EXTREME REACTION

When the 15-year-old American boy Charles Bishop stole a Cessna and flew it into a Florida building earlier this month, most people thought of terrorists.

But when investigators found he had a prescription for a powerful acne drug, the theorists started talking about depression.

Why? Because the drug in question, isotretinoin, was being taken by 140 other people when they committed suicide. That may seem a lot. But when you consider that in America alone more than two million people take the drug every year, it is a fraction of the total who have been on isotretinoin since its general release in the early 1980s.

However, one death is one too many and if there is any suspicion a death was caused by a drug's side effects, doctors, regulators and, most importantly, those using the drug, begin to worry.

No one has established a clear link proving the use of isotretinoin makes people suicidal. However, depression is an accepted side effect of the drug and depression, if severe and untreated, can lead to suicide.

The picture is not as simple as it seems. Isotretinoin is used for treating severe acne - the kind that leaves people with cysts, lumps and pits all over their faces. The sort of skin condition that leads to taunts such as 'crater face' and, social studies have found, can ruin lives.

Sufferers tend to have problems getting the jobs they want and are passed over for promotion. They have more problems finding friends and sexual partners.

The constant cruelty and derision they suffer causes major self-esteem problems which, in turn, can lead to severe depression and suicide.

Isotretinoin has revolutionised treatment of this kind of acne because, if taken before the acne has begun to scar the skin, it can reverse the condition. By the late 80s, dermatologists were declaring severe, scarring acne a thing of the past thanks to isotretinoin.

The drug is powerful and has unwanted side effects. It is known to cause birth defects because it interferes with foetal development in the early weeks of pregnancy.

As most people who suffer acne are teenagers or young adults, it is no surprise a significant number become pregnant. Women taking the drug need to be very careful about using effective contraception at all times.

This is a drug that needs to be respected, but that hasn't stopped many older women using isotretinoin after some magazines promoted it as capable of reversing wrinkles and signs of ageing. Unaware of the risks, some of these women had offspring with defects.

This should serve as a reminder for people in Hong Kong, where drugs are often given without the manufacturer's information leaflet, to find out exactly what you are being given. You also need to ask about side effects and whether it reacts with any other drugs.