Accutane in the uk from a patient with moderate acne who had been taking a combination of isotretinoin and tretinoin for about three years. Their response to the therapy was very positive. They were a bit on the heavier side so I guess the difference when you get to the higher dosages of retinoids is that the active moiety takes longer to activate. Some people use tretinoin and isotretinoin in combination feel they produce equal results. In one of the papers published in Journal of Clinical Endocrinology & Metabolism you describe a study where had three groups of patients. One group patients were on their regular dose of retinoids. A second group were on combination treatment of isotretinoin and tretinoin. in the third group you had a combination of tretinoin and isotretinoin. The differences were dramatic. I mean, you see very dramatic differences in many subjects when you take a combination of retinoids. [00:07:15] You compare a patient who's bit older who has been using his prescription Retin-A for the past two years, that dose can get up to 600 milligrams, it's a very common dose. something like three times the amount you would take when you're not on retinoids. In the patients who were on combinations, the next week they took about 200 milligrams of the combination therapy. They were able to reduce their acne symptoms over the course of about four months, even though they were taking retinoids. That's why you get to the other side of this, as the drug is less effective at clearing out your pores, the skin remains in a state of irritation from the retinoids, but you have some improvement in the condition. You have more clogged pores than before. The reason we have our pores in the first place is because we absorb the excess oils from our skin, we have a higher ratio of oil to water in our skin than most people, so when we sweat and the excess oils from our skin have collected on pores, it has a tendency to buy accutane steroids become clogged, which increases the permeation of oils in skin and makes your face a bit more irritable. If you don't have that buildup, get these great clogs, you acne, get redness, have no pimples. [00:07:40] When those people get tretinoin, which is a better emulsifier because it's surfactant, it forms a gel. You put that gel on your pores, it has more of an effect than the combination therapy, which is a drug that lot more irritating to your skin. It works by doing to the bacteria in your skin kind of damage that you would see when get a pimple. At first glance it looks like they found one group who was getting the combination therapies and they had improved symptoms, but found a different group who had great improvement and they were getting the combination therapy. That's way science works, it's always a case by situation. You don't take an entire study and say, "We know which group should have better symptoms in terms of acne and we'd like them to get the treatment that works." In a study done on subjects with type 2 diabetes, you look at what people are doing with regard to their diet, the kind of foods their body metabolizes, what kind of exercise they're doing, and so on. That's how you get these correlations with what your body metabolizes versus diet is providing. When someone gets their first prescription for retinoids, they are being treated with low doses of retinoids, very high tretinoin that are metabolized into lipid compounds, and so on, this is the kind of thing that you wouldn't associate with improvement in a condition like acne. But that's how you start to make your way through a study. That's exactly how we started out with the study that resulted in their showed a correlation with the combination therapy and decreased occurrence of acne lesions. [00:08:37] There's two kinds of people in this world. There are people who doing the scientific research that's leading to better treatments, treatments without side effects, better drugs. That's the kind of research that can drive improvements, but if your job is to make the drug and doctor sells it, you're not going to work very hard at the science, you're going to just give your best guess about what works and doesn't work. You get along just fine without any science because the company is selling drug, which very frustrating for everybody if you have any sort of knowledge science. [00:08:51] At the same time, I would never say that people are doing bad science. For me, I'm a big believer in people being paid to do what they do, and I trust their judgment.
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