Abstract
Isotretinoin (13-cis-retinoic acid) is an effective treatment for severe cystic or recalcitrant acne vulgaris. However, concerns have been raised regarding its potential association with depression and suicidal behavior. We have explored the proposed relationship between isotretinoin use and the risk of depression and suicide in patients with acne vulgaris. Rates of depression among users ranged from 1 to 11% across studies, with similar rates compared with oral antibiotic. Clinical studies comparing depression before and after treatment never demonstrate any statistically significant increase in depression, except for one recent study. However, isolated clinical case reports indicate a possible clinical relationship between depressive symptoms and isotretinoin. In these conditions, it appears today that the link between suicides and severe depressions has not yet been clearly demonstrated. One of the hypotheses could be that these psychiatric side effects are unpredictable idiosyncratic phenomena, whose rarity would require many more patients in prospective studies to be identified.
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Acknowledgements
We thank Marion Pinet, Anne Castot, Sophie Choulika, Carmen Kreft-Jais for complementary informations.
Disclosure
B Dreno is a member of the International Acne Board of Galderma, speaker for Acne Symposium organized by Pierre Fabre Dermatology and investigator for an isotretinoin trial in Rosacea supported by Bailleul-Biorga; Olivier Chosidow is a consultant for Pierre Fabre Dermatology, the principal investigator of an isotretinoin trial in Rosacea supported by Bailleul Biorga and received travel grants from Expanscience. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.