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

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.

When I use a word . . . . Too much healthcare—observational studies

“…12 For example, the evidence that isotretinoin is associated with an increased of suicide, as reported anecdotally, is poor. 13 Observational studies have in general been negative; when they have been positive, confounding by indication has been likely, since acne itself is associated with an increased risk. Despite this, the association has been widely accepted, although there have been contradictory statements.…”

Isotretinoin‐induced psychosis in a child on treatment for high‐risk neuroblastoma

“…1,4,5 The exact association remains controversial, though isotretinoin is known to cross the blood-brain barrier and bind to retinoic acid receptors in the brain. 2,[6][7][8] In addition to treatment for acne, isotretinoin is a vital component of high-risk neuroblastoma treatment. Previous studies have shown it reduces the risk for relapse and improves overall survival.…”

Side Effects of Treating Acne Vulgaris With Isotretinoin: A Systematic Review

“…Isotretinoin, a retinoid authorized by the FDA in 1982, is one of the most efficient treatments for acne [ 5 ]. Reduced keratinization, reduction of the inflammatory response, and limited inhibition of sebaceous gland activity are the impacts of isotretinoin on acne vulgaris [ 6 ].…”