus suffer fewer side effects, 20-22 including lower incidence of scarring. For people with more severe acne, staying on a lower dose of Accutane for a longer period of time until the full 120mg/kg cumulative dose is achieved may be a way to produce long-term remission with significantly fewer side effects. 23 The current recommendation based on this initial research is that the cumulative dose—the amount of Accutane that accumulates in the body—is the most important factor that determines the success of the treatment. 1

A good explanation on how to reach a desired cumulative dose of Accutane was published in the Journal of Clinical and Aesthetic Dermatology: " If a patient weighs 70kg, the cumulative total dose target of 120mg/kg for his or her course of therapy would be 8400mg (70kg x 120mg). Considering convenience and the practical consideration of capsule strengths, if the patient was started on 40mg daily (slightly more than 0.5mg/kg / day) for the first month, then increased to 60mg daily (slightly less than 1mg/kg / day) thereafter, it would take five months for the patient to reach the cumulative total dose of 8400mg based on the 120mg/kg target (1200mg [40mg x 30 days/month x 1 month] + 7200mg [60mg x 30 days/month x 4 months]). If the daily dose needs to be lowered due to side effects, the cumulative total dose target can be reached by lengthening the duration of therapy to what is needed to reach 120 to 150mg/kg."

Intermittent dosing: Intermittent dosing (taking Accutane only one week of every month) also produces fewer side effects but may not work as well. It has been studied twice. In both studies people receiving an intermittent dose ended up receiving a lower cumulative dose, so we do not know if the poorer results are due to the intermittent administration of the drug or the lower cumulative dose. The first study compared an intermittent dose to a regular dose. Researchers gave patients in the intermittent dose group the same dose as patients in the regular dose group but for only one week out of the month. This resulted in only ¼ the cumulative dose after treatment ended. This produced slightly less clearing of acne and more than three times the relapse rate compared to the regular dose group. 24 The second study compared a similar intermittent dose for only one week out of the month to a continuous low-dose every day. While exact numbers were not reported, from what we can glean from the study, this resulted in approximately ½ the cumulative dose for the intermittent group when compared to the continuous low dose group. Both groups in this second study achieved completely clear skin by the end of treatment, but more people relapsed in the intermittent group. 21

Accutane is a systemic medication that affects the entire body. Side effects are numerous and widespread, and affect almost all patients. 1 Side effects can be moderate and reversible, but in some cases can be severe or long term.

Isotretinoin is associated with teratogenicity resulting in severe birth defects and spontaneous abortions.

To date, no causal association has been found between isotretinoin and depression/suicide.

To date, no causal association has been found between isotretinoin and inflammatory bowel disease.

To date, no causal association has been found between isotretinoin and celiac disease.

To date, no causal association has been found between isotretinoin and problems in bone density in young patients using short term isotretinoin.

  • Teratogenicity. Isotretinoin is associated with teratogenicity resulting in severe birth defects and spontaneous abortions.
  • Depression/Suicide. To date, no causal association has been found between isotretinoin and depression/suicide.
  • Inflammatory bowel disease. To date, no causal association has been found between isotretinoin and inflammatory bowel disease.
  • Celiac disease. To date, no causal association has been found between isotretinoin and celiac disease.
  • Bone density. To date, no causal association has been found between isotretinoin and problems in bone density in young patients using short term isotretinoin.

Accutane is the number one teratogen on the market. A teratogen is a medication that interferes with normal development of the fetus and causes birth defects. Shortly after Accutane became available on the market, the Centers for Disease Control (CDC) reported that a large proportion of pregnancies in women who are exposed to Accutane result in spontaneous abortions and birth defects and advised against the use of Accutane by pregnant women. 1 Birth defects include:

  • skull
  • ear
  • eye
  • facial
  • central nervous system
  • cardiovascular
  • thymus and parathyroid abnormalities
  • death 2

Clinical research shows extremely high risk for birth defects if Accutane is taken by pregnant women. 3 The effects and risks of Accutane on unborn children are so severe that the FDA approved the iPledge program, which requires female patients of childbearing age to commit to using two (2) forms of birth control while on Accutane. 4

However, despite warnings to women not to get pregnant while using Accutane, studies published in Canada, the Netherlands, and the UK report a range of 11-24 per 1000 women getting pregnant while on Accutane. 5-7 This is lower than the pregnancy rate in the general population of these countries which stands at approximately 50 per 1000 women, but is still unacceptably high, leading to tragic outcomes.

Another study performed in California looked at rates of pregnancy before and after the iPledge program was implemented. Thankfully, they found lower rates of pregnancy among women using Accutane in California, but found that the iPledge program had only modest results. Before iPledge, 3.1 women in California per 1000 taking Accutane got pregnant, and after iPledge this number dropped to 2.7. Researchers stated, “We found that most women on isotretinoin depend on contraceptive methods that require considerable adherence to be effective. Unfortunately, our results suggest that this degree of adherence is unrealistic for many women.” 8 Abstinence, condoms, and the birth control pill were all cited as areas of non-adherence.

The iPledge program. Roche started with a program called SMART (System to Manage Accutane Related Teratogenicity) in 2000, which became the iPLEDGE program in March, 2006. Female patients of childbearing age are required to use two (2) forms of birth control while on Accutane. 4,10

iPLEDGE program telephone: 1-866-495-0654. iPLEDGE program website: ipledgeprogram.com

Patients have reported depressive symptoms while taking Accutane since the drug hit the market in 1982. Whether the drug causes these depressive feelings remains a subject of intense debate. There are, after all, millions of people taking the drug, and there are bound to be people experiencing depression amongst them. Despite the confusion around this topic, Roche Pharmaceuticals, the makers of Accutane, added a warning to its label regarding suicide and depression in 1998.

Media coverage on the topic spiked in 2000 when Michigan Congressman Bart Stupak's son BJ committed suicide while on Accutane. Research began in earnest to determine whether there is a causal link between Accutane, suicide, and depression. 1-2

Quite a few studies have been conducted since. These have included large population-based cohort studies, retrospective analysis studies, relative risk estimates, prospective, observational, and longitudinal studies, and questionnaires performed in the United States and around the world. 3-16 The first of these studies showed no conclusive evidence linking Accutane with depression or suicide. 1-2 As the studies mounted, the data continued to show no evidence of a link. 7-9,17 One study published in The New England Journal of Medicine found "431 cases of depression, suicidal ideation, suicide attempts, or suicide in U.S. patients treated with isotretinoin," within a 10-year period. The article went on to note that the numbers listed do not exceed the U.S. suicide rate. 18

If a researcher were to examine the evidence from 2000 until 2005, he or she would likely conclude that there is no evidence linking Accutane with suicide or depression. 7-9 However, as is often the case, further analysis showed limitations to many of the studies. 19-20 A general overview published in 2006 by the International Journal of Dermatology noted, "the overall lack of concrete scientific data limits any conclusion that can be drawn about a causal relationship between isotretinoin and psychiatric adverse events." 21

Then, in 2006, mice injected with the drug exhibited depression-related behaviour. While animal studies often do not reflect human models, it was marginally intriguing. 10 But even more provocative was a large cohort case-crossover study published in 2008 by the Journal of Clinical Psychiatry, which was the first controlled study to find a correlation between Accutane, suicide, and depression, albeit relatively minor. 11 More recent studies have leant more credibility to the argument that Accutane does not negatively affect depression or mood, 5,6 and several studies show significant improvements to depression, anxiety, and obsessive thoughts, 12-16 presumably due to the power of Accutane to clear acne and thus increase quality of life.

A review of literature on the link between Accutane in depression in 2015 stated, “The major part of the dermatology community states that there is no causal link between isotretinoin and depression with this postulate: acne causes anxiety and depression; treating acne with isotretinoin is a way to manage depression.” However, there is still controversy, with critics pointing out the dermatology community’s tendency to not understand depression as well as the psychiatric community. “Literature studies have demonstrated two opposing views as to the role of isotretinoin from two differing clinical specialties. The psychiatric literature…suggests a causal link between isotretinoin and depression. The dermatological literature suggests that acne is an independent risk factor for depression and isotretinoin could be used to improve depression by treating acne and improving self-image. These differing views could be explained by a recruitment bias. Dermatologists may not have been aware of the occurrence of psychiatric disorders.” 22

The preponderance of the evidence at this point is that Accutane does not appear to be linked with suicide and depression. 20,23 However, to be safe, it is important for anyone taking Accutane to closely monitor their mental health while on the drug. 4,1,24 Doctors prescribing Accutane can also check for signs of depression. A paper published in the Journal of the American Academy of Dermatology in 2016 recommends that all patients who are prescribed Accutane be screened for depression. The authors of the paper state, “Regardless of whether depression in these patients is rooted in the underlying acne or its treatment, the prevalence and serious nature of depression, suicide, and suicidal ideation demand attention. Given the chronic nature of acne treatment, dermatologists are uniquely situated to help screen for depression and suicidal ideation. It is our duty to care for all aspects of our patients' health, including their mental health.” 25 The paper also provided a screening tool for depression, which allows physicians to quickly screen patients who are at high risk of developing depression while taking Accutane. The tool consists of a series of questions and if a patient receives a score of 3 or more, he or she should be further examined to determine if they could safely take Accutane.

Isotretinoin is a fat-soluble molecule, meaning that it is best absorbed into the blood if taken with a meal that contains an adequate amount of fat. 1-2 According to drug labeling information submitted to the U.S. National Library of Medicine by the makers of Accutane, "Both peak plasma concentration (Cmax) and the total exposure (AUC) of isotretinoin were more than doubled following a standardized high-fat meal when compared with Accutane given under fasted conditions. Therefore, Accutane capsules should always be taken with food. Failure to take Accutane with food will significantly decrease absorption." 3 This failure to take Accutane with fat-containing meals may account for some of the relapse that we see post-Accutane.

So what kind of meal should be eaten when taking Accutane, and how much dietary fat should it contain? So far only 2 studies have been performed. The first asked participants to ingest approximately 20g of fat (2 poached eggs, toast with margarine, plus 8oz. of skimmed milk), and found that this was enough to approximately double the absorption of Accutane. 2 The second asked participants to ingest 50g of fat (1 bagel, 2 tablespoons of peanut butter, 5 slices of bacon, 6oz. of apple juice, and 1 donut), and found that this was also enough to approximately double the absorption rate. 4 Further research is required to determine exactly how much fat one must optimally ingest to reach maximum isotretinoin levels in the blood, but suffice it to say that isotretinoin must be taken with a meal which contains dietary fat to deliver its full potential. Based on the research thus far, it is prudent to ingest at least 20 grams of fat when taking a daily dose of isotretinoin. 5

One exception – Absorica™: In 2012, the FDA approved a new version of isotretinoin, called isotretinoin-Lidose, for sale in the United States that is marketed under the brand name Absorica. This formulation encapsulates isotretinoin in fat molecules and therefore reduces the need to take it with a fatty meal. 1,4 The package insert states that Absorica "(1) is bioequivalent with Accutane when both are taken with a high fat meal; (2) has 83% greater absorption than Accutane under fasted conditions; (3) is not interchangeable with generic products of Accutane, and (4) can be dosed without regard to meals." 7 While data does show that absorption of Absorica is significantly greater than absorption of regular isotretinoin on an empty stomach, the claim that Absorica can be dosed without regard to meals may be skewed, since data show that even with Absorica, the amount of isotretinoin in the blood remains significantly higher when taken with a high-fat-containing meal. 4

Thus, it may also be prudent to take Absorica with a meal which contains an adequate amount of dietary fat. In addition, since there are no generic forms of Absorica, it is considerably more expensive than other forms of isotretinoin. 8

Gerald Peck and co-workers from the NIH (National Institutes of Health) in Bethesda, Maryland first studied isotretinoin in patients with skin cell disorders. They accidentally found that it also worked on patients with severe acne. Isotretinoin was registered in 1979, released in the United States in 1982 as Accutane, and released in Europe in 1985 as Roaccutane.

Roche's patent expired in 2002, and manufacturers began selling generic forms of the drug.

In June, 2009, shortly after a jury awarded $33 million in damages to people who claimed Accutane caused bowel disease, Roche decided to discontinue selling brand name, Accutane. The company cited declining sales as their reason.

Topical isotretinoin exists but does not produce the results of oral isotretinoin. It is largely of historical significance in acne treatment.

  1. "Buying (Accutane) over the Internet bypasses important procedures to ensure that patients can take this drug safely. When these procedures are ignored, isotretinoin can cause serious and harmful side effects."
  2. You should NEVER buy Accutane (isotretinoin) without first seeing your healthcare professional.
  3. You should NEVER take Accutane (isotretinoin) or any of the generic versions of Accutane if you are pregnant or trying to get pregnant or could accidentally become pregnant.
  4. Some websites sell prescription drugs without a prescription. This is illegal and DANGEROUS.

Buying Accutane or any other prescription over the Internet often means you will receive pills that contain little or no active ingredient, or in some cases, a different medication entirely. Buying Accutane over the Internet is not only illegal, it is potentially dangerous and is also a waste of money. 4 I agree strongly with the FDA. NEVER buy Accutane over the Internet."

As a critical sociology major in college, I learned that it is important for an author to present his or her bias. Because we are human and it is impossible to be completely unbiased, the presentation of bias allows the reader to take the author's bias into account when absorbing content.

My bias: I suffered with moderately severe acne in my adolescence and early adulthood. I took Accutane at age 20 but do not recall the dosage my doctor prescribed. It cleared me up completely within weeks. I transformed from a shy introvert to an outgoing college student. As a result of my skin clearing up, my mental state felt relatively light and good, albeit still somewhat anxious as I had always been. My short-term side effects included severely dry lips, extremely dry skin, dry eyes, and sometimes severe joint pain. I now live with two long-term conditions which may be from taking Accutane or may be coincidence. Since Accutane, whenever I sprint or exert myself in quick bursts my joints react with pain and inflammation, thus limiting my sports endeavors. I also have a mild version of an eye condition called pterygium, which is an irreversible and not-so-attractive growth on the white part of both eyes. My acne relapsed post-Accutane somewhat aggressively to what would be described as moderate acne. I am now able to control my acne symptoms with The Acne.org Regimen."

Our team of medical doctors, biology & chemistry PhDs, and acne experts work hand-in-hand with Dan (Acne.org founder) to provide the most complete information on all things acne. If you find any errors in this article, kindly use this Feedback Form and let us know.

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  5. Henry, D. et al. Occurrence of pregnancy and pregnancy outcomes during isotretinoin therapy. CMAJ188, 723–730 (2016).
  6. Zomerdijk, I. M. et al. Isotretinoin exposure during pregnancy: a population-based study in The Netherlands. BMJ Open4, e005602 (2014).
  7. Berard, A. et al. Isotretinoin, pregnancies, abortions and birth defects: a population-based perspective. Br J Clin Pharmacol63, 196–205 (2007).
  8. Collins, M. K. et al. Compliance with pregnancy prevention measures during isotretinoin therapy. J Am Acad Dermatol70, 55–59 (2014).
  9. Shin, J. et al. The impact of the iPLEDGE program on isotretinoin fetal exposure in an integrated health care system. J Am Acad Dermatol65, 1117–1125 (2011).
  10. Sundstrom, A. et al. Association of suicide attempts with acne and treatment with isotretinoin: retrospective Swedish cohort study. BMJ341, c5812 (2010).

  1. Jacobs, D. G., Deutsch, N. L. & Brewer, M. Suicide, depression, and isotretinoin: is there a causal link? J Am Acad Dermatol45, S168–175 (2001).
  2. Jick, S. S., Kremers, H. M. & Vasilakis-Scaramozza, C. Isotretinoin use and risk of depression, psychotic symptoms, suicide, and attempted suicide. Arch Dermatol136, 1231–1236 (2000).
  3. Hull, P. R. & D'Arcy, C. Acne, depression, and suicide. Dermatol Clin23, 665–674 (2005).
  4. Magin, P., Pond, D. & Smith, W. Isotretinoin, depression and suicide: a review of the evidence. Br J Gen Pract55, 134–138 (2005).
  5. Kaymak, Y., Taner, E. & Taner, Y. Comparison of depression, anxiety and life quality in acne vulgaris patients who were treated with either isotretinoin or topical agents. Int J Dermatol48, 41–46 (2009).
  6. Sundstrom, A. et al. Association of suicide attempts with acne and treatment with isotretinoin: retrospective Swedish cohort study. BMJ341, c5812 (2010).
  7. Chia, C. Y., Lane, W., Chibnall, J., Allen, A. & Siegfried, E. Isotretinoin therapy and mood changes in adolescents with moderate to severe acne: a cohort study. Arch Dermatol141, 557–560 (2005).
  8. Hersom, K., Neary, M. P., Levaux, H. P., Klaskala, W. & Strauss, J. S. Isotretinoin and antidepressant pharmacotherapy: a prescription sequence symmetry analysis. J Am Acad Dermatol49, 424–432 (2003).
  9. Ferahbas, A. et al. A pilot study evaluating anxiety and depressive scores in acne patients treated with isotretinoin. J Dermatolog Treat15, 153–157 (2004).
  10. O'Reilly, K. C., Shumake, J., Gonzalez-Lima, F., Lane, M. A. & Bailey, S. J. Chronic administration of 13-cis- retinoic acid increases depression-related behavior in mice. Neuropsychopharmacology31, 1919–1927 (2006).
  11. Azoulay, L., Blais, L., Koren, G., LeLorier, J. & Berard, A. Isotretinoin and the risk of depression in patients with acne vulgaris: a case-crossover study. J Clin Psychiatry69, 526–532 (2008).
  12. Yesilova, Y., Bez, Y., Ari, M., Kaya, M. C. & Alpak, G. Effects of isotretinoin on obsessive compulsive symptoms, depression, and anxiety in patients with acne vulgaris. J Dermatolog Treat23, 268–271 (2012).
  13. Ergun, T. et al. Isotretinoin has no negative effect on attention, executive function and mood. J Eur Acad Dermatol Venereol26, 431–439 (2012).
  14. Marron, S. E., Tomas-Aragones, L. & Boira, S. Anxiety, depression, quality of life and patient satisfaction in acne patients treated with oral isotretinoin. Acta Derm Venereol93, 701–706 (2013).
  15. Nevoralova, Z. & Dvorakova, D. Mood changes, depression and suicide risk during isotretinoin treatment: a prospective study. Int J Dermatol52, 163–168 (2013).
  16. Yesilova, Y., Bez, Y., Ari, M. & Turan, E. Effects of isotretinoin on social anxiety and quality of life in patients with acne vulgaris: a prospective trial. Acta Dermatovenerol Croat20, 80–83 (2012).
  17. Cohen, J., Adams, S. & Patten, S. No association found between patients receiving isotretinoin for acne and the development of depression in a Canadian prospective cohort. Can J Clin Pharmacol14, e227–233 (2007).
  18. Wysowski, D. K., Pitts, M. & Beitz, J. Depression and suicide in patients treated with isotretinoin. N Engl J Med344, 460 (2001).
  19. Marqueling, A. L. & Zane, L. T. Depression and suicidal behavior in acne patients treated with isotretinoin: a systematic review. Semin Cutan Med Surg26, 210–220 (2007).
  20. Wysowski, D. K. & Beitz, J. Methodological limitations of the study "Isotretinoin use and risk of depression, psychotic symptoms, suicide, and attempted suicide". Arch Dermatol137, 1102–1103 (2001).
  21. Strahan, J. E. & Raimer, S. Isotretinoin and the controversy of psychiatric adverse effects. Int J Dermatol45, 789–799 (2006).
  22. Wysowski, D. K., Pitts, M. & Beitz, J. An analysis of reports of depression and suicide in patients treated with isotretinoin. J Am Acad Dermatol45, 515–519 (2001).
  23. Wolverton, S. E. & Harper, J. C. Important controversies associated with isotretinoin therapy for acne. Am J Clin Dermatol14, 71–76 (2013).
  24. Misery, L. et al. [Isotretinoin and adolescent depression]. Ann Dermatol Venereol139, 118–123 (2012).
  25. Thiboutot, D. & Zaenglein, A. Isotretinoin and affective disorders: thirty years later. J Am Acad Dermatol68, 675–676 (2013).

paxil paroxetine 20 mg

L’acné se manifeste par la présence de petits kystes blancs, de points noirs, de boutons rouges sur le visage, le décolleté ou le haut du dos. Elle est concomitante de la peau grasse et luisante dans la plupart des cas. L’acné empoisonne la vie de 80% des adolescents mais elle peut persister à l’age adulte, chez la femme notamment. Il existe de nombreux traitements efficaces de l’acné permettant d’atténuer les boutons mais aussi de réduire le risque de voir apparaître des cicatrices.

Tout d’’abord, il faut se départir des idées reçues :

  • L’’ acné n’’est pas due à un défaut d’’hygiène,mais plutôt à une variation et une sensibilité hormonale
  • elle ne guérit pas lors du mariage, mais il est vrai que l’acné guérit le plus souvent spontanément à la sortie de l’adolescence, vers 18-20 ans
  • le fait de manipuler ses boutons ne l’’améliore pas, bien au contraire
  • et enfin l’acnée n’’est pas contagieuse

C’est une maladie de la glande sébacée donnant des boutons : lors de l’adolescence et sous l’influence des hormones sexuelles, la peau produit

un excès de sébum et devient grasse et luisante. Ce sébum

s’accumule et obstrue les petites glandes sébacées, ce qui engendre des petits kystes blancs et des points noirs. Une bactérie normalement présente sur la peau, appelée Propionibacterium acnes

peut infecter ces lésions rétentionnelles qui deviennent alors des boutons rouges contenant du pus (pustules).

Elle concerne 1/4 de la population française, soit environ 15 million de personnes, dont 6 millions consultent ce qui engendre plus de 5 millions de prescriptions.

C’est la pathologie cutanée qui motive le plus de consultations chez le dermatologue

L’acnée touche en effet environ 80% des adolescents (dont 15% ont une forme sévère) et près de 25% des adultes, en particulier des femmes puisque près de 20% des femmes adultes ont de l’acné de la femme, dite tardive.

L’’acnée est une maladie de la glande sébacée (glande située à coté des poils et qui sécrète une substance grasse : le sébum).

Cette glande se bouche et forme les boutons (points noirs et points blancs, les microkystes).

Ces boutons se surinfectent à cause d’une bactérie appelée Propionibacterium acnes. La bactérie pullule et sécrète des substances qui favorisent l’inflammation (rougeur, douleur, chaleur).

Parfois ces boutons donnent des kystes plus grands (nodules), qui peuvent laisser des

L’acnée siège sur le visage et le haut du tronc.

La peau est souvent grasse et luisante à cause de la séborrhée, l’écoulement en abondance du sébum, notamment sur la partie centrale du visage (front, nez, menton… ).

Les boutons sont de deux types :

L’excès de sébum et la fermeture du canal pilaire par lequel le sébum s’écoule, crée une rétention de sébum dans la glande sébacée, engendrant points noirs et points blancs :

Ils sont encore appelés comédons ouverts

Points noirs vus de près, encore appelés comédons

ou comédons fermés ou microkystes correspondent à des glandes sébacées bouchées sous la peau, formant des petits kystes. L’aspect du sébum sous la peau parait blanc par transparence, d’ou son aspect de point blanc.

L’ensemble des lésions rétentionnelles forment donc des poches fermées propices au développement de la bactérie propionibacterium acnes. L’acné rétentionnelle non traitée devient donc inflammatoire par pullulation microbienne, provoquant des lésions rouges :

sont des boursouflures rouges de la peau, parfois douloureuses qui mesurent quelques millimètres.

sont des papules rouges centrées par un point blanc contenant du pus

Pustule formant un bouton blanc

    sont des boules rouges, souvent issues de la complication des papules et pustules par extension de l’infection en profondeur dans la peau. Les nodules peuvent évoluer en cicatrices d’acné

    Parfois, l’ensemble des lésions rétentionnelles et inflammatoires peuvent se transformer en kystes , des sortes de gros points blancs de quelques millimètres à quelques centimètres. Ce sont des boules de sébum entouré d’une coque, fréquents dans le dos, mais on peut aussi en observer sur le visage.

    C’est une maladie ayant plusieurs causes parmi lesquelles on peut citer :

    L’’acnée est plus fréquente et généralement plus grave chez les sujets ayant des antécédents familiaux. Dans ces cas, l’acnée est souvent plus difficile à traiter car on ne peut pas encore influer sur la génétique. Plusieurs études sur les jumeaux suggèrent une base génétique notamment en ce qui concerne la gravité des boutons

    L’acné n’est pas une maladie due au stress, mais il est reconnu que le stress est un facteur déclencheur de poussées d’acné. Le stress provoque en effet la libération par les cellules nerveuses en grand nombre dans la peau de substance P, qui stimule la production de sébum par les glandes sébacées

    Les hormones mâles jouent un rôle important sur le déclenchement de l’’acné. Il faut savoir que les femmes ont aussi des hormones mâles, et peuvent donc avoir aussi de l’’acné. Le traitement de l’acné chez les femmes requiert donc parfois l’emploi d’une contraception ou de médicaments ayant un effet sur les hormones.

    L’acnée est une maladie où l’influence hormonale est prépondérante. Ces dernières engendrent la séborrhée qui enclenche l’acné. La période de l’’adolescence étant marquée par un bouleversement hormonal, pourvoyeur de séborrhée, l’’acné est très fréquente chez les adolescents (nous avons vu que l’acné touche 80% d’entre eux).

    il faut donc signaler au médecin les médicaments que l’on prend

    L’’acnée due aux crèmes cosmétiques grasses : il faut savoir y penser et les signaler au médecin

    L’acnée prépubertaire se voit chez des enfants de 8, 9 ans, parfois même dès 6 à 7 ans! Elle peut être de mauvais pronostic car elle peut évoluer vers une acné sévère durant l’adolescence, notamment en cas d’antécédent familial d’acné sévère.

    Elle peut faire l’objet d’un bilan hormonal notamment en cas de signes d’hyperandrogénie ou de retard pondéral, à la recherche d’un bloc en 21 hydroxylase au niveau surrénal.

    L’acné prépubertaire n’est pas en soit un signe de puberté précoce qui est définie par l’augmentation du volume des seins avant 8 ans chez la fille

    et l’augmentation du volume testiculaire avant 9 ans chez le garçon.

    Par contre l’acnée peut accompagner cette puberté précoce. Il n’y a donc pas lieu de réaliser un bilan de puberté précoce chez un enfant présentant de l’acné sans les signes de puberté précoce énoncés ci-avant.

    Voir l’article consacré à l’acné de la femme

    La glande sébacée est sous la gouverne des hormones sexuelles. L’impact de la contraception chez la femme est donc important

    Tout ce qu’une femme (ou un professionnel de santé) a besoin de savoir sur les DIU (page mise à jour !) http://t.co/SkIlYp3ghk

    — Martin Winckler (@MartinWinckler) 8 Octobre 2015

    Tout (ou presque) ce qu’il faut savoir sur l’implant contraceptif. (Article mis à jour.) http://t.co/sXr4w4M2ya

    — Martin Winckler (@MartinWinckler) 13 Octobre 2015

    • patch au norelgestromine,
    • anneau vaginal à l’étonorgestrel,
    • changement de pilule : ce sont les progestatifs contenus dans les pilules qui sont potentiellement acnéigènes : gestodene, desogestrel, norgestrel, levonorgestrel, norgestrienone, norethisterone, lynestrenol… ). Toute apparition d’acné apres mise en place d’une nouvelle contraception doit encourager à consulter son medecin

    Cependant, les recommandations de la Haute Autorité de Santé (HAS) indiquent que les pilules de 1ère ou 2ème génération sont indiquées en première intention, et celles de 3ème ou 4ème génération en deuxième intention uniquement, compte tenu du risque accru de maladie thromboembolique veineuse.

    Si un contraceptif doit être prescrit à une femme présentant de l’acné, il sera recommandé de prescrire :

    1. en première intention : lévonorgestrel qui est plutôt acnéigène… (Adepal*, Trinordiol*, Ludeal*, Minidril*, Optilova*… )
    2. en seconde intention : norgestimate (assimilé 2ème génération) et comportant une AMM (Autorisation de mise sur le marché) pour la contraception chez la femme présentant une acné (Triafemi*, Tricilest *… ).

    Les seules pilules potentiellement anti acnéiques sont à base de :

    – Acétate de chlormadinone (Belara *)

    – Acetate de cyproterone (Diane *, Holgyeme*, Evepar*, Minerva… ) : en cas d’hyperandrogénie et/ou d’hirsutisme, en cas de résistance à un traitement dermatologique bien conduit

    – Norgestimate (vu au dessus, les recommandations de prescription ne sont qu’en deuxième intention)

    L’acné excoriée est une acnée manipulée, ce qui engendre des plaies et un risque de cicatrices. Elle est fréquente chez les jeunes femmes. L’acné excoriée nécessite une consultation médicale car le risque de cicatrices d’acné est important. Voir dermatillomanie, la compulsion de toucher et gratter la peau et les boutons

    La grossesse, periode de bouleversement hormonal, peut etre marque par une amélioration ou une aggravation de l’acné. Le traitement de l’acné pendant la grossesse n’est pas aisé car de nombreux traitements utilisés pour l’acné ne peuvent être prescrits durant la grossesse. Il est donc important de consulter en cas d’acné durant la grossesse.

    L’acnée grave ou sévère est la seule acné pouvant être traitée directement par l’isotretinoine (On distingue plusieurs types d’acnés graves, et parmi celles-ci :

    accompagnée de fièvre, de fatigue et parfois de rhumatismes

    sorte d’acnée commençant à l’adolescence mais ne guérissant pas à l’entrée dans l’âge adulte et se compliquant en gagnant le tronc, les épaules, les fesses et la racine des membres, formant des comédons de grande taille, des kystes qui peuvent se rejoindre entre eux et fistuliser (donner des écoulements purulents).

    caractérisée par la prédominance de kystes inflammatoires

    Nous avons vu que les hormones, l’hérédité, le stress… étaient des facteurs déclencheurs d’acné.

    Plusieurs facteurs appelés « exposome » (environnement d’exposition, soit la somme des expositions environnementales auxquelles un individu est soumis de la conception à la mort) sont susceptibles, par leur interaction avec la barrière cutanée, les glandes sébacées, l’immunité innée et le microbiote cutané, d’influer sur la réponse au traitement de l’acne et sur la probabilité de rechute

    Cet exposome, consistant en la mesure cumulative des influences environnementales et des réponses biologiques associées tout au long de la vie, y compris les expositions dues à l’environnement, au régime alimentaire, au comportement et aux processus endogènes, peut être classé en six catégories :

    Les facteurs psychosociaux, les émotions, la privation de sommeil et l’impact du mode de vie moderne infleuncent les maladies inflammatoires de la peau, dont probablement l’acné

    Les polluants atmosphériques exercent un effet nocif sur la peau en augmentant le stress oxydatif et en induisant des altérations sévères des fonctions normales des lipides, de l’acide désoxyribonucléique et / ou des protéines dans la peau humaine

    Autres polluants atmosphériques, le tabac et le cannabis peuvent jouer un rôle dans l’acné.

    Nous avons déjà vu le rôle de la contraception dans l’acné (pilule acne). On connait aussi l’impact des corticostéroïdes,des dérivés halogénés, de l’isoniazide, du lithium, de la vitamine B12, des immunosuppresseurs et de certains agents anticancéreux

    Les conditions climatiques et les variations saisonnières résultant d’une combinaison de chaleur, d’humidité et de rayons UV intensifs peuvent déclencher une poussée d’acné inflammatoire, qui a été appelée acné tropicale.

    Forts de ce constat de l’influence de l’exposome sur l’acné, on peut recommander avant tout traitement médical :

    • Avant toute prescription, identifier les facteurs d’exposition négatifs à éviter ( limitation des aliments à indice glycémique élevé chez les patients prédisposés et des suppléments alimentaires contenant des protéines, arret voire diminution du tabagisme et/ou du cannabis, des modifications des contraceptifs et des soins de la peau)

    Nettoyer délicatement les zones atteintes par l’acné le soir avec produit nettoyant doux spécifique des peaux acnéiques.

    Le matin, privilégier de l’eau froide sans savon. En cas d’irritation, appliquer une crème hydratante le matin pour restaurer ou améliorer la fonction naturelle de barrière cutanée afin de réduire la pénétration des polluants cutanés pendant la journée et pour limiter les irritations, fréquemment observées avec les rétinoïdes.

    c’’est un faux-ami puisqu’’il améliore un peu l’’acné lors des expositions puis on observe une poussée après l’’arrêt des expositions au soleil (la classique poussée de la rentrée scolaire).

    Par ailleurs, le soleil est souvent contre-indiqué avec les médicaments et les crèmes utilisés contre l’’acné.

    Si vous n’avez pas le choix pour l’éviction solaire, privilégiez une crème solaire non comédogène, spécifique des peaux acnéiques

    Les manipulations des boutons d’acné peuvent les aggraver et entraîner l’’apparition de cicatrices d’acné ou de taches brunes sur la peau.

    De même, méfiez vous de vos mains : il est fréquent d’observer plus d’acnée sur la moitié du visage homolatérale à la main directrice. En effet, il est fréquent de prendre l’habitude de manipuler ses boutons avec sa main directrice en travaillant…

    Évitez les cosmétiques trop gras ou épais.

    On trouve maintenant d’excellents fonds de teint couvrants en poudre ou en texture non grasse. Il faut utiliser un maquillage non comédogène

    En cas de boutons sur la barbe, privilégiez le rasoir électrique pour éviter de couper les boutons comme avec le rasoir a lame.

    Si vous ne pouvez utiliser de rasoir électrique et préférez la lame, changez souvent les lames, assouplissez la barbe avec de l’’eau et du savon doux avant d’’appliquer de la crème à raser ou utilisez un gel à raser qui oblige à mouiller la barbe. Il existe des gels à raser antibactériens qui peuvent limiter un peu l’acné

    N’utilisez pas de lotion après-rasage contenant de l’’alcool.

    Evitez les mèches sur le front et les cheveux qui tombent sur le visage :

    L’acnée peut être lourde de conséquences :

    l’acnée est une dermatose affichante puisqu’elle touche principalement les zones exposées : visage, décolleté et dos et social. Qui plus est, l’acné survient le plus souvent dans une période d’instabilité et de fragilité émotionnelle : l’adolescence. Il est donc important de prendre en charge l’acné le plus tôt possible et d’apporter un traitement de l’acné afin d’éviter son aggravation.

    l’acnée peut engendrer des cicatrices d’acné, qui peuvent être comme des trous dans la peau (en bas relief) ou en relief, dont le traitement correcteur (chirurgie correctrice : relèvement des cicatrices, excision-suture voire greffes, peeling, laser ablatif… ) est parfois difficile.

    Interview du Pr Brigitte Dréno, Unité de Cancérologie cutanée, Hôtel-Dieu, Place Alexis Ricordeau, 44093 NANTES CEDEX 01

    Quelle est l’evolution de l’incidence de l’acné : augmente-t-elle, est-elle stable ou diminue-t-elle?

    L’’incidence de l’acné est stable et ce quelque soit les pays. Elle est de l’ordre de 80% en incluant les acnés minimes de type rétentionnelles.

    Les acnés sévères représentent environ 10% des acnés

    Par contre, l’’acné de l’’adulte et notamment l’acné de la femme est en augmentation et représente aujourd’hui environ 20% des acnés

    Quels sont les rapports entre alimentation et acné?

    Aucun rapport entre acné et alimentation n’ a été à ce jour bien établi. Mais des études récentes indiquent que les sucres d’assimilation rapide, certains acides gras contenus dans l’alimentation pourraient jouer un rôle indirect via l’activation de récepteurs ou cytokines qui modifieraient la prolifération et la différentiation kératinocytaire et ainsi induiraient la formation de lésions rétentionnelles. De même, les produits laitiers allégés en graisses ou écrémés ont été incriminés. Mais tout ceci reste à prouver.

    • L’acné n’est pas due à un défaut d’hygiene mais à un problème hormonal. Il n’empêche que l’hygiène est importante en cas d’acné
    • L’acné la plus fréquente est celle de l’adolescent. Elle peut avoir de lourdes répercussions psychologiques
    • Il est important d’éviter de toucher ses boutons car cela peut les aggraver et engendrer des cicatrices
    • Evitez aussi le soleil qui est un faux-ami
    • Le traitement de l’acné fait l’objet d’un consensus bien codifié chez les dermatologues et permet dans la majorité des cas d’améliorer l’acné

    – Mon acné s’améliore au soleil, dois-je m’exposer?

    – L’hygiène est-elle importante dans l’acné ?

    L’acné n’est pas liée à un manque d’hygiène, mais un lavage du visage et des zones touchées une fois par jours, si possible avec un produit spécifique des peaux acnéiques, est important pour éliminer l’exces de sébum et lutter contre la pullulation microbienne

    – J’’ai entendu parler de laser anti-acné, qu’est-ce que c’est ?

    La technologie laser est de plus en plus utilisée en Dermatologie. Il existe deux types de lasers pouvant entrer dans le cadre des traitements de l’acné : certains lasers non ablatifs ont fait l’objet de publications signalant une amélioration des lésions inflammatoires superficielles, mais ces améliorations semblent transitoires.certains lasers ablatifs entrent dans la prise en charge des cicatrices d’acné

    Vidéo sur le mécanisme de l’acné par la Société Francaise de Dermatologie :