1. Lauren Tran Acne and Accutane: My Journey Dr. Karan K. Sra, MD The Dermatological Association of Texas ISM Health Science Fall 2014 Mrs. Click R.N *Some information in this presentation comes from outside sources.

2. Dr. Karan K. Sra, MD Dr. Sra completed her undergraduate training at the University of Texas in Austin and graduated with honors. She attended medical school at the University of Texas Medical Branch at Galveston with an internship and a Dermatology residency. Before completing her training, she was a part of the clinical trials at the Department of Dermatology at the University of Texas Medical branch at Galveston and Center for Clinical Studies in Houston. "Karan K. Sra, MD, FAAD." dermtexas. Dermatological Association of Texas, n.d. Web. 12 Oct. 2014. <http://dermtexas.com/about-us/ karan-k-sra-md-faad/>.

3. What is ISM? ISM is an abbreviation for Independent Study Mentorship  Multi- Disciplinary  Health Science Students are given the opportunity to choose a career based on their interests Students also choose a mentor that fits into their desired field in order to assist them on their project as well as provide an introduction to their profession At the end of the semester, the students showcase their knowledge of their project topic at the Career Fair

4. ISM Requirements Students must:  Document a minimum of 2-3 hours of mentorship activities each week  Complete a Journal Entry each week documenting mentorship experiences  Complete an ISM Professional Portfolio showcasing all of the assignments during the course and final project

5. My Project Topic My project is about acne, Accutane and my Accutane journey Why did I choose this topic?  I chose this topic because I want to educate others about acne, Accutane, and to share my experience with Accutane.

6. What is Acne? Acne is a skin condition that is caused by:  Hair follicles that are blocked due to oil (sebum: produced form sebaceous glands) and dead skin cells  Overproduction of sebum (puberty/pregnancy due to hormones)  Buildup of bacteria  Collection of dead skin cells  Heredity Commonly appears on:  Face, chest, back, neck, and shoulders "Acne." Mayo Clinic. Mayo Foundation for Medical Education and Research, n.d. Web. 12 Oct. 2014..

7. The Different Types of Acne Non-inflammatory lesions  Comedones  Whiteheads- pimples that stay under the surface of the skin  Blackheads- the pimples that rise to the surface of the skin and looks black Inflammatory lesions  Papules- raised bumps (signal of inflammation/infection)  Pustules (pimples)- red and tender filled with pus at the tips  Nodules- large and solid lumps beneath the surface of the skin  Cysts-(the most painful) boil-like infections that cause scarring "Acne." Mayo Clinic. Mayo Foundation for Medical Education and Research, n.d. Web. 12 Oct. 2014..

8. Nase, Geoffrey. "Rosacea Symptoms and Rosacea Triggers: Details and Rosacea Photos by Dr. Geoffrey Nase." Rosacea Symptoms and Rosacea Triggers. Nase Publications, n.d. Web. 06 Dec. 2014. "Acne: It's Not Just a Teen Problem." - WGEM.com: Quincy News, Weather, Sports, and Radio. N.p., n.d. Web. 06 Dec. 2014.

9. Facts vs. Myths Factors that could worsen acne:  Hormones (especially during puberty)  Certain medications  Diet  Oil based cosmetics  Sweat Myth factors  Fried foods (greasy)  Chocolate  Dirty skin "Acne." Mayo Clinic. Mayo Foundation for Medical Education and Research, n.d. Web. 12 Oct. 2014..

10. Treatments for Acne Topical medications  Epiduo  Differin Oral medications  Antibiotics (Solodyn)  Oral contraceptives (Ortho Tri-Cyclen) Laser and light therapy Cosmetic procedures (chemical peels or microdermabrasion) Drainage and extraction procedure Dehn, Elizabeth. Epiduo. Digital image. Beautybets.com. N.p., 30 July 2013. Web. 12 Oct. 2014 "Var R_text = New Array (); R_text[0] = "Excellence in Dermatology™"; R_text[1] = "Excellence in Dermatologic Surgery™"; R_text[2] = "Excellence in Medical Dermatology™"; R_text[3] = "Excellence in Dermatopathology™"; Var I = Math.floor(4*Math.random()) Document.write(r_text[i]);." Acne: Diagnosis, Treatment, and Outcome. American Academy of Dermatology, n.d. Web. 05 Dec. 2014.

11. Why Did I Choose Accutane? I tried all sorts of medications and none of them were effective  Topical treatments (Epiduo and Differin)  Oral medications (Solodyn- antibiotic)  Birth control (Ortho Tri-Cyclen) My dermatologist Dr. Sra, introduced me to Accutane "10 Things to Know about Differin." Clear Clinic Acne Acne Scar Treatment Centers. N.p., n.d. Web. 06 Dec. 2014. "Solodyn Antitrust Class Action Lawsuits Consolidated into MDL." Top Class Actions. N.p., n.d. Web. 06 Dec. 2014.

12. What is Accutane? Isotretinoin “Last resort pill” (if other medications aren’t effective) Powerful medication that is used to treat severe acne

13. How Does Accutane Work? Vitamin A derivative 1. Dramatically reduces size of the sebaceous glands (35%-58%) and the amount of oil production (about 80%) 2. Reduces amount of bacteria 3. Slows down the process of skin cell production inside the pore (prevents clogged skin) 4. Anti-inflammatory properties Accutane. Acne. Dan Kern, n.d. Web. 12 Oct. 2014..

14. Temporary Side Effects  Bone/joint pain  Burning and dryness of eyes  Nosebleeds  Dry nostrils  Extremely dry lips  Peeling skin  Rash (eczema)  Hair loss  Increased sunburn susceptibility  Diminished night vision  Blurred vision  Fatigue  Slow healing of cuts and sores  Hearing impairment  Headaches "Accutane (isotretinoin)." - How It Works, Side Effects, and Reviews - Acne.org. N.p., n.d. Web. 06 Dec. 2014.

15. Permanent Side Effects  Elevated liver enzymes  Inflamed pancreas  Respiratory symptoms  Inflammatory bowel disease/ Chrohn’s disease "Accutane (isotretinoin)." - How It Works, Side Effects, and Reviews - Acne.org. N.p., n.d. Web. 06 Dec. 2014.

17. iPledge System Roche started a program SMART (System to Manage Accutane Related Teratogenicity) in 2000 which became iPledge Launched in March 2006 Purpose of the program is to prevent females from becoming pregnant  Must use two forms of birth control while on Accutane "Call Our Toll Free Number 1-866-495-0654 to Report Any of the Following:." Public Home Page. N.p., n.d. Web. 06 Dec. 2014.

18. "IPLEDGE." Wikipedia. Wikimedia Foundation, 29 Nov. 2014. Web. 06 Dec. 2014.

19. Birth Defects Include:  Skull  Ear  Eye  Facial  Central nervous system  Cardiovascular  Thymus  Parathyroid abnormalities  Death Effects and risks of Accutane on unborn children are so severe that female patients at childbearing age are required to use two forms of birth control while on Accutane. "Acne Drug Accutane's Side Effect Is Death. So Why Is It Still on the Market?" CBSNews. CBS Interactive, n.d. Web. 06 Dec. 2014.

20. Depression and Suicide Betwe en 1982-2000, the FDA received reports of 431 cases of depression, suicide attempts, or suicide.  37 patients who committed suicide  24 while using it and 13 after using it  84%, 31 were male between the ages of 13-32 years  110 patients were hospitalized  56%, 62 were female between the ages of 12-47 years 2008- Journal of Clinical Psychiatry was the first controlled study to find a correlation between Accutane, suicide, and depression were relatively minor More recent studies have led to more credibility that Accutane does not negatively effect depression or mood “It showed significant improvements to depression, anxiety, and obsessive thoughts due to the power of Accutane to clear acne and thus increase the quality of life.” "Depression and Suicide in Patients Treated with Isotretinoin — NEJM." New England Journal of Medicine. N.p., 8 Feb. 2001. Web. 06 Dec. 2014.

21. Patient Protocol Required to sign papers accepting the terms and policies for the program Required to take a monthly test on the iPledge program and pass in order to obtain refills Shouldn’t go out in the sunlight too much Shouldn’t use any treatments to treat acne (salicylic acid) Shouldn’t wax or thread eyebrows Every month the patient must take a:  Urine test to make sure the female patient is not pregnant  Blood test to make sure the liver, vitamin, iron, cholesterol, and blood platelet levels are stable enough to continue using Accutane

22. Statistics on Accutane 1997-2002: the Food and Drug Administration received 83 cases of inflammatory bowel disease among uses of Accutane Researchers found a relationship between dosage and the risk of getting ulcerative colitis (higher dose= greater risk of disease) Study based on 87 health insurance companies  Out of 8,189 cases in the study population:  3,664 had Crohn’s disease  4,428 had ulcerative colitis  97 had unspecified bowel disease "Accutane® Statistics." Accutane Statistics. N.p., n.d. Web. 06 Dec. 2014.

23. Lawsuits Against Accutane Roche has been ordered to pay more than $53 million to Accutane patients Cases:  2008- Jury awarded a woman with inflammatory bowel disease 10.5 million in compensatory damages and $78,500 for medical expenses  2010- Roche was forced to pay $25 million (largest award) to Andrew McCarrell, who developed inflammatory bowel disease years after he had taken Accutane. He had five surgeries and was forced to have his colon removed. The judge who ruled the case, Carol E. Higbee, said that McCarrell’s “testimony and that of his wife and doctors presented a picture of probably the worst case of pain, suffering and loss of quality of life I ever heard described in my eighteen years on the bench.” "Accutane Lawsuit." - Settlements, Claims & Compensation. DrugWatch, 10 Oct. 2014. Web. 06 Dec. 2014.

24. My Accutane Journey Before After May 2014 December 2014

27. Side Effects That I Had Dry lips Dry eyes (Restasis) Dry patches on hands Joint pain Fatigue Dry nostrils

29. Portfolio Binder

30. Weebly Website www.laurentran.weebly.com

31. Final Product www.laurentran28.weebly.com

32. Conclusion I chose this topic because it was something that I’ve wanted to share for a while. I’ve had acne since I was 10 years old. It has affected me emotionally and psychologically. I would be scared to walk out of the house fearing that people would judge and laugh at my face. I would also occasionally cry because I hated the fact that I was so self- conscious about myself even though at an early age I shouldn’t have been. Even though having acne made me have a low self-esteem, I wouldn’t say that I “suffered” from acne. Acne has made a grand and positive impact on my life.  Healthy lifestyle- only water, no rice, occasionally have baked and fried goods  Skincare- acne isn’t curable but my proper skincare routine helped me prevent/maintain my skin from breaking out to its highest potential  Knowledge/passion- that I have gained from all of this. I know so much information about acne, Accutane, and skin care as well as cosmetic products  I share my knowledge because I desire to help others because I can understand what they have gone through.

33. Conclusion Continued What I’ve learned from my mentorship:  Nothing ever runs smoothly  They deal with different kinds of patients  There are definitely the fantasies vs. realities of being a doctor  Having this mentorship has completely changed my perspective of the medical field

35. Questions? The nurses working hard Part of the lab Liquid Nitrogen to freeze warts Dr. Robare searching for Scabies Part of the lab

36. Thank You I would like to thank:  My mentor: Dr. Sra  Mrs. Tufano  Dr. Robare  My evaluators: Mrs. Deckert and Mrs. Cotton  My teacher: Mrs. Click  My parents: Nga Tieu and Long Tran

37. Work Cited "10 Things to Know about Differin." Clear Clinic Acne Acne Scar Treatment Centers. N.p., n.d. Web. 06 Dec. 2014. "Accutane (isotretinoin)." - How It Works, Side Effects, and Reviews - Acne.org. N.p., n.d. Web. 06 Dec. 2014. "Accutane Lawsuit." - Settlements, Claims & Compensation. DrugWatch, 10 Oct. 2014. Web. 06 Dec. 2014. "Accutane® Statistics." Accutane Statistics. N.p., n.d. Web. 06 Dec. 2014. "Acne Center: Blackheads, Cystic Acne, Whiteheads, Scarring, and Acne Treatments." WebMD. WebMD, n.d. Web. 07 Dec. 2014. "Acne." Definition. Mayo Foundation, n.d. Web. 07 Dec. 2014. "Acne: It's Not Just a Teen Problem." - WGEM.com: Quincy News, Weather, Sports, and Radio. N.p., n.d. Web. 06 Dec. 2014. "Depression and Suicide in Patients Treated with Isotretinoin — NEJM." New England Journal of Medicine. N.p., 8 Feb. 2001. Web. 06 Dec. 2014. "Var R_text = New Array (); R_text[0] = "Excellence in Dermatology™"; R_text[1] = "Excellence in Dermatologic Surgery™"; R_text[2] = "Excellence in Medical Dermatology™"; R_text[3] = "Excellence in Dermatopathology™"; Var I = Math.floor(4*Math.random()) Document.write(r_text[i]);." Acne: Diagnosis, Treatment, and Outcome. American Academy of Dermatology, n.d. Web. 05 Dec. 2014.