Isotretinoin and neuropsychiatric side effects: Continued vigilance is needed

Bremner, J. Douglas

doi:10.1016/j.jadr.2021.100230

Cited by 19 publications

(24 citation statements)

References 356 publications

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“…Moreover, the high treatment satisfaction and willingness to restart the treatment (71%) provided a positive subjective perspective on the efficacy and viability of this therapy. The SEQ showed psychosocial improvement in subjects during and after treatment with no adverse neuropsychiatric events; this, in addition to the topical, non‐invasive nature of the 1726 nm laser technology, suggests a neuropsychiatric‐safe alternative to isotretinoin which has been linked to depression 19 …”

Section: Discussionmentioning

confidence: 76%

“…The SEQ showed psychosocial improvement in subjects during and after treatment with no adverse neuropsychiatric events; this, in addition to the topical, non-invasive nature of the 1726 nm laser technology, suggests a neuropsychiatric-safe alternative to isotretinoin which has been linked to depression. 19 The main limitation of this study is the small number of patients were involved in the final review and approval of the manuscript.…”

Section: Discussionmentioning

confidence: 98%

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Selective photothermolysis with a novel 1726 nm laser beam: A safe and effective solution for acne vulgaris

Goldberg

Kothare²,

Doucette³

et al. 2022

J of Cosmetic Dermatology

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Background Selective photothermolysis on sebaceous glands is an effective method for treating acne vulgaris (AV); however, safety, efficacy, and discomfort hinder its utilization in clinical settings. Aims The primary objective is to evaluate the safety and efficacy of a novel 1726 nm laser with contact cooling to treat AV. Methods Seventeen patients aged 18 to 36 were enrolled and treated in this IRB‐approved, single‐center, open‐label study. Patients received up to three facial laser sessions up to seven weeks apart. Follow‐up visits happened ten days post‐session and at the 4 and 12 weeks following the final session. The investigator assessed the severity of device‐related adverse events (AEs). Investigator Global Assessment (IGA) and inflammatory lesion counts (ILC) were used as metrics to evaluate acne resolution and skin condition enhancement. Patients' perspectives on satisfaction and comfort using this technology were assessed using Subject Experience Questionnaires (SEQ). Results Safety assessment showed mild and transient AEs. All subjects tolerated anesthetics‐free treatments well, with a mean treatment discomfort score of 4.9 ± 1.5. Compared to baseline, a statistically significant reduction in ILC (p = 0.003) of 52% to 56% is achieved four to twelve weeks following treatment. Long‐term follow‐ups showed progressive improvement 24 months post‐treatment with a 97% reduction in ILC. SEQs revealed high subject satisfaction (71%) with psychosocial improvement three months post‐treatment. Conclusion The novel 1726 nm laser appears safe and effective for treating mild‐to‐severe acne. Acne resolution is apparent within the first month and progresses beyond the study duration.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 98%

Selective photothermolysis with a novel 1726 nm laser beam: A safe and effective solution for acne vulgaris

Goldberg

Kothare²,

Doucette³

et al. 2022

J of Cosmetic Dermatology

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“…In particular, there have been concerns and controversy regarding whether isotretinoin is associated with psychiatric morbidity, including suicidality. 3 In this issue of JAMA Dermatology, Tan et al 4 report further evidence relevant to this contentious area of study.In a systematic review of observational studies (mainly cohort studies) of patients treated for acne, Tan et al investigated the incidence and relative risk of suicide and psychiatric disorders (for 1-, 5-, and 10-year periods post treatment). Meta-analyses were performed for the 1-year incidence of the outcomes and for relative risk at a range of times post treatment for a suite of psychiatric outcomes, including completed suicide, suicide attempt, suicide ideation, self-harm, all psychiatric disorders, anxiety, psychotic disorders, sleep disorders, depression, mood disorders, and bipolar disorder.…”

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confidence: 99%

Isotretinoin and Adverse Psychiatric Effects

Magin,

Prentice

2024

JAMA Dermatol

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“…Continuing rare reports of completed suicide during and after treatment and are extremely distressing. Isotretinoin crosses the blood–brain barrier, and neurobiologists have identified plausible mechanisms to account for brain effects, particularly in young people 8 . Physical side‐effects from isotretinoin may contribute to low mood, and it is also possible there are higher rates of awareness of psychiatric adverse events in patients on isotretinoin (ascertainment bias) due to regulatory requirements such as the ‘I‐Pledge’ programme in the USA, which mandates monthly physician visits, giving more frequent opportunity to record mental health issues.…”

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confidence: 99%

Isotretinoin does not contribute to increased neuropsychiatric risk in the overall acne population, but risk management during treatment remains essential

Ravenscroft

Eichenfield

2022

Br J Dermatol

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life, especially in patients with chronic HE (CHE). According to recently published guidelines for diagnosis, prevention and treatment of HE, topical corticosteroids are recommended as a short-term treatment for HE, as potent corticosteroids may cause skin atrophy and interfere with recovery in the long term. [2][3][4] The topical calcineurin inhibitor, tacrolimus, is also suggested for short-term treatment in patients with HE. In daily practice, it is used in patients refractory to topical corticosteroids, when fear of side-effects exists or in patients with CHE. 2 For severe CHE, alitretinoin is the only registered systemic drug in some countries. Consequently, there is a significant unmet need for effective and safe topical treatments for long-term control of CHE.In this issue of the BJD, Worm and colleagues report the promising results of a 16-week double-blind, randomized phase IIb trial in which they explore the dose response, efficacy and safety of the topical pan-Janus kinase (JAK) inhibitor delgocitinib for CHE. 5 Adults with mild-to-severe CHE were treated with delgocitinib cream 1, 3, 8 or 20 mg g À1 , or cream vehicle twice daily for 16 weeks. Delgocitinib 8 mg g À1 and 20 mg g À1 showed a statistically significant treatment effect against vehicle; treatment success was achieved in 37% and 38% of patients, respectively. The treatment effect had not reached a plateau at week 16, suggesting that more prolonged treatment could show additional benefits. Delgocitinib was well tolerated without raising any safety concerns.It is strongly recommended to patch test all patients with CHE, which was also performed prior to the study from Worm et al. 2,5 However, patch testing results were not restrictive for inclusion. Consequently, patients entering the study could have had exposure to contact allergens that were highly relevant for the severity of their HE. As the proportion of patients with a main diagnosis of allergic contact dermatitis was rather small, this possibly had limited influence on the study results.JAK inhibitors target several cytokine pathways instead of one single pathway. Therefore, delgocitinib may benefit different aetiological and clinical subtypes of CHE. The current study included several subtypes of HE, but no data were presented on the effectiveness of delgocitinib on the different subtypes. This is an important issue that needs further assessment.In this study, patients with mild-to-severe HE were included. In general, mild eczema can be treated quite well with existing topical treatments. There is a large unmet need for effective treatment in patients with moderate-to-severe CHE. The effectiveness of delgocitinib in this subgroup should be evaluated separately in future studies.As clinicians, we need an effective and safe treatment option for prolonged treatment of patients with CHE in daily practice. Therefore, new data on the long-term effectiveness and safety should be awaited to draw firm conclusions on the value of this new drug for CHE treatment. As recommended in the Cochran...

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Isotretinoin and neuropsychiatric side effects: Continued vigilance is needed

Cited by 19 publications

References 356 publications

Selective photothermolysis with a novel 1726 nm laser beam: A safe and effective solution for acne vulgaris

Selective photothermolysis with a novel 1726 nm laser beam: A safe and effective solution for acne vulgaris

Isotretinoin and Adverse Psychiatric Effects

Isotretinoin does not contribute to increased neuropsychiatric risk in the overall acne population, but risk management during treatment remains essential

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