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Accure

Isotretinoin is a generic medication used for the treatment of severe acne and most commonly known under the brands Accutane and Roaccutane. It is a retinoid, meaning it is derived from vitamin A and is found naturally in the body, produced by the liver in small quantities. more...

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History

Prior to the development of isotretinoin, the mainstay treatment of severe acne was oral antibiotics such as the tetracyclines and erythromycin. While these drugs have proven efficacy, they worked against only one contributing factor of acne, Propionibacterium acnes bacteria. The antibiotics gradually became less effective over time as more resistant strains of the bacterium became prominent.

An early, effective treatment of acne was high doses of the fat soluble vitamin A. At these dose levels (sometimes 500,000 IU per day) effects such as reduced production of sebum and dry hair could be noticed. However the vitamin also had many other prominent side effects which inhibited its widespread use.

The development of the derivative of retinoic acid, isotretinoin (13-cis-retinoic acid), and its release in 1982 by Hoffmann-La Roche was a great step forward in the treatment of acne. The synthetic compound provided better therapeutic benefit than vitamin A, while also producing fewer side effects. In February 2002 Roche's patents for isotretinoin expired, there are now many other companies selling cheaper generic versions of the drug.

Today isotretinoin is usually prescribed after other acne treatments have failed to produce results. The treatment of acne usually begins with topicals, moves onto oral antibiotics (or a combination) and finally isotretinoin therapy. This is because other treatments, while less effective than isotretinoin, produce far fewer side effects.

Brand names

Isotretinoin is produced under many brand names by many manufacturers. It is available typically as 5 mg, 10 mg, 20 mg and (in the USA) 40 mg capsules.

Some brands of isotretinoin include:

  • Accure® by Alphapharm
  • Accutane® and Roaccutane® by Roche
  • Aknenormin® by Hermal
  • Amnesteem® by Mylan
  • Ciscutan® by Pelpharma
  • Claravis® by Barr
  • Isohexal® by Hexal Australia
  • Isotroin® by Cipla
  • Oratane® by Douglas Pharmaceuticals
  • Sotret® by Ranbaxy

Indications

Isotretinoin is indicated for treatment for a number of dermatological conditions, most commonly acne. It is generally not used as a first-line treatment due to the potential side effects. Antibiotics (such as the tetracyclines) are usually prescribed before isotretinoin.

Severe forms of acne (conglobata, fulminans and nodulocystic) as well as acne that scars can be successfully treated with isotretinoin.

Acne that has not responded to other treatment will usually respond to isotretinoin. Dysmorphophobic patients may also be prescribed isotretinoin.

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Mandatory retirement: public safety hazard
From Science News, 1/25/92 by Bruce Bower

Forced retirement of police officers, fire fighters and correctional officials based solely on age, currently allowed under federal law, fails to increase public safety and probably does more harm than good, according to a Congressional mandated study.

"You can't use chronological age to predict who can best protect the public," asserts psychologist Frank J. Landy of Pennsylvania State University in University Park, director of the 16-month, $1-million project. "It may be that public safety is enhanced by allowing experience to accure in these occupations."

In 1986, federal lawmakers passed a bill eliminating mandatory retirement before age 70 for all workers except tenured college faculty and public safety officers, a category consisting of police officers, fire fighters and correctional officials. Airline pilots now also face age limits in employment. Mandatory retirement ages vary from one employer to another, but usually fall within the range of 60 to 65 years old.

Congress will review these exemptions in 1993. The 1986 bill authorized the funding of studies examining the effects of mandatory retirement ages for college and public safety employees. Another panel recommended last year that Congress remove age barriers to employment for college faculty.

Available data indicate that age proves a poor predictor of job performance among police, fire and correctional workers, according to Landy's 21-member scientific team. Instead, physical fitness and mental abilities -- which vary greatly from one person to another, regardless of age -- show the strongest link with the performance of public safety duties, concludes the report. Landy described its findings last week at a seminar held by the American Psychological Association in Washington, D.C.

He and his colleagues reviewed more than 2,000 published studies on various aspects of aging. They then gathered data on current and retired employees from 182 police departments, 165 fire departments and 102 correctional facilities throughout the United States. The researchers also used national data bases charting deaths, injuries and medical illnesses among public safety officers.

The investigation reveals a "vanishingly small" rate of medical emergencies among public safety workers carrying out critical safety tasks, even those aged 65 to 70. In fact, workers in their early 60s display greater average physical fitness than employees as much as 20 years younger, Landy says. Measures of mental abilities, such as memory and reasoning, remain roughly equal for all age groups. Average reaction times to new stimuli dip slightly for older workers, but the averages obscure the fact that many individuals aged 60 or older retain fast reaction times, Landy contends.

Moreover, older public safety workers often move into supervisory positions where their accumulated knowledge aids younger workers on the front lines, Landy maintains.

The new report recommends that police, fire and correctional departments adopt available physical and psychological tests for retirement evaluations.

COPYRIGHT 1992 Science Service, Inc.
COPYRIGHT 2004 Gale Group

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