Dr. Skin has a large dermatology practice with an emphasis on acne. Many of his fellow dermatologists refer to him their most difficult patients. In fact, Dr. Skin prides himself on his ability to manage these difficult acne patients. For twenty years, he has been a strong advocate of using oral retinoids for treatment-resistant cystic acne and has successfully treated many patients.
As would be expected, many patients have had some side effects; all have been manageable. He has seen dose-related headaches, arthralgias, dry skin and eye, as well as occasional nausea and vomiting in some patients. In addition, because of the rare reports of mood changes from oral retinoids, he asks all patients about a psychiatric history.
All of his patients have done well until one (a married highly successful businessman with 3 children), who had virtually no prior difficulty with other acne treatments, shot himself in the head 2 years ago. Although Dr. Skin is saddened by his patient’s death, he assumes this was a rare tragedy that was unrelated to the patient’s treatment.
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