Effects of isotretinoin treatment on sleep in patients with severe acne: a pilot study

Evaluation of isotretinoin effects on depression, sleep apnea and sleep quality

BACKGROUND

Isotretinoin is used to treat severe acne, treatment-resistant moderate acne, and acne that leads to scarring or psychological distress. It has many side effects and is also associated with depression, sleep apnea, and sleep disturbances.

OBJECTIVES

In this study, we aimed to evaluate the effects of isotretinoin on depression, sleep apnea, and sleep quality.

METHODS

A total of 42 patients diagnosed with acne and started isotretinoin treatment were included in the study. In order to compare the effects of isotretinoin, patients were asked to fill out a questionnaire containing the Beck Depression Inventory (BDI), the Berlin Questionnaire (BQ), and the Pittsburg Sleep Quality Index (PSQI) at baseline and third months of treatment.

RESULTS

There was no statistically significant difference in BDI, BQ, and PSQI scores between the 1st and 3rd months of treatment (p = .53, p = .5, p = .35).

CONCLUSION

This study showed that isotretinoin had no significant effects on depression and sleep quality.

Severe Insomnia Induced by Isotretinoin Use for the Management of Acne Vulgaris: A Rare Side Effect

Isotretinoin has been widely prescribed for the management of moderate to severe acne vulgaris worldwide. It has been associated with different sleep disorders, mainly sleep apnea and hypersomnia. To our knowledge, only one study has found an association between isotretinoin use and insomnia. In addition, psychiatric disorders, such as psychosis and depression, have been linked to the use of isotretinoin previously. Here, we present a case of a 21-year-old male patient with severe acne vulgaris that underwent a therapeutic course of isotretinoin. During the course of treatment, he developed severe insomnia and depression. By reducing the daily dose, his insomnia was treated, as well as his depression. This case led to the conclusion that isotretinoin is associated with severe insomnia, and the severity of insomnia is dose-dependent.

Psychiatric and Developmental Effects of Isotretinoin (Retinoid) Treatment for Acne Vulgaris

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Isotretinoin teratogenicity well established; psychiatric effects documented, controversial

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Disturbed retinoid signaling implicated in isotretinoin teratogenic and psychiatric effects

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Effect of genetics on susceptibility to psychiatric side effects is possible, not yet known

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Postnatal neurocognitive effects of isotretinoin not yet established

Background

An association between isotretinoin (13-cis-retinoic acid, sold under trade names including Accutane [Hoffmann-La Roche Inc, Basel, Switzerland]) and birth defects, depression, and suicide is well documented but controversial. A link to psychosis and exacerbation of bipolar symptoms is less extensively addressed in the literature.

Objective

Given recent conceptualization of psychotic disorders as neurodevelopmental, and current interest in possible shared etiology of different neurodevelopmental disorders such as psychosis, autism, and intellectual disability, this review concurrently examines the literature on developmental (primarily teratogenic) and psychiatric side effects of isotretinoin exposure. The goal of concurrent review is to identify shared mechanisms in the literature that may inform future efforts to clarify the neurocognitive and psychiatric effects of isotretinoin exposure at different developmental stages or given different genetic backgrounds.

Methods

Literature was obtained by PubMed search for the term isotretinoin in combination with each of the terms psychosis, psychiatric, and teratogenic. Resulting articles met inclusion criteria for review if they addressed psychiatric side effects of isotretinoin treatment or the neurobehavioral teratology of isotretinoin.

Results

The association of isotretinoin exposure with prenatal developmental toxicity is well established. Although numerous reports also link isotretinoin treatment with psychiatric side effects, this association remains controversial.

Conclusions

The extent to which isotretinoin influences pediatric and adult development and cognition, and whether and why certain individuals may be susceptible to psychiatric side effects, remains to be clarified. Curr Ther Res Clin Exp. 2019; 80:XXX–XXX)

Obstructive sleep apnea and dermatologic disorders

Obstructive sleep apnea (OSA) is present in at least 2% of women and 4% of men, and its prevalence is increasing, because a major predisposing factor for OSA is a high body mass index. Psoriasis has the most strongly substantiated link with OSA, where the relationship may be bidirectional. Dermatologic disorders may be comorbid with OSA due to several factors: (i) the heightened proinflammatory state in OSA, which can occur independent of body mass index, and may exacerbate inflammatory dermatoses; (ii) intermittent hypoxemia may promote neovascularization and tumor growth in certain cancers, such as melanoma; (iii) obesity, present in majority of OSA patients, can be associated with a heightened proinflammatory state; (iv) upper airway obstruction due to local tumors or soft tissue swelling due to physical urticaria or angioedema; (v) acute nasal congestion in the atopic patient with allergic rhinitis; (vi) dermatologic disorders associated with other OSA risk factors (eg, acanthosis nigricans and metabolic syndrome); and (vii) a high sympathetic tone (eg, in atopic dermatitis) and resultant sleep fragmentation contributing to upper airway instability during sleep. In many instances, the dermatology patient with OSA may have other medical and psychiatric comorbidities that are also associated with increased OSA risk.