Is there an association between isotretinoin therapy and adverse mood changes? A prospective study in a cohort of acne patients

Effect of isotretinoin treatment on sleep quality in acne vulgaris patients

Isotretinoin is a systemic treatment agent used in patients with severe acne vulgaris. It has been reported to have side effects associated with depression, sleep apnea, and hypersomnia. There are some studies in the literature suggesting that isotretinoin may cause sleep disturbances. The aim of this study was to investigate whether sleep quality is affected in acne vulgaris patients receiving isotretinoin treatment. Fifty patients with acne vulgaris who were receiving isotretinoin treatment and who were referred to the dermatology polyclinic were included in the study. Two Pittsburgh Sleep Quality Index (PSQI) questionnaires, consisting of 7 components and 19 items, were administered to the patients, one during the treatment period and one before the treatment period. Scores ranged from 0 to 21, with scores of 5 and above indicating poor sleep quality. Before isotretinoin treatment, the average PSQI score of male patients was 11.5 ± 4.95, while after treatment it was 18.0 ± 6.69. In female patients, the average PSQI score before treatment was 9.50 ± 4.81, During treatment, it was observed as 14.0 ± 6.28. An increase in scores was observed in both sexes after isotretinoin. The change before and after treatment was considered significant (P < 0.001). In our study, we observed a negative effect of isotretinoin on sleep quality. Some experimental studies have shown that retinoic acids can affect the pathways in the brain that regulate sleep, but further research is needed in this area.

Guidelines of care for the management of acne vulgaris

BACKGROUND

Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older.

OBJECTIVE

The objective of this study was to provide evidence-based recommendations for the management of acne.

METHODS

A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations.

RESULTS

This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements.

LIMITATIONS

Analysis is based on the best available evidence at the time of the systematic review.

CONCLUSIONS

These guidelines provide evidence-based recommendations for the management of acne vulgaris.

Acne treatment challenges - Recommendations of Latin American expert consensus

BACKGROUND

Acne is a chronic inflammatory disorder of the pilosebaceous unit that is associated with a negative impact on quality of life, causing anxiety, depression, and poor self-esteem. The treatment of acne is not simple and presents some new challenges. This article addresses important issues faced by dermatologists on their daily, some of them specific for Latin America.

OBJECTIVE

To discuss daily practice recommendations when managing acne patients.

METHODS

A literature review was conducted by a group of eight experts with extensive experience in the field of acne. The results of the data review were presented at an initial kick-off meeting to align the consensus topics. Two e-surveys using the Delphi methodology and an interim group webinar meeting were held.

RESULTS

The expert panel reached a consensus on all proposed key statements, providing scientific support to help dermatologists and healthcare providers make acne management decisions on topics that can be challenging in the everyday practice of dermatology, such as the characteristics of Generation Z or the importance of the maintenance phase of adult acne treatment.

CONCLUSION

This article provides current recommendations for managing acne patients. The high level of agreement achieved based on the latest evidence supports the best acne therapeutic choices in both established topics and new important issues that have emerged in recent years, such as the impact of social media, Generation Z characteristics, and transgender male patient specifics.

The Psychological Impact of Isotretinoin Therapy on Acne Vulgaris Patients

Introduction Acne vulgaris is a dermatologic condition that affects the pilosebaceous unit. It is the most common skin disorder worldwide, and it is most prevalent during puberty. For patients with moderate to severe acne that is unresponsive to antibiotic treatment, the main treatment is oral isotretinoin. The objective of this study was to define the impact of isotretinoin and its well-established adverse effects on the psychological status of acne patients during treatment.  Methods The sample cohort included 80 patients with acne vulgaris who were treated with isotretinoin. The sample size was calculated using the Raosoft [Raosoft.com (2015) Sample Size Calculator by Raosoft, Inc.] sample size calculator to maintain a confidence interval of 95% and a margin of error of 5%. The participants were assessed using the Depression and Anxiety Stress Scale-21 (DASS-21). The DASS-21 is a self-reporting scale used to measure the emotional states of depression, anxiety, and stress. This study was a cross-sectional survey conducted at the dermatology outpatient clinic at King Abdulaziz Medical City, Jeddah, Saudi Arabia. All patients diagnosed with acne vulgaris between January and April 2020 were included in the study. A multivariate regression analysis was also conducted to determine the presence of any significant independent factors associated with depression, anxiety, and stress. A P-value of ≤0.05 was considered statistically significant. Results We observed that the most prevalent psychiatric disorder among acne patients on isotretinoin therapy was anxiety. Our results also indicate that a history of mental illness is an independent risk factor for developing depression when isotretinoin is used. In addition, known adverse physical effects of isotretinoin treatment, including muscle pain, arthralgia, and headaches significantly increase the likelihood of patients developing psychiatric morbidity during therapy.  Conclusion Isotretinoin is a highly potent therapy for acne. Overall, the physical side effects profile is well acknowledged, yet the exact psychological impact the treatment predisposes the patients to is yet to be determined.

Comparing the frequency of isotretinoin-induced hair loss at <0.5-mg/kg/d versus ≥0.5-mg/kg/d dosing in acne patients: A systematic review

Over 1 million isotretinoin prescriptions are authorized in the United States per year. An insight into the frequency, dose dependency, timing, and reversibility of hair loss associated with isotretinoin treatment for acne vulgaris could help guide dosing regimens and patient counseling. The objective of this systematic review was to assess the frequency of hair loss in patients with acne vulgaris on <0.5 mg/kg/d daily doses of isotretinoin versus the frequency of hair loss in patients with acne vulgaris on ≥0.5 mg/kg/d daily doses of isotretinoin.

An Embase and MEDLINE search was conducted on July 15, 2020, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review focused on acne vulgaris patients. The treatment of acne vulgaris is the most common use of isotretinoin, and the population is typically younger and with fewer comorbidities.

Twenty-two studies reported hair loss with oral isotretinoin treatment. A frequency analysis suggested that patients with acne vulgaris on <0.5 mg/kg/d of isotretinoin experienced hair loss at a frequency of 3.2% (n = 18/565) compared with those on ≥0.5 mg/kg/d, who experienced hair loss at a frequency of 5.7% (n = 192/3375). Inferential statistics were not possible.

Physicians should consider counseling patients about the risk of telogen effluvium prior to drug initiation, as is commonly done for other side effects. The potential trend of increased hair loss frequency at a higher daily dosing warrants further investigation using higher-quality research.

Efficacy and tolerability of system isotretinoin and effect of this therapy on the quality of life of patients with severe and moderate acne

Background. The relationship between acne and depression is being actively studied by the medical community. Question is depression a restriction in prescribing or a side effect when using systemic isotretinoin remains controversial. Noteworthy is the presence in the scientific literature of data on the possible positive effect of adequately and timely prescribed acne therapy on the psychoemotional state of patients with this ailment. Aims. The aim of our study was to evaluate the effectiveness of therapy with systemic isotretinoin in patients with moderate and severe acne, to assess the effect of the therapy on the quality of life of patients, as well as the persistence of remission after the end of the course of therapy with systemic retinoid. Methods. We observed 32 patients with moderate and severe acne, the average age of patients was 24 years, the duration of the disease was on average 8 years. All patients underwent therapy with systemic isotretinoin (Sotret) at an average daily dose of 0.51.0 mg/kg until a cumulative dose of 120150 mg/kg was reached. The effectiveness and tolerability of the therapy was assessed, as well as the quality of life of patients was assessed using the dermatological index of the quality of life (DQL), the dermatological akne index (DIA), the HADS scale (anxiety and depression scale). The indicators were assessed before the start of therapy, during therapy, at the end of the course of treatment with systemic isotretinoin, and also 12 months after the end of therapy. Results. 100% of patients achieved clinical remission as a result of treatment with systemic isotretinoin. Before starting therapy with systemic isotretinoin, the indices were as follows: DQL 18 (1520), HADS 10 (716) and DIA 13 (615) scores. By the end of the therapy, the indices decreased to 1 (01), 2 (04) and 1 (01) points, respectively (p 0.001). 12 months (year) after the end of therapy with systemic isotretinoin, the indices remained at zero or one level in all patients: DQL 1 (01), HADS 0 (01) and CIA 1 (01) points (p 0.001). Conclusion. A causal relationship between the intake of systemic isotretinoin and the development of depression has not been established. Systemic isotretinoin therapy was effective in all patients (100%), was well tolerated and had a positive effect on the psychoemotional status of patients with acne. 12 months after the end of therapy with the drug Erase, stable remission of the disease was noted in all patients

Isotretinoin and neuropsychiatric side effects: Continued vigilance is needed

Background

Isotretinoin (13-cis-retinoic acid, marketed under the names Accutane, Roaccutane, and others) is an effective treatment for acne that has been on the market for over 30 years, although reports of neuropsychiatric side effects continue to be reported. Isotretinoin is an isomer of the active form of Vitamin A, 13-trans-retinoic acid, which has known psychiatric side effects when given in excessive doses, and is part of the family of compounds called retinoids, which have multiple functions in the central nervous system.

Methods

The literature was reviewed in pubmed and psychinfo for research related to isotretinoin and neuropsychiatric side effects including depression, suicidal thoughts, suicide, mania, anxiety, impulsivity, emotional lability, violence, aggression, and psychosis.

Results

Multiple case series have shown that successful treatment of acne with isotretinoin results in improvements in measures of quality of life and self esteem However, studies show individual cases of clinically significant depression and other neuropsychiatric events that, although not common, are persistent in the literature. Since the original cases of depression were reported to the United States Food and Drug Administration, numerous cases have been reported to regulatory agencies in the United Kingdom, France, Ireland, Denmark, Australia, Canada, and other countries, making isotretinoin one of the top five medications in the world associated with depression and other neuropsychiatric side effects. Clinicians are advised to warn patients of the risks of neuropsychiatric side effects with isotretinoin which may arise from the medication itself, and not just as a side effect of acne or youth.

Isotretinoin for acne vulgaris - an update on adverse effects and laboratory monitoring

A significant barrier to the usage of isotretinoin has been concerns regarding its adverse effect profile. The dose-dependent mucocutaneous side effects of isotretinoin are well recognised and easily managed, particularly if a lower dose is used. A possible association with depression has gained widespread media attention and is a source of concern for many patients and their carers, but data from prospective studies and recent meta-analyses has been reassuring. Furthermore, there has been much confusion amongst both patients and physicians regarding a possible association with inflammatory bowel disease, as well the ocular and rheumatological adverse effects of isotretinoin. We provide an update on the evidence surrounding the adverse effects of isotretinoin, and discuss practical strategies to prevent and manage these adverse effects. We also discuss appropriate laboratory monitoring for patients taking isotretinoin.

Acne in the first three decades of life: An update of a disorder with profound implications for all decades of life

Acne vulgaris is a chronic, inflammatory, skin condition that involves the pilosebaceous follicles and is influenced by a variety of factors including genetics, androgen-stimulation of sebaceous glands with abnormal keratinization, colonization with Cutibacterium acnes (previously called Propionibacterium acnes), and pathological immune response to inflammation. Acne can occur at all ages and this discussion focuses on the first three decades of life. Conditions that are part of the differential diagnosis and/or are co-morbid with acne vulgaris are also considered. Acne in the first year of life includes neonatal acne (acne neonatorum) that presents in the first four weeks of life and infantile acne that usually presents between 3 and 6 months of the first year of life with a range of 3 to 16 months after birth. Acne rosacea is a chronic, inflammatory, skin condition that is distinct from acne vulgaris, typically presents in adults, and has four main types: erythemato-telangiectatic, papulopustular, phymatous and ocular. Treatment options for acne vulgaris include topical retinoids, topical benzoyl peroxide, antibiotics (topical, oral), oral contraceptive pills, isotretinoin, and others. Management must consider the increasing impact of antibiotic resistance in the 21st century. Psychological impact of acne can be quite severe and treatment of acne includes awareness of the potential emotional toll this disease may bring to the person with acne as well as assiduous attention to known side effects of various anti-acne medications (topical and systemic). Efforts should be directed at preventing acne-caused scars and depigmentation on the skin as well as emotional scars within the person suffering from acne.

Prevalence and predictors of depression among dermatology clinic patients in a teaching hospital, Jeddah, Saudi Arabia

Context:

Depression in patients with a skin condition can lead to severe consequences that affect the quality of life. To our knowledge, the estimated prevalence of depression in patients who visited dermatological clinics in Jeddah remains unknown.

Aims:

To assess the prevalence of depression among patients with dermatological conditions and evaluate the association between clinical and demographic characteristics and depressive symptoms.

Settings and Design:

A cross-sectional study was conducted among dermatological patients at King Abdulaziz University Hospital in Jeddah, Saudi Arabia.

Materials and Methods:

The Patient Health Questionnaire-9 (PHQ-9) was used for screening depression.

Statistical Analysis Used:

Chi-square test and odds ratios (ORs) were used to determine the association among variables.

Results:

The study included 273 participants. More than two-thirds (194) of the participants were women (71.1%). Depressive symptoms were prevalent in 43 (15.8%) participants. Depression was the most prevalent among patients with psoriasis (39.5%, P < 0.001), followed by those with acne (30.2% P = 0.04).

Conclusion:

Psychosocial assessment should be addressed when evaluating and treating dermatological diseases. Screening tools, including PHQ-9, can facilitate the early detection of depressive symptoms and improve clinical outcomes. Addressing psychosocial aspects of skin conditions may help in reducing exacerbation of symptoms, mainly for conditions aggravated by stress, including dermatitis and psoriasis.