Isotretinoin linked to lower risk for psychiatric comorbidities in severe acne treatment
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Isotretinoin produces a lower risk of six psychiatric comorbidities, as well as comparable risk of suicidal attempts, compared with other oral antibiotics in the treatment of severe acne, according to study findings.
“[Isotretinoin] boasts outstanding clinical efficiency and long-term results in even the most recalcitrant cases,” Khalaf Kridin, MD, PhD, and Ralf J. Ludwig, MD, both of the Lübeck Institute of Experimental Dermatology at University of Lübeck in Germany, wrote.
“A large body of long-standing controversy surrounds the question of whether isotretinoin predisposes patients with acne to develop psychiatric disturbances, chiefly depression and suicidal behavior,” Kridin and Ludwig continued.
In the global population-based retrospective cohort study, the researchers evaluated the risk of nine psychiatric comorbidities among patients with acne treated with isotretinoin (n = 75,708) compared with their counterparts treated with oral antibiotics (n = 75,708).
The isotretinoin group vs. oral antibiotics group experienced lower incidences of depression (HR = 0.9; 95% CI, 0.87-0.93). However, risk of major depressive disorder (HR = 0.97; 95% CI, 0.92-1.03) and risk of suicidal attempts (HR = 0.97; 95% CI, 0.85-1.11) were comparable between groups.
Despite the negligible difference between the risk of suicidal attempts between groups, patients on isotretinoin showed an elevated risk of suicidal ideation (HR = 1.41; 95% CI, 1.32-1.5).
Patients in the isotretinoin groups displayed a lower risk of five additional psychiatric outcomes, including PTSD (HR = 0.75; 95% CI, 0.68-0.82), anxiety (HR = 0.84; 95% CI, 0.82-0.87), bipolar disorder (HR = 0.65; 95% CI, 0.59-0.72), schizophrenia (HR = 0.6; 95% CI, 0.48-0.76) and adjustment disorder (HR = 0.82; 95% CI, 0.77-0.87).
“The current global study demonstrates reassuring findings regarding a decreased risk of depression, and comparable risk of [major depressive disorder] and suicidal attempts in acne patients prescribed isotretinoin as compared to those prescribed oral antibiotics,” Kridin and Ludwig wrote. “While the findings are largely reassuring, the increased risk of suicidal ideation (despite comparable risk of suicidal attempts) should maintain the prudent prescribers’ attitude toward isotretinoin.”