Acne vulgaris is a terrible condition for teens--or anybody--to deal with. It's visible to all and afflicts many with shame, humiliation, low self esteem and confidence, etc. One of the mainstays of treatment has been benzoyl peroxide, which for decades has been proven safe and useful in controlling the pustules and papules. A big drawback is the irritation it causes, and one formulation in particular, Brevoxyl made by Stiefel Pharma, has been around since I was a resident. It had a micro-encapsulated delivery where the molecule would preferentially get into the pores and not sit on the surface of the skin leading to redness and irritation. I don't have a lab and can't attest to the biochemistry involved, but clinically speaking, it was wonderful and worked great.
A casualty of the current recession is Brevoxyl. Stiefel sold "the name" to another pharmaceutical company, apparently because it went off patent, so the product is still called Brevoxyl, but the teenagers I'm seeing have terrible flare-ups and complain that they're getting irritation and redness that they weren't before. One bright kid brought in the current Brevoxyl "kit" and pointed out that the stripes on the box are different colors and the wash runs out of the bottle like water instead of like a creamy lotion as it did before. SO-- the patients know that something is up.
I did a little sleuthing and Brevoxyl as we knew it in the past is no more. It's basically now a generic. Savvy money-hungry pharmacists are refusing to fill renewals and prescriptions and simply directing the patients to Aisle 4 where the Clearasil is located. Uh, hello, are you the doctor? Do you know what this person has and how to treat it? Do you know if the person is intolerant of Clearasil? It's absolutely appalling. Patients have been abandoned by their medication, it is simply no longer available. "Too bad, you figure it out" is the attitude.Mothers are calling me in tears.
I have heard of this happening in other fields--certain chemotherapies where the manufacturers simply ceased operations, some FDA half-hearted investigations happened, with no conclusions. I cannot imagine the hell those patients and their oncologists have been put through.
Turns out Panoxyl is the new benzoyl peroxide OTC made by Stiefel but no "wholesaler" will get it for the patients because of order minimums and that's right, it's now OTC. Patients can order it from amazon.com or drugstore.com. if they so choose.
But for the most part, now it's back to the drawing board for many patients. The nice balance they achieved and the good control has been upset. They're red, irritated, and pimply. They need to be come in, be examined by me and we need to start at square one and get them on different therapy to manage their acne.
