My best suggestion is for you and/or your doctor to contact FIRST (the Foundation for Ichthyosis and Related Skin Types). You can reach them at 215-631-1411 or on the web at www.scalyskin.org
Talk to them about putting your doctor in touch with someone on FIRST's Medical Advisory Board. FIRST's MAB members are all derms who are experienced with ichthyosis and most are experienced with using retinoids for treating ichthyosis. One of them can give you and your doctor some more insights.
This is a very personal decision. Only you and your family can make the "right" decision for you (so try not be unduly swayed by people who either say "yes, do it now!" or "omigod, what are you thinking, of course not!" and I think you'll hear both). I think what you're doing (trying to gather as much info as you can) and then making a decision, is a good approach.
I personally took Accutane for about 14 years, starting when I was 13. I personally have mostly good things to say about my Accutane experience (and happy to tell you more than you want to know about my experiences! [img]http://www.ichthyosis.com/ubb/wink.gif
What I've generally heard people say (like at FIRST's national conferences--the next one is in Seattle in 2002) about age to start retinoids with a child is that they try to wait a little longer than 3 years. The things that you're most concerned about are bone changes. The most serious side effect that's seen with some frequency with people who take high doses of retinoids for long periods of time is bone changes (most likely: calcium deposits, bone spurs, on joints). There's some thinking that since a small child's bones are still growing so fast, you should be extra cautious about introducing retinoids at an early age.
Also, a small child may not be prepared to deal adequately with other side effects (in terms of being able to recognize them, communicate them, or care for themselves to deal with them).
I might ask your doctor some follow-up questions about his experience with retinoids.
- Why were his patients on retinoids--for ichthyosis or for other things (like acne)? People who take retinoids for severe acne typically take *much* lower daily doses than someone who is looking to improve their ichthyosis. Also, people with acne only take retinoids for a limited period of time (I think 2-3 months is common). People with ichthyosis take retinoids potentially indefinitely. It's a very different management program, managing the retinoid treatment of someone with ichthyosis vs. someone with acne or some other issue.
- When he says that none of his patients have had anyside effects (that's a very strong statement), this makes me wonder if he's either 1) not really used retinoids very much in his practice, or only used them for treating acne or 2) is only referring to the more severe side effects, like bone changes.
I don't know anyone who has taken retinoids for ichthyosis who hasn't had some side effects. For me, they were mostly limited to "annoyance" type issues: very dry lips (needing chapstick all the time), peeling of the skin from underneath my finger nails, and nose bleeds. Lots of nose bleeds. Mostly they were very short and easily controlled, but I did end up in the emergency room one night in college after my nose had been bleeding from both nostrils heavily for about 3 hours. Not to be gross, but most of them happened totally spontaneously--I wasn't picking nose, my nose hadn't been hit by anything, etc. Nosebleeds would just start, anytime, anywhere. At age 13 and up, I considered this an annoyance--a small child might find this much more traumatic.
- How exactly does your doctor propose managing your daughter's treatment? How often will she have blood work done (to monitor triglyceride levels, which tend to elevate with retinoid use)? How often will she have x-rays to monitor whether she's experiencing any bone changes? How much of her body will be x-rayed (and I'm not implying that more is necessarily better--have to balance the risk of bone changes with the risks of x-rays).
I started with blood work every 8 weeks, and x-rays every six months. After getting a "comfort" level that I wasn't experiencing any changes (over 2 or 3 years' time), that backed down to blood work at the beginning, and near the end, of a treatment cycle (do a search on this forum on "drug holiday"--that's another issue altogether when managing retinoid use for ichthyosis. There's some thinking that if you take breaks, "drug holidays", you reduce your risk of serious side effects...rather than taking a retinoid continuously, without ever stopping).
Also, keep copies of your x-rays (pay to have your own personal copies). Then take them with you when your daughter has new x-rays taken. It's very important for the technician reading the films to be able to compare with previous x-rays. The first signs of bone changes resulting from retinoid use can be very subtle (re: possibly dismissed as normal, or something else). If you go to the same hospital for the x-rays every time, they should theoretically have them on file. But why take a chance? Keep your own file and take your personal file with you for them to use.
Hoi. That's what comes to mind right away (I know that was kind of stream-of-consciousness. Sorry for being so disorganized).
I hope some of the other mom's will respond here. I've heard several moms say that they're waiting until social pressures really seem to make retinoid use more necessary (also at an age when the child can understand more the risks and rewards, and actually ask
to be put on retinoids). Seems like 10-13 years old is the range I hear a few people shooting for.
But there are definitely people out there who have started their children on retinoids very young (at least as young as 3) and as far as I know, have been very happy with their decision.
I hope some of those parents will see this and take the time to respond with their thoughts.
Very best of luck in your decision.
[This message has been edited by Laura Phillips (edited July 18, 2001).]