Skin diseases drive sufferers to suicide

A doctors' report says failures to prescribe a proven drug have caused needless deaths, writes Roger Dobson

Doctors have warned that skin disease can be a hidden killer after one treatment centre found that 16 of its past patients had committed suicide.

The patients had a variety of skin problems, including acne, psoriasis and scarring: the youngest was only 16. In two cases, the patients had psychiatric problems and stalked their doctors before killing themselves.

The two doctors who carried out the research into suicides among former patients say that skin disease should be accepted as a cause of suicide, and that rationing of a drug to treat acne may result in some patients who cannot get it killing themselves. Britain's use of isotretinoin, the most effective drug against severe acne, is one of the lowest in the western world, only one-fifth that of France.

Professor Bill Cunliffe, a leading authority on acne, and co-author of a report in the current issue of the British Journal of Dermatology, says that acne and facial scarring can cause deep depression.

"Our message is that it causes a lot of psychological and social effects, with low self-esteem, job discrimination, employment problems and interpersonal problems, and that there are people who will take their own lives as a consequence," he says.

The report says that research has shown that one in 10 psoriasis sufferers have a deathwish, and adds that there is a considerable risk of suicide in patients with acne.

The Leeds research into the deaths of former patients is believed to be the first of its kind. No national figures are available on suicide among dermatology patients, but both suicide rates and the incidence of some types of acne are increasing.

It is estimated that about 5 per cent of acne sufferers are severe cases and suitable for isotretinoin, an oral drug which is a vitamin A derivative, marketed as Roaccutane by Roche, and which costs about pounds 500 for a four- to six-month course of treatment.

"It is extremely effective and can virtually guarantee to get rid of acne after about four to six months with about a 70 per cent likelihood of a long-term cure. It suppresses all the factors that cause acne. It reduces grease, blocked pores, bacteria and inflammation," says Professor Cunliffe, professor of dermatology at Leeds General Infirmary.

The report in the BJD warns of the dangers of the health service not funding drugs for acne and other skin conditions. It says: "Funding problems in regard to provision of this drug could have potentially fatal consequences. Most hospitals have funding problems, producing a rationing of acne care which is clearly undesirable."

Acne patients also face discrimination, says the professor: "There are all kinds of discrimination against people with acne. Unemployment, for instance, is 45 per cent higher among people with acne. I have had two young patients this week who have not been to school for six months because of acne.

"In our report we emphasised the need for the early use of isotretinoin to control inflammatory acne and lessen the scarring. It is expensive but it is cost-effective in the long term because you only need to treat for a limited length of time."

Britain lags behind most of the rest of the world in the use of the drug. In the USA, Canada, Australia and Sweden, for example, usage per head of the population is twice that of the UK. It is estimated that only around 1 per cent of acne sufferers in the UK who consulted their GPs are offered the drug through the NHS, but that three times as many could benefit.

Noel Rabouhans, Roche product manager for Roaccutane, says: "Roaccutane is an effective treatment in patients where conventional antibiotic therapy has been unsuccessful, but unlike other acne treatments it cannot be prescribed by a GP, only by a dermatologist. As a result the hospital picks up the bill and it is a prime target for cuts when the NHS is looking for savings.

"One of the problems is that there is a notion that acne is a trivial complaint, but, as the report shows, that is very much not the case."

Acne is precipitated by the male hormone testosterone which encourages the sebaceous glands in the skin to produce increasing amounts of sebum, an oily substance whose job is to lubricate the skin. Over-production of the oil is usually found in people who have acne and it leads to blockage of the hair ducts.

In mild forms, the pores scale-up, resulting in blockages, which materialise as the classic blackheads or whiteheads caused by dead skin cells and sebum collecting in a pore.

In more severe cases, the pore loses its structure and ruptures, and the bacteria-carrying oil gets into the skin tissue itself, causing the red inflammation typically seen in sufferers with severe forms of acne.

The Acne Support Group has a helpline on 0181-561 6868.

A catalogue of deaths that might have been prevented

The report details the cases of the 16 patients who were referred to Professor Cunliffe and a colleague, and who subsequently killed themselves, over the past 20 years. The average age of the acne victims was 20, with the youngest, two teenagers, aged 16 and 17.

The deaths included:

A 31-year-old woman who was desperate for treatment with isotretinoin, but "the drug was not available when she presented because of the budgetary controls in the NHS". She became so depressed that she killed herself.

A 26-year-old woman who complained of excessive facial hair and thinning of the scalp hair who threatened to kill her doctor, and later killed herself by jumping off a block of flats.

A 51-year-old unemployed woman suffering with psoriasis who set fire to herself in her own bed.

A 57-year-old woman who had delusions of parasitosis and who stalked her doctor. She eventually suffocated herself.

A 71-year-old man who had psoriasis and who threw himself in front of a train.

n A 23-year-old man with facial scarring from acne who failed to respond to treatment.

n Six other acne sufferers who killed themselves, all but one using an overdose. They were aged from 16 to 24.