However, the evidence base for severe neuropsychiatric outcomes is mixed and inconclusive. 8 In addition, severe neuropsychiatric outcomes, such as anxiety, depression, suicidal ideation, self-harm and completed suicide, have been reported. Some patients also experience an initial worsening of acne symptoms (flare-up) after the start of treatment.
#Retrospective cohort skin#
6, 7 The various mucocutaneous and central nervous system side-effects of isotretinoin are mostly dose related and some, such as dry skin and skin irritation, are common with lower therapeutic doses. 5 Many patients treated with isotretinoin experience adverse side-effects such as dry skin or mouth, headache or musculoskeletal pain. Isotretinoin can also be used off-label, including to treat and prevent certain types of skin cancer.
4 Oral isotretinoin is a vitamin A derivative, and it is indicated for the treatment of recalcitrant inflammatory acne. 1- 3 Acne is known to affect both physical and psychosocial health and wellbeing. When monitoring potential adverse outcomes during isotretinoin treatment, clinicians should also consider the high mental health burden associated with treatment-resistant acne and the potential contribution of physical side-effects of prescribed medication on mental health.Īcne vulgaris (acne) is a highly prevalent long-term inflammatory skin condition with symptom onset typically in adolescence, with the highest prevalence between the ages of 14 and 19 years.
Isotretinoin was not independently associated with excess adverse neuropsychiatric outcomes at the population level. Patients exposed to isotretinoin experienced significantly more incident physical symptoms than patients in any of the three comparison cohorts. After propensity score matching for baseline confounders, the odds ratio (OR) for any incident neuropsychiatric outcomes in patients with acne exposed to isotretinoin was 0♸0 compared with those on oral antibiotics 0♹4 (95% CI 0♸7–1♰2) compared with those using topical anti-acne medicines and 1♰6 (95% CI 0♹7–1♱6) compared with those without a prescription for anti-acne medicines. We included 30 866 patients prescribed isotretinoin for their acne, 44 748 prescribed oral antibiotics, 108 367 prescribed topical anti-acne agents and 78 666 patients with acne but without an anti-acne prescription. Outcomes included diagnoses of any incident sleep or mental health disorder, or nonfatal self-harm within 1 year of the index prescription. We analysed data for individuals with acne in this age range with a dispensed prescription for isotretinoin or a control prescription. The database included over 12 million patients aged 12–27 years. MethodsĪ propensity score-matched cohort study of electronic medical records between the years 20 with patients followed up for 1 year after their index dispensed prescription was conducted. To establish and quantify the association between isotretinoin use for acne and 1-year incident neuropsychiatric adverse outcomes. Severe neuropsychiatric outcomes have been reported in individuals exposed to isotretinoin, but the evidence is inconclusive and complicated by several methodological limitations.