Important Controversies Associated with Isotretinoin Therapy for Acne

@article{Wolverton2013ImportantCA,
  title={Important Controversies Associated with Isotretinoin Therapy for Acne},
  author={Stephen E Wolverton and Julie Harper},
  journal={American Journal of Clinical Dermatology},
  year={2013},
  volume={14},
  pages={71-76}
}
Isotretinoin is a remarkably effective drug for severe, recalcitrant acne vulgaris. Soon after the drug’s release in the early 1980s, a number of important adverse effects were reported subsequently leading to a variety of medical and medicolegal controversies. Three of these controversies will be highlighted concerning the putative role of isotretinoin in (1) depression and suicide, (2) inflammatory bowel disease, and (3) iPledge and pregnancy prevention programs. It appears that a very small… 
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References

SHOWING 1-10 OF 29 REFERENCES
No association found between patients receiving isotretinoin for acne and the development of depression in a Canadian prospective cohort.
TLDR
Isotretinoin does not appear to be associated with the development of depression, and denying patients with significant acne an effective medication for fear of developing depression may not be indicated at this point in time.
Possible Association Between Isotretinoin and Inflammatory Bowel Disease
TLDR
In a subgroup of patients, isotretinoin might serve as a trigger for IBD, and strength of causality was determined using the Naranjo adverse drug reaction (ADR) probability scale.
Isotretinoin and antidepressant pharmacotherapy: a prescription sequence symmetry analysis.
TLDR
The results do not support an association between the use of isotretinoin and the onset of depression, and results were found for minocycline.
Evaluation of depressive symptoms in acne patients treated with isotretinoin
TLDR
The results provide no relationship between isotretinoin use and depression in acne patients and Improvement in anxiety was detected later than the improvement in depressive symptoms and a statistically significant difference was detected between the first and the second follow-up.
Changes of psychiatric parameters and their relationships by oral isotretinoin in acne patients
TLDR
Results indicate that oral isotretinoin therapy alleviates depressive symptoms and improvements in depression are directly related to acne‐related life quality improvements rather than to improvement in acne grade.
A pilot study evaluating anxiety and depressive scores in acne patients treated with isotretinoin
TLDR
This pilot study was unable to detect an association between the use of isotretinoin and an increased risk for anxiety, depression, or suicidal thoughts.
Isotretinoin use and the risk of inflammatory bowel disease: a population-based cohort study.
TLDR
In prespecified secondary analyses, some evidence was found of associations with isotretinoin as well as topical acne medications, suggesting a possible association between IBD and acne itself, and additional research is needed to explore this possibility.
A Causal Association Between Isotretinoin and Inflammatory Bowel Disease Has Yet to Be Established
TLDR
Current evidence is insufficient to confirm or refute a causal association between isotretinoin and IBD, and additional prospective or well-designed retrospective studies are needed to definitively establish causality.
A prospective study of the responsiveness of depression and suicidal ideation in acne patients to different phases of isotretinoin therapy.
TLDR
Patients with acne were prescribed a standard 16-week treatment regime with isotretinoin and reported significant improvements in the cognitive-affective features of depression during the first phase of treatment, but not during the second phase, and Corresponding Improvements in the somatic symptoms of depression and hopelessness were not found.
Prospective study of depressive symptoms and quality of life in acne vulgaris patients treated with isotretinoin compared to antibiotic and topical therapy
TLDR
This pilot study does not appear to support any direct link between depression and isotretinoin, apart from being a rare unpredictable idiosyncratic side‐effect, and because of the study limitations, a larger study is needed to confirm the findings.
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