It used to be said that dermatology was the best branch of medicine to be in, because the patient never gets better, and never dies.

In this short statement, there are two confessions and a lie. The statement may be partly in jest, but many a true word is spoken in jest.

The first confession is that the patient never gets better. For example, with acne patients, in the absence of very strong drugs, this is often how it goes, with patients being dependent on continuous use of antibiotics, long term, even for years, to suppress their condition.

The second confession is that it's beneficial to the system that the patient never gets better. "A patient cured is a customer lost."

The lie is that the patient never dies. Some patients do die - and young - as a result of the treatment they receive.

Recently, the case of Annabel Wright has been in the news. Wright was 15 years old, and prescribed Roacccutane® (a brand name for isotretinoin) for mild acne. She committed suicide in 2019. The family blame the drug, which has been linked to suicide.

The list of known medical side effects is long. Here is a small subset, from an orthodox source:

Gastrointestinal

Dry lips, chapped lips, cheilitis, nausea, constipation, diarrhea, abdominal pain, vomiting, inflammatory bowel disease, hepatitis, pancreatitis, bleeding and inflammation of the gums, colitis, esophagitis, esophageal ulceration, ileitis.

Neurological

Headache, syncope, intracranial hypertension (pseudotumor cerebri), dizziness, drowsiness, lethargy, malaise, nervousness, paresthesia, seizures, stroke, weakness.

Psychiatric

Suicidal ideation, insomnia, anxiety, depression, irritability, panic attack, anger, euphoria, violent behaviors, emotional instability, suicide attempts, suicide, aggression, psychosis and auditory hallucinations. Of the patients reporting depression, some reported that the depression subsided with discontinuation of therapy and recurred with reinstitution of therapy.

Suicides linked to the drug are rare - about 10 cases per year in the UK - but considering the long list of other side effects, they are only part of the problem, albeit one of the most extreme side effects.

Also, there are severe reproductive risks with the drug, not limited to the following warning from the FDA:

[T]here is an extremely high risk that a deformed infant can result if pregnancy occurs while taking Accutane in any amount even for short periods of time . . . . In some cases death has occurred . . . .