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Kim HJ, Kim YH. Exploring Acne Treatments: From Pathophysiological Mechanisms to Emerging Therapies. Int J Mol Sci 2024; 25:5302. [PMID: 38791344 PMCID: PMC11121268 DOI: 10.3390/ijms25105302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Acne vulgaris is a common dermatological condition that can present across different ages but predominantly affects adolescents and young adults. Characterized by various lesion types, the pathogenesis of acne is complex, involving genetic, hormonal, microbial, and inflammatory factors. This review comprehensively addresses current and emerging acne management strategies, emphasizing both topical and systemic treatments, procedural therapies, and dietary modifications. Key topical agents include retinoids, benzoyl peroxide, antibiotics, and other specialized compounds. Systemic options like antibiotics, hormonal therapies, and retinoids offer significant therapeutic benefits, particularly for moderate to severe cases. Procedural treatments such as laser devices, photodynamic therapy, chemical peels, and intralesional injections present viable alternatives for reducing acne symptoms and scarring. Emerging therapies focus on novel biologics, bacteriophages, probiotics, and peptides, providing promising future options. This review underscores the importance of personalized approaches to treatment due to the multifaceted nature of acne, highlighting the potential of innovative therapies for improving patient outcomes.
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Affiliation(s)
- Hyun Jee Kim
- Department of Dermatology, International St. Mary’s Hospital, College of Medicine, Catholic Kwandong University, Incheon 22711, Republic of Korea;
| | - Yeong Ho Kim
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Miller K, McKean A, Hand J, Rackley S, Leung JG, LeMahieu A, Geske J, Bostwick JM. The occurrence of mental health symptoms in isotretinoin-treated adolescents. Pediatr Dermatol 2024. [PMID: 38500340 DOI: 10.1111/pde.15595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/24/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Isotretinoin treatment for acne can reduce adverse psychiatric outcomes in adults, but there has been little investigation of the incidence of psychiatric outcomes in treated adolescents. METHODS This retrospective cohort study using the Rochester Epidemiology Project identified 606 patients aged 12-18 prescribed isotretinoin over a 10-year period between January 1, 2008 and December 31, 2017. Medical records were reviewed to identify psychiatric diagnoses before and during isotretinoin therapy, as well as psychiatric symptoms not captured by formal diagnoses and changes to isotretinoin dosing because of psychiatric diagnoses or symptoms. RESULTS One hundred seventy-seven (29.2%) had a psychiatric diagnosis prior to isotretinoin initiation, but 98 (16.2%) had a new psychiatric diagnosis or psychiatric symptom while taking isotretinoin. Patients with a psychiatric history were no more likely than those without to receive a new psychiatric diagnosis during treatment (4.5% vs. 3.7%; p = .650), but did experience more psychiatric symptoms, primarily low mood and mood swings (23.7% vs. 7.7%; p < .001). Only 25.5% of the 98 with a new psychiatric diagnosis or psychiatric symptom had a subsequent dose change. A dose change was more likely if patients received a new psychiatric diagnosis (41.7% vs. 20.3%; p = .037) or patients did not have a psychosocial explanation for psychiatric symptoms (34.4% vs. 10.8%; p = .009). CONCLUSIONS A substantial proportion of adolescent patients prescribed isotretinoin had a prior psychiatric diagnosis. This predicts more psychiatric symptoms during isotretinoin treatment. Adolescents with a psychiatric history who have worsening symptoms and those with new-onset psychiatric symptoms would benefit from close monitoring while taking isotretinoin.
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Affiliation(s)
- Keith Miller
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alastair McKean
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer Hand
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Sandra Rackley
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan G Leung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - Allison LeMahieu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer Geske
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - J Michael Bostwick
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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Jarab AS, Al-Azzam SI, Al-Mutairi S, Abu Heshmeh S, Mukattash TL, AL-Qerem W, Beiram R, Aburuz S. Community pharmacists' knowledge and awareness about isotretinoin therapy and its dispensing practice in Jordan. Heliyon 2023; 9:e22354. [PMID: 38053915 PMCID: PMC10694323 DOI: 10.1016/j.heliyon.2023.e22354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/07/2023] Open
Abstract
A validated self-reported questionnaire was used to evaluate pharmacists' knowledge about isotretinoin and their awareness of isotretinoin dispensing practice. The majority were not able to recognize the initial dose of isotretinoin, the potential side effects such as dyslipidemia and liver toxicity, the potential interaction with tetracycline and Vitamin A and the contraindications of isotretinoin. Around 41.3 % of the pharmacists dispensed isotretinoin without a prescription, and the majority did not recognize that isotretinoin should be dispensed for only 30 days, should not be dispensed without an emphasis on the appropriate indication, and did not know the appropriate duration of isotretinoin therapy. Male gender and postgraduate degree were associated with better awareness, while increased work experience and postgraduate degree were associated with better knowledge about isotretinoin therapy. Nevertheless, both male and female pharmacists demonstrated equivalent knowledge levels. The current study demonstrates the need to implement educational programs to improve pharmacists' knowledge and awareness about isotretinoin and its dispensing practice.
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Affiliation(s)
- Anan S. Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Sayer I. Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | | | - Shrouq Abu Heshmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Tareq L. Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Walid AL-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P.O. Box 130, Amman, 11733, Jordan
| | - Rami Beiram
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Salah Aburuz
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
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Fernandes T, Magina S. Oral isotretinoin in the treatment of juvenile acne and psychiatric adverse effects - a systematic review. Cutan Ocul Toxicol 2023; 42:83-90. [PMID: 37343232 DOI: 10.1080/15569527.2023.2227889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Acne vulgaris is a very prevalent dermatological condition, especially among adolescents and young adults up to 25 years old, classifying it as juvenile acne. One of the most effective treatments for severe acne is isotretinoin, a derivative of retinoic acid. Despite its high efficacy, this drug has been linked to several side effects including psychiatric adverse alterations, such as anxiety, depression and even suicide. With this systematic review we aim to determine if it is possible to establish a causal relation between oral isotretinoin in the treatment of juvenile acne and the appearance of psychiatric adverse effects. MATERIALS AND METHODS We searched two distinct databases, PubMed and Web of Science, and considered the work published between January 2000 and November 2021. RESULTS Out of the 599 identified articles, we included 19 studies in this systematic review. Globally, the results we found do not support an association between the use of isotretinoin for acne treatment and mental side effects and the safety of this drug appears to be assured. However, the individual characteristics of each adolescent and their environment should be considered; the personal and family history of mental disorders are pointed out as red flags we should look out for when treating these patients. CONCLUSION Despite this being a highly debated topic, especially among the dermatology community, more studies with larger populations and randomised controlled trials are necessary to increase the strength of the evidence presented.
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Affiliation(s)
- Tânia Fernandes
- Department of Biomedicine - Pharmacology and Therapeutics Unit, Faculty of Medicine, University of Oporto, Porto, Portugal
| | - Sofia Magina
- Department of Dermatology and Venereology, CHSJoão, Porto, Portugal
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Aktas H, Bahçe ZŞ. Evaluation of the Incidence of Anal Fissures in Patients who Systemic Isotretinoin Therapy for Acne. Dermatol Pract Concept 2023; 13:e2023133. [PMID: 37557107 PMCID: PMC10412088 DOI: 10.5826/dpc.1303a133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Isotretinoin is an effective drug widely used in the treatment of severe acne. In this study, we tried to evaluate the incidence of anal fissures with clinical and laboratory side effects associated with isotretinoin. METHODS The study evaluated 210 patients who received systemic isotretinoin treatment. Especially patients with constipation and anal bleeding were evaluated by the General Surgery clinic to arrange appropriate treatments. RESULTS Of 210 patients included in the study, 138 (65.7%) were female and 72 (34.3%) were male, with a mean age of 23.7 years. The most common adverse event was dry lips in 206 (98.1%) patients. The mucocutaneous side effects were constipation 36 (17.1%), anal bleeding 18 (8.6%), mucosal erosion 10 (4.7%), anal fissure 7 (3.3%). Treatment was discontinued due to elevated liver function tests in 5 patients (2.3%), and because anal bleeding could not be controlled in 1 patient. CONCLUSIONS Isotretinoin is the most effective acne medicine used today. Clarification of the patients about the rarely seen side effects such as dryness, erosion, fissure and bleeding in the anal mucosa in addition to the common mucocutaneous side effects will ensure that patients are more cautious and increase their tolerance to the treatment.
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Affiliation(s)
- Hamza Aktas
- Private Memorial Hospital, Department of Dermatology, Diyarbakır, Turkey
| | - Zeynep Şener Bahçe
- Private Memorial Hospital, Department of General Surgery, Diyarbakır, Turkey
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Abstract
IMPORTANCE Acne vulgaris is an inflammatory disease of the pilosebaceous unit of the skin that primarily involves the face and trunk and affects approximately 9% of the population worldwide (approximately 85% of individuals aged 12-24 years, and approximately 50% of patients aged 20-29 years). Acne vulgaris can cause permanent physical scarring, negatively affect quality of life and self-image, and has been associated with increased rates of anxiety, depression, and suicidal ideation. OBSERVATIONS Acne vulgaris is classified based on patient age, lesion morphology (comedonal, inflammatory, mixed, nodulocystic), distribution (location on face, trunk, or both), and severity (extent, presence or absence of scarring, postinflammatory erythema, or hyperpigmentation). Although most acne does not require specific medical evaluation, medical workup is sometimes warranted. Topical therapies such as retinoids (eg, tretinoin, adapalene), benzoyl peroxide, azelaic acid, and/or combinations of topical agents are first-line treatments. When prescribed as a single therapy in a randomized trial of 207 patients, treatment with tretinoin 0.025% gel reduced acne lesion counts at 12 weeks by 63% compared with baseline. Combinations of topical agents with systemic agents (oral antibiotics such as doxycycline and minocycline, hormonal therapies such as combination oral contraception [COC] or spironolactone, or isotretinoin) are recommended for more severe disease. In a meta-analysis of 32 randomized clinical trials, COC was associated with reductions in inflammatory lesions by 62%, placebo was associated with a 26% reduction, and oral antibiotics were associated with a 58% reduction at 6-month follow-up. Isotretinoin is approved by the US Food and Drug Administration for treating severe recalcitrant nodular acne but is often used to treat resistant or persistent moderate to severe acne, as well as acne that produces scarring or significant psychosocial distress. CONCLUSIONS AND RELEVANCE Acne vulgaris affects approximately 9% of the population worldwide and approximately 85% of those aged 12 to 24 years. First-line therapies are topical retinoids, benzoyl peroxide, azelaic acid, or combinations of topicals. For more severe disease, oral antibiotics such as doxycycline or minocycline, hormonal therapies such as combination oral conceptive agents or spironolactone, or isotretinoin are most effective.
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Affiliation(s)
- Dawn Z Eichenfield
- Department of Dermatology, University of California San Diego School of Medicine, La Jolla
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California
| | - Jessica Sprague
- Department of Dermatology, University of California San Diego School of Medicine, La Jolla
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California
| | - Lawrence F Eichenfield
- Department of Dermatology, University of California San Diego School of Medicine, La Jolla
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
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Melo DF, Lemes LR, Alves AL, Frattini SC, Obadia DL, Tortelly VD. Low-dose oral isotretinoin in a young female with dissecting cellulitis. Pediatr Dermatol 2021; 38:1573-1574. [PMID: 34647351 DOI: 10.1111/pde.14829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/13/2021] [Accepted: 09/18/2021] [Indexed: 11/30/2022]
Abstract
Dissecting cellulitis (DC) is a chronic inflammatory primary neutrophilic scarring alopecia. It predominantly affects the vertex and occipital regions of Afro-descendent men. Female DC is uncommon, and little is known about this condition in childhood. This paper reports a pediatric female case of DC with an excellent therapeutic response to low-dose oral isotretinoin.
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Affiliation(s)
- Daniel Fernandes Melo
- Dermatology Department, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Luciana Rodino Lemes
- Dermatology Department, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Ana Luisa Alves
- Dermatology Department, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | | | - Daniel Lago Obadia
- Dermatology Department, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
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Abstract
Retrospective medical record review is often used to answer the "why" questions that statistical modeling cannot. In addition to its utility as an explanatory tool, it can be used to generate hypotheses using available retrospective data and so is a convenient guide for developing future prospective studies. A recent review of articles that used the retrospective medical record review method listed 10 best practices that ought to be followed. However, an issue that is not listed is the use of sampling weights, which are important when one can only conduct retrospective medical record review for a sample of the target population. Although that review acknowledged the importance of carefully selecting a sampling strategy for such a scenario and indeed had outlined 3 commonly used sampling methods (convenience, simple random, and systematic), the authors say nothing of the use of sampling information at the data analysis stage. This article aims to fill that gap and to demonstrate why the use of sample weights ought to be another best practice to add to the list by reviewing well-known theoretical details and some published data analysis examples.
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Affiliation(s)
- Ernest Shen
- Kaiser Permanente Department of Research and Evaluation, Pasadena, CA
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Oliveira CMMD, Almeida LMC, Bonamigo RR, Lima CWGD, Bagatin E. Consensus on the therapeutic management of rosacea - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:53-69. [PMID: 33172727 PMCID: PMC7772594 DOI: 10.1016/j.abd.2020.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/14/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Rosacea is a chronic inflammatory disease of the skin, relatively more frequent in women over 30 with a low phototype and proven genetic predisposition. Although its etiology is unknown and possibly multifactorial, the immunological abnormality, associated with neurovascular dysregulation and triggering factors, are important elements in its pathophysiology, which lead to the main changes of inflammation, vasodilation, and angiogenesis that are responsible for the clinical manifestations. Despite the lack of cure, numerous therapeutic options are available for the different clinical presentations of the disease, with satisfactory responses. OBJECTIVE To reach a consensus, with recommendations from experts, on the therapeutic management of rosacea suitable to the Brazilian setting. METHODS The study was conducted by five specialized dermatologists from university centers, representatives of the different Brazilian regions, with experience in rosacea, who were appointed by the Brazilian Society of Dermatology. Based on the adapted DELPHI methodology, the experts contributed through an updated bibliographic review of the scientific evidence, combined with personal experiences. RESULTS The group of experts reached a consensus on the relevant aspects in the therapeutic management of rosacea, providing information on epidemiology, pathophysiology, triggering factors, clinical condition, classification, quality of life, and comorbidities. Consensus was defined as approval by at least 90% of the panel. CONCLUSION Despite the impossibility of cure, there are several therapeutic alternatives specific to each patient that provide excellent results, with chances of total improvement and long periods of remission, promoting a positive impact on quality of life. This consensus provides detailed guidance for clinical practice and therapeutic decisions in rosacea.
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Affiliation(s)
| | - Luiz Mauricio Costa Almeida
- Department of Dermatology, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil; Dermatology Service, Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, MG, Brazil
| | - Renan Rangel Bonamigo
- Dermatology Service, Hospital das Clínicas de Porto Alegre, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Ediléia Bagatin
- Department of Dermatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Sharma S, Sahu P, Dayal S, Yadav A, Brar K. Nevus Comedonicus Suppurativa: A Report of a Novel Entity. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2020; 13:36-39. [PMID: 32884617 PMCID: PMC7442311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Nevus comedonicus and hidradenitis suppurativa (HS) are disorders of the pilosebaceous unit sharing a similar pathogenesis of follicular occlusion. To our knowledge, less than 10 cases of HS-like lesions complicating nevus comedonicus have been reported. We describe a six-year-old female child with congenital linear nevus comedonicus in the left axilla and groin, complicated by recurrent HS-like lesions in the two years prior to presenting to our clinic. After a meticulous review of the literature, we propose a novel term, nevus comedonicus suppurativa, for this clinical entity.
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Affiliation(s)
- Shruti Sharma
- Drs. Sharma, Sahu, Dayal, and Yadav are with the Department of Dermatology at the Pandit B.D. Sharma Postgraduate Institute of Medical Sciences in Rohtak, Haryana, India
- Dr. Brar is with the Department of Pathology at the Pandit B.D. Sharma Postgraduate Institute of Medical Sciences in Rohtak, Haryana, India
| | - Priyadarshini Sahu
- Drs. Sharma, Sahu, Dayal, and Yadav are with the Department of Dermatology at the Pandit B.D. Sharma Postgraduate Institute of Medical Sciences in Rohtak, Haryana, India
- Dr. Brar is with the Department of Pathology at the Pandit B.D. Sharma Postgraduate Institute of Medical Sciences in Rohtak, Haryana, India
| | - Surabhi Dayal
- Drs. Sharma, Sahu, Dayal, and Yadav are with the Department of Dermatology at the Pandit B.D. Sharma Postgraduate Institute of Medical Sciences in Rohtak, Haryana, India
- Dr. Brar is with the Department of Pathology at the Pandit B.D. Sharma Postgraduate Institute of Medical Sciences in Rohtak, Haryana, India
| | - Anjali Yadav
- Drs. Sharma, Sahu, Dayal, and Yadav are with the Department of Dermatology at the Pandit B.D. Sharma Postgraduate Institute of Medical Sciences in Rohtak, Haryana, India
- Dr. Brar is with the Department of Pathology at the Pandit B.D. Sharma Postgraduate Institute of Medical Sciences in Rohtak, Haryana, India
| | - Komal Brar
- Drs. Sharma, Sahu, Dayal, and Yadav are with the Department of Dermatology at the Pandit B.D. Sharma Postgraduate Institute of Medical Sciences in Rohtak, Haryana, India
- Dr. Brar is with the Department of Pathology at the Pandit B.D. Sharma Postgraduate Institute of Medical Sciences in Rohtak, Haryana, India
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Suuberg A. Psychiatric and Developmental Effects of Isotretinoin (Retinoid) Treatment for Acne Vulgaris. Curr Ther Res Clin Exp 2019; 90:27-31. [PMID: 30828405 PMCID: PMC6383167 DOI: 10.1016/j.curtheres.2019.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/29/2019] [Indexed: 12/22/2022] Open
Abstract
Isotretinoin teratogenicity well established; psychiatric effects documented, controversial Disturbed retinoid signaling implicated in isotretinoin teratogenic and psychiatric effects Effect of genetics on susceptibility to psychiatric side effects is possible, not yet known Postnatal neurocognitive effects of isotretinoin not yet established
Background An association between isotretinoin (13-cis-retinoic acid, sold under trade names including Accutane [Hoffmann-La Roche Inc, Basel, Switzerland]) and birth defects, depression, and suicide is well documented but controversial. A link to psychosis and exacerbation of bipolar symptoms is less extensively addressed in the literature. Objective Given recent conceptualization of psychotic disorders as neurodevelopmental, and current interest in possible shared etiology of different neurodevelopmental disorders such as psychosis, autism, and intellectual disability, this review concurrently examines the literature on developmental (primarily teratogenic) and psychiatric side effects of isotretinoin exposure. The goal of concurrent review is to identify shared mechanisms in the literature that may inform future efforts to clarify the neurocognitive and psychiatric effects of isotretinoin exposure at different developmental stages or given different genetic backgrounds. Methods Literature was obtained by PubMed search for the term isotretinoin in combination with each of the terms psychosis, psychiatric, and teratogenic. Resulting articles met inclusion criteria for review if they addressed psychiatric side effects of isotretinoin treatment or the neurobehavioral teratology of isotretinoin. Results The association of isotretinoin exposure with prenatal developmental toxicity is well established. Although numerous reports also link isotretinoin treatment with psychiatric side effects, this association remains controversial. Conclusions The extent to which isotretinoin influences pediatric and adult development and cognition, and whether and why certain individuals may be susceptible to psychiatric side effects, remains to be clarified. Curr Ther Res Clin Exp. 2019; 80:XXX–XXX)
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Brewer AC, Huber JT, Girardo ME, Kosiorek HE, Burns MW, Stewart TD, Blair JE. Cutaneous effects associated with fluconazole in patients treated for coccidioidomycosis. Int J Dermatol 2018; 58:250-253. [PMID: 30229876 DOI: 10.1111/ijd.14238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/03/2018] [Accepted: 08/21/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Fluconazole is the most commonly used antifungal treatment for various forms of coccidioidomycosis. Although we had anecdotally observed a high proportion of patients reporting cutaneous adverse effects associated with fluconazole treatment, this observation was not well described in the medical literature, and we were unsure of the additional effect of the arid desert environment of Arizona. METHODS We performed a one-time, voluntary survey of patients with coccidioidomycosis and compared the responses of patients treated with fluconazole with those of untreated patients. RESULTS From January 1, 2015, to August 22, 2017, 62 fluconazole-treated and 35 untreated patients with coccidioidomycosis provided consent and were enrolled in the study; demographics were similar between the two groups. Among the 62 fluconazole-treated patients, daily dosages ranged from 200 mg to 800 mg. However, most (44/62, 71%) took 400 mg daily, the typical dose for the treatment of coccidioidomycosis. The median fluconazole treatment duration at the time of study participation was 6 months. When compared with untreated patients, those taking fluconazole had more moderate to severe dry lips (74.2% [46/62] vs. 23.5% [8/34]; P < 0.001), dry skin (45.8% [27/59] vs. 22.9% [8/35]; P = 0.03), and alopecia (31.1% [19/61] vs. 11.4% [4/35]; P = 0.004). CONCLUSIONS For the treatment of coccidioidomycosis, patients receiving fluconazole reported significantly more severe cutaneous effects, including dry lips, dry skin, and alopecia, than untreated patients. Our findings identify an association but do not prove causality.
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Affiliation(s)
| | - Jordan T Huber
- Department of Dermatology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | | | | | - Mark W Burns
- Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ, USA
| | | | - Janis E Blair
- Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ, USA
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Abstract
Acne vulgaris is a disorder of the sebaceous follicle. The cause is multifactorial, and both adolescents and adults can be affected. Acne is associated with a significant financial burden and considerable psychological distress. Treatment options are reviewed, including over-the-counter medications, prescription medications, and in-office procedures.
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Affiliation(s)
- Danielle Well
- Danielle Well is a nurse practitioner specializing in dermatology at Rockville Dermatology, P.C. Rockville Centre, N.Y., and Dr. Stuart R. Levine Dermatology and Dermatologic Surgery, Brooklyn, N.Y
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14
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Abstract
Acne vulgaris is a commonly seen dermatologic condition that plagues millions and can be very psychosocially disabling. Severe and recalcitrant acne is typically treated with isotretinoin. Isotretinoin is a synthetic vitamin A derivative that has been available since 1982.This therapeutic option has been the most effective at putting severe and recalcitrant acne vulgaris into remission. Despite its effectiveness,it has been associated with inflammatory bowel disease, depression, suicidality, and teratogenicity. We review the current literature on isotretinoin's role in inflammatory bowel disease, depression, and suicidality. In addition, we review whether or not the iPledge program has been successful at reducing pregnancy rates while on isotretinoin.
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