Isotretinoin and mental health in adolescents: Australian consensus

Abstract

Acne is a common condition among adolescents and has the potential to negatively impact on the psychological well-being of those who suffer from it. In particular, depression and suicidal ideation are more common in adolescents with acne. Successful treatment of acne can improve the quality of life and reduce levels of anxiety and depression in these individuals. The current treatment of choice for severe or refractive acne is isotretinoin, a retinoid. While the possible causal association between isotretinoin and mental illness remains a controversial topic, a recent systematic review has presented evidence to support this relationship. In light of this evidence, a group of dermatologists and psychiatrists have collaborated to develop these recommendations to aid the safe prescribing of isotretinoin in adolescents. These clinical suggestions are aimed at practitioners in both disciplines to increase awareness of the current evidence in support of the association between isotretinoin and adolescent depression.

Actualización en psicodermatología

“…Sin embargo, existe la controversia respecto de si cumple un rol causal en la sintomatología psiquiátrica o si más bien se deba a la severidad de los cuadros que han de requerir dicho fármaco (31) . En este contexto, un consenso realizado de manera conjunta por dermatólogos y psiquiatras en Australia, plantea la importancia de llevar a cabo una acabada evaluación clínica previa al inicio de la isotretinoína, con enfoque en la salud mental, además de un control permanente de los síntomas psiquiátricos durante el período de tratamiento (32) .…”

Acne Pathogenesis: History of Concepts

“…After 30 weeks of treatment of 346 patients, they could observe a significant reduction of the negative impact on quality of life as did the depression scale scores for anxiety and depression [390]. Following the study of Bremner et al [388], Rowe et al [391] published recommendations prior to the initiation of isotretinoin, throughout treatment and for a period following the cessation of treatment: establishing the degree of the impact the patients' acne has on their quality of life; identifying mental health for each patient concurrently with the prescription of isotretinoin; reducing the initial dose of isotretinoin in order to alleviate the patient's concerns about using the medication; performing routine baseline investigations prior to the prescription of isotretinoin; monitoring the mental state of patients from 4 weeks after the beginning of isotretinoin; referring to a mental health practitioner if mental symptoms are identified [391]. Finally, the Psychodermatology Group of the French Dermatology Society considered that prescription of isotretinoin is not contraindicated in subjects presenting depression [392].…”

Suicidal risk with isotretinoin treatment – a never‐ending story

“…The current treatment of choice for severe or refractive acne is isotretinoin, a retinoid, and they suggest the safe prescribing of isotretinoin in adolescents. 16 Interestingly, some other psychiatric aspects occur together with isotretinoin treatment. Patients with bipolar disorder had possibly an increased risk for a clinical exacerbation of symptoms undergoing treatment with isotretinoin.…”

“…The Australian dermatologist recognized the risk of suicidal attempts more seriously than other countries and published their guidelines, while the possible causal association between isotretinoin and mental illness remains a controversial topic, a systematic review has presented evidence to support this relationship. But on the other hand, Rowe et al 16 stated that successful treatment of acne can improve the quality of life and reduce levels of anxiety and depression in these individuals. The current treatment of choice for severe or refractive acne is isotretinoin, a retinoid, and they suggest the safe prescribing of isotretinoin in adolescents 16 …”

“…But on the other hand, Rowe et al 16 stated that successful treatment of acne can improve the quality of life and reduce levels of anxiety and depression in these individuals. The current treatment of choice for severe or refractive acne is isotretinoin, a retinoid, and they suggest the safe prescribing of isotretinoin in adolescents 16 …”