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Researcher questions isotretinoin use for acne with link to IBD, psychiatric conditions

DENVER — Isotretinoin treatment for severe acne might not be the cause of inflammatory bowel disease or psychiatric conditions, according to information presented at the American Academy of Dermatology annual meeting.

“Isotretinoin remains the gold standard for treating severe acne, but there are many aspects that must be taken into consideration before it is prescribed,” William D. James, MD, FAAD, professor of dermatology at the University of Pennsylvania School of Medicine, said in a press release. “It is important that dermatologists and patients who are good candidates for isotretinoin … work together to ensure the safest and most effective treatment outcome.”

James presented research that disputes the link between isotretinoin therapy and inflammatory bowel disease (IBD). He reported that by the mid-2000s, studies published in gastrointestinal journals linked isotretinoin to IBD, resulting in subsequent lawsuits.

James cited studies from 2013 that denied an association between isotretinoin and IBD and instead implicated a possible link between acne severity and IBD. Inflammatory diseases such as SAPHO syndrome, which includes several bone disorders that could be linked with skin changes, and PAPA syndrome, a rare genetic disorder affecting the skin and joints, were associated with IBD in those studies.

Since the mean age that IBD begins is 19 years — about the same age when a patient might develop severe acne — James said severe acne might predispose a person to IBD, regardless of isotretinoin treatment.

James also provided evidence suggesting that other medical factors might trigger the drug’s association with psychiatric conditions. While side effects, including depression, have been reported in studies of patients taking isotretinoin, James said patients with acne and attention-deficit/hyperactivity disorder might already have a greater risk for depression. He cited a recent study that examined mood changes in a small group of patients taking isotretinoin and found a marked improvement in psychiatric symptoms in relationship to improved acne.

James also presented new research suggesting that higher doses of isotretinoin could provide extended results. He cautioned, however, that larger doses could increase severely dry skin, nosebleeds, lip inflammation, triglyceride levels and psychiatric or mood disorders.

“It is encouraging that new studies continue to be conducted on the use of isotretinoin, and I expect more studies will further expand our knowledge of this powerful and effective medication,” he said.

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James WD. Presented at the 2014 American Academy of Dermatology annual meeting; March 21-25; Denver.

 Disclosures: William D. James, MD, FAAD, reports financial ties with Elsevier and WebMD.