A daily oral intake of vitamin A derivative isotretinoin (marketed as Accutane, Amnesteem, Sotret, Claravis, Clarus) over a period of four to six months can cause long-term resolution or reduction of acne. Doctors believe that isotretinoin works primarily by reducing the secretion of oils from the glands, however some studies suggest that it affects other acne-related factors as well. Isotretinoin research shows it to be very effective in treating severe acne and can either improve or clear well over 80 percent of patients. The drug has a much longer effect than anti-bacterial treatments and will often cure acne for good. The treatment requires close medical supervision by a dermatologist because the drug has many known side effects (many of which can be severe). About 25 percent of patients may relapse after one treatment. In those cases, patients require a second treatment for another four to six months to obtain desired results. Doctors recommend that one allow a few months pass between the two treatments, because acne can actually improve somewhat over time. Occasionally a third or even a fourth course is used, but the benefits are often less substantial. The most common side effects are dry skin and occasional nosebleeds (secondary to dry nasal mucosa). Oral retinoids also often cause an initial flare up of acne within a month or so, which can be severe. There are reports that the drug has damaged the liver of patients. For this reason, doctors recommend that patients have blood samples taken and examined before and during treatment. In some cases, doctors terminate or reduce treatment due to elevated liver enzymes in the blood of the patient, which suggest a link to liver damage. Other dermatologists claim that the reports of permanent damage to the liver are unsubstantiated, and deem routine testing unnecessary. A doctor must also monitor the blood triglycerides. However, routine testing is part of the official guidelines for the use of the drug in many countries. Some press reports suggest that isotretinoin may cause depression but as of September 2005, there is no agreement in the medical literature as to this risk. The drug also causes birth defects if a woman becomes pregnant while taking it or takes it while pregnant. For this reason, female patients are required to use two separate forms of birth control or vow abstinence while on the drug. Many doctors only supply isotretinoin to women as a last resort after milder treatments have proven insufficient. The USA put into effect restrictive usage rules (see iPledge program) beginning in March 2006 to prevent misuse, causing occasioned widespread editorial comment.

Cognitive Behavioral Therapy

Doctors developed cognitive behavioral therapy as a method of preventing relapse when treating a patient with problem drinking. Later cognitive doctors adapted behavioral therapies to help individuals addicted to cocaine. Cognitive behavioral strategies stem from the theory that learning processes play a critical role in the development of maladaptive behavioral patterns. Individuals learn to identify and correct problematic behaviors by applying a range of different skills to stop drug abuse and to address other problems that often exist with it. Therapies for treating alcohol, marijuana, cocaine, methamphetamine and nicotine exist. Cognitive behavioral therapy generally consists of a collection of strategies that aim to enhance self control. Specific techniques include: exploring the positive and negative consequences of continued use, monitoring oneself to recognize drug cravings early on and to identify risky situations for use and developing strategies for coping with and avoiding risky situations associated with the desire to use. A central element of cognitive behavioral therapy is anticipating problems and helping patients develop effective coping strategies. Research indicates that the skills individuals learn through cognitive behavioral approaches remain in use after the completion of treatment. In several studies, most people who choose a cognitive behavioral approach to recovery showed progress throughout the following year. Current research focuses on how to produce effects that are even more powerful by combining cognitive behavioral therapy with medications for drug abuse and with other types of behavioral therapies. Researchers are also evaluating how best to train treatment providers to deliver cognitive behavioral therapy.

Medical Device Registration

Medical device registration offers a single place for patients to learn about registered devices and provides information about recalls. Medical devices include a wide range of products that vary in complexity and application. The Food and Drug Administration recognizes three classes of medical devices based on the level of control necessary in order to assure the safety and effectiveness of the device. An implant is a medical device manufactured to replace a missing biological structure, support a damaged biological structure or enhance an existing biological structure. Medical implants are manufactured devices. The surface of implants that come in contact with body might be made of a biomedical material such as titanium, silicone or apatite, depending on what is the most functional. In some cases, implants contain electronics e.g. artificial pacemaker and cochlear implants. Some implants are bioactive, such as subcutaneous drug delivery devices in the form of implantable pills or drug-eluting stents. Among the most common types of medical implants are pins, rods, screws and plates used to anchor fractured bones as they heal. There have been many examples of implant failures, including rupture of silicone breast implants, faulty hip replacement joints and breakable artificial heart valves. The consequences of implant failure depend on the critical nature of the implant and its position in the body. Thus, heart valve failure is likely to threaten the life of the individual, while breast implant or hip joint failure is less likely to be life threatening. The process of implantation of medical devices is subject to the same complications as any other invasive medical procedure, including infection, inflammation and pain. Patients also run the risk of implant rejection if the immune system of the host reacts poorly.

Dry Skin

Many older people suffer from dry skin, particularly on their lower legs, elbows and forearms. The skin feels rough and scaly and often causes a distressing, intense itchiness. Low humidity--caused by overheating during the winter and air conditioning during the summer--contributes to dryness and itching. The loss of sweat and oil glands with age may worsen dry skin. Anything that further dries out the skin--such as overuse of soaps, antiperspirants, perfumes or hot baths--will make the problem worse. Dehydration, sun exposure, smoking and stress also may cause dry skin. Dry skin itches because it is irritated easily. If your skin is very dry and itchy, see a doctor. Dry skin and itching can affect your sleep, cause irritability or be a symptom of a disease. For example, diabetes and kidney disease can cause itching. Some medicines make the itchiness worse. The most common treatment for dry skin is moisturizing to reduce water loss and to soothe the skin. Moisturizers come in several forms: ointments, creams and lotions. Ointments are mixtures of water in oil, usually either lanolin or petrolatum. Creams are preparations of oil in water, which is the main ingredient. Creams are more often than ointments to be as effective. Lotions contain powder crystals dissolved in water, again the main ingredient. Because of their high water content, they feel cool on the skin and do not leave the skin feeling greasy. Although they are easy to apply and may be more pleasing than ointments and creams, lotions lack the same protective qualities. Lotions should applied more frequently to relieve the signs and symptoms of dryness. People should always use moisturizers to prevent recurrence of dry skin.