The drug Accutane (isotretinoin) has been used for many years to treat severe acne. It's often seen as the last resort for those who have acne that causes pitting and scarring on the face and body. The drug is associated with severe birth defects, and women taking the drug must submit to monthly pregnancy tests and use at least two methods of birth control. Accutane was also anecdotally linked to depression and suicidal behavior, and parents pressured the Food and Drug Administration to pull the drug. The brand name version was taken off the market in June, but generic versions of the drug are still available.

The makers of Accutane, Roche Holding, pulled the drug after several lawsuits that resulted in large payments to plaintiffs who claimed that Accutane caused their inflammatory bowel disease (IBD). A recent study (presented at the American College of Gastroenterology's 2009 meeting) of 21,832 healthy people and 8,189 people with IBD showed that those who had taken Accutane were one and a half times more likely to have developed IBD. The risk further increased with long-term use of the drug. A similar study done amongst Canadians in July showed no such association: people who had taken Accutane were no more or less likely to have developed IBD than those who did not.

With this recent study and the results of the court cases, the availability of the generic version of the drug is in question. It can already be difficult to obtain, but soon it may be impossible for those who wish to take it to treat their severe acne. Dermatologists and other professionals argue that the risk of developing IBD is still very low, and that therapy with isotretinoin is very effective and can help prevent the facial scarring and that can occur with severe acne.

After weighing these arguments -- would you take Accutane to treat your acne? After voting, click on "Comments" and tell me why or why not.

_{Sources:
Crockett S, et al "Accutane use is associated with inflammatory bowel disease: A case control study using administrative data." ACG 2009; Abstract P1122.
Clara I, Lix LM, Walker JR, et al. "The Manitoba IBD Index: Evidence for a New and Simple Indicator of IBD Activity." Amer J Gastroenterol July 2009 104:1754-1763. 10 Nov 2009.}

Results from a recent retrospective cohort study presented at the American College of Gastroenterology's annual meeting has shown that people with IBD who take a class of drugs called thiopurines are at an increased risk for non-melanoma skin  cancer (NMSC). Two IBD drugs that are thiopurines are Imuran (azathioprine) and Purinethol (6-mercaptopurine).

The risk of NMSC was calculated to be 3 times greater in those with IBD who took a thiopurine when compared to people with IBD who were not taking these drugs. An open question that the study was not able to resolve was whether the risk of skin cancer was due solely to the thiopurines, or if the changes in the immune system caused by the IBD itself contribute to the risk. Because of this risk of skin cancer connected with the thiopurines, the authors of the study recommend that people taking these drugs use broad-spectrum sunscreen daily.

_{Source:
Long M, et al. "New Study Reveals Possible Link Between Therapy for Inflammatory Bowel Disease And Non-�Melanoma Skin Cancer." American College of Gastroenterology 26 Oct 2009. 5 Nov 2009.}

It's been a while since this has happened to me, so last night's dreams were a surprise to me. I was dreaming about bathrooms. For those of us with IBD, it's usually not a pleasant dream, but typically the bathrooms we encounter in our dreams are dirty, unusable, missing doors, or otherwise unavailable to us. Compounding the nightmare-quality is the fact that you are usually in dire need of a bathroom -- immediately (if not sooner). In my dream, some of the restrooms were under construction, so they were unusable, and there were signs over the restrooms, telling us which ones we could use. The line for the "IBD" restroom was long, and I was in terrible pain while waiting. When I finally woke up -- you guessed it -- I needed to empty my j-pouch.

Do we dream about bathrooms because our bodies are trying to tell us something, to wake us up? Or is it because the finding of restrooms takes up so much of our waking life, that it's only normal that it would enter into our dreaming life, too? We might never know the answers. What we do know is that sleep is incredibly important, even more so when you have a chronic condition. Guard your sleep as the precious commodity it is, and learn how to improve your quality of sleep.

More about sleep:

• Dreaming of Toilets
• Does IBD Keep You Up At Night?
• How Do You Get Better Sleep When Your IBD is Flaring?
• IBD and Night Sweats

The Crohn's and Colitis Foundation of Canada (CCFC) has designated November as Crohn's and Colitis Awareness Month. This year, the CCFC is developing an initiative to better understand Crohn's disease and ulcerative colitis in children and adolescents. They are working with pediatric gastroenterologists to create a system to track cases of IBD in kids across Canada. Other events in November include the "Gutsiest Canadian" contest, which will honor seven Canadians who are making a difference in the IBD community, and educational symposia in cities across Canada. If you haven't become involved with the CCFC, this month is a great time to get started!