Is Isotretinoin in Acne Patients a Psychological Boon or a Bane: A Systematic Review

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Abstract

Acne vulgaris is a frequently encountered dermatological condition in clinical practice. Isotretinoin is one of the drugs prescribed for this condition. However, it is unclear whether the use of this drug worsens or improves the psychological effects in an acne patient and whether it is advisable to use this drug commonly. This systematic review aims to assess the relationship between Isotretinoin and psychiatric side effects in acne patients.

A literature search was conducted using PubMed, Cochrane, and Google Scholar databases in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Articles published within the last 10 years were taken into account and a review was conducted on the relevant articles after critical appraisal.

Nine studies were finalized for discussion and out of the nine studies, two studies concluded that Isotretinoin could cause psychiatric effects. Five studies showed no association between them. Two studies unexpectedly found that psychiatric symptoms improved because of Isotretinoin use. Lack of adequate sample size and absence of randomized controlled trials are the limitations of this study.

To conclude, Isotretinoin can be prescribed as a treatment option for severe acne despite some evidence of link with psychiatric effects. However, bearing the side effects in mind, a detailed evaluation before initiating the drug and a thorough monitoring while using the drug should be done as a standard practice in order to be on the safer side.

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Most cited references 21

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Acne Vulgaris: Diagnosis and Treatment.

Linda K Oge', Alan Broussard, Marilyn Marshall (2019)

Acne vulgaris is the most prevalent chronic skin disease in the United States, affecting nearly 50 million people per year, mostly adolescents and young adults. Potential sequelae of acne, such as scarring, dyspigmentation, and low self-esteem, may result in significant morbidity. Typical acne lesions involve the pilosebaceous follicles and the interrelated processes of sebum production, Cutibacterium acnes (previously called Propionibacterium acnes) colonization, and inflammation. Acne may be classified as mild, moderate, or severe based on the number and type of skin lesions. Multiple treatment agents and formulations are available, with each agent targeting a specific area within acne pathogenesis. Treatment selection is based on disease severity, patient preference, and tolerability. Topical retinoids are indicated for acne of any severity and for maintenance therapy. Systemic and topical antibiotics should be used only in combination with benzoyl peroxide and retinoids and for a maximum of 12 weeks. Isotretinoin is used for severe, recalcitrant acne. Because of the risk of teratogenicity, patients, pharmacists, and prescribers must register with the U.S. Food and Drug Administration-mandated risk management program, iPledge, before implementing isotretinoin therapy. There is limited evidence for physical modalities (e.g., laser therapy, light therapy, chemical peels) and complementary therapies (e.g., purified bee venom, low-glycemic-load diet, tea tree oil); therefore, further study is required.

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Association of suicide attempts with acne and treatment with isotretinoin: retrospective Swedish cohort study

Anders Sundström, Lars Alfredsson, Gunilla Sjölin-Forsberg … (2010)

Objective To assess the risk of attempted suicide before, during, and after treatment with isotretinoin for severe acne. Design Retrospective cohort study linking a named patient register of isotretinoin users (1980-9) to hospital discharge and cause of death registers (1980-2001). Setting Sweden, 1980-2001. Population 5756 patients aged 15 to 49 years prescribed isotretinoin for severe acne observed for 17 197 person years before, 2905 person years during, and 87 120 person years after treatment. Main outcome measures Standardised incidence ratio (observed number divided by expected number of suicide attempts standardised by sex, age, and calendar year), calculated up to three years before, during, and up to 15 years after end of treatment. Results 128 patients were admitted to hospital for attempted suicide. During the year before treatment, the standardised incidence ratio for attempted suicide was raised: 1.57 (95% confidence interval 0.86 to 2.63) for all (including repeat) attempts and 1.36 (0.65 to 2.50) counting only first attempts. The standardised incidence ratio during and up to six months after treatment was 1.78 (1.04 to 2.85) for all attempts and 1.93 (1.08 to 3.18) for first attempts. Three years after treatment stopped, the observed number of attempts was close to the expected number and remained so during the 15 years of follow-up: standardised incidence ratio 1.04 (0.74 to 1.43) for all attempts and 0.97 (0.64 to 1.40) for first attempts. Twelve (38%) of 32 patients who made their first suicide attempt before treatment made a new attempt or committed suicide thereafter. In contrast, 10 (71%) of the 14 who made their first suicide attempt within six months after treatment stopped made a new attempt or committed suicide during follow-up (two sample test of proportions, P=0.034). The number needed to harm was 2300 new six month treatments per year for one additional first suicide attempt to occur and 5000 per year for one additional repeat attempt. Conclusions An increased risk of attempted suicide was apparent up to six months after the end of treatment with isotretinoin, which motivates a close monitoring of patients for suicidal behaviour for up to a year after treatment has ended. However, the risk of attempted suicide was already rising before treatment, so an additional risk due to the isotretinoin treatment cannot be established. As patients with a history of suicide attempts before treatment made new attempts to a lesser extent than did patients who started such behaviour in connection with treatment, patients with severe acne should not automatically have isotretinoin treatment withheld because of a history of attempted suicide.

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Adverse effects of isotretinoin: A large, retrospective review

Janusz Śmigielski, Anca Edward Chiriac, Piotr Brzezinski … (2017)

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Author and article information

Journal

Journal ID (nlm-ta): Cureus

Journal ID (iso-abbrev): Cureus

Journal ID (issn): 2168-8184

Title: Cureus

Publisher: Cureus (Palo Alto (CA) )

ISSN (Electronic): 2168-8184

Publication date (Electronic, pub): 2 August 2021

Publication date (Electronic, collection): August 2021

Volume: 13

Issue: 8

Electronic Location Identifier: e16834

Affiliations

[1 ] Medicine, Indira Gandhi Medical College and Research Institute, Pondicherry, IND

[2 ] Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA

[3 ] Medicine, S.S Institute of Medical Sciences and Research Centre, Davangere, IND

[4 ] Emergency Medicine, Healthway Hospitals, Goa, IND

[5 ] Internal Medicine, Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, IND

[6 ] Medicine, Mahatma Gandhi Mission (MGM) Medical College, Navi Mumbai, IND

[7 ] Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA

[8 ] Internal Medicine, Government Medical College, Surat, IND

[9 ] Pediatrics, Wyckoff Heights Medical Center, Brooklyn, USA

[10 ] Health Care Administration, University of Cincinnati Health, Cincinnati, USA

[11 ] Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA

[12 ] Medicine, Atlantic University School of Medicine, Gros Islet, LCA

Author notes

Savitri Chandrasekaran savitrichandrasekaran@ 123456gmail.com

Article

DOI: 10.7759/cureus.16834

PMC ID: 8407467

SO-VID: fa51dc3c-d2fb-4f1d-9128-78654add09c4

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 1 June 2021

Date accepted : 2 August 2021

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