No association between isotretinoin and impulsivity in patients with moderate-to-severe acne vulgaris

BACKGROUND

Acne vulgaris (AV) is one of the common dermatologic diseases that usually affects people during adolescence. Reports have shown that isotretinoin, the first-line therapy option for moderate-to-severe AV, could lead to mood disturbances and suicidality. Impulsivity is the tendency to act prematurely without foresight and is a significant risk factor for suicidality. This study aimed to test the hypothesis that isotretinoin would lead to an increase in impulsivity.

METHODS

Seventeen patients with AV were enrolled. The study was planned as a naturalistic 3-month follow-up study. Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Barratt Impulsiveness Scale (BIS), Go/No-go Task (GNG), and Balloon Analog Risk Task (BART) were administered before and after the isotretinoin treatment.

RESULTS

We found a significant improvement in the severity of anxiety (P = 0.015; t = 2.72) and depression symptoms (P = 0.08; t = 3.04) in AV patients at the end of 3 months. Self-report impulsivity characteristics with BIS stayed unchanged (P = 0.434; t = 0.80). Besides, no statistically significant difference was found in behavioral task results associated with response inhibition with GNG (P = 0.52; t = 0.65) and impulsive decision-making with BART (P = 0.842; t = -0.20). However, there was a significant decrease in omission errors, with GNG suggesting improvement in attention domain (P = 0.020; W = 90.0) after the follow-up.

CONCLUSIONS

It has been demonstrated that isotretinoin treatment improves the severity of depression, anxiety symptoms, and attention performance in AV patients. However, there was no significant change in patients' impulsivity severity based on self-reports and behavioral performances based on GNG and BART.

First use of the Adolescent Depression Rating Scale (ADRS) in the management of young people with severe acne treated with isotretinoin: a pilot study of an active monitoring of depressive disorders by dermatologists

BACKGROUND

During isotretinoin treatment, special attention is required to detect any symptom or change in the mental health of patients. The monitoring is complex for adolescents because of confounding factors such as mood changes associated with adolescence and puberty and the higher psychosocial impairment due to the acne itself.

AIM

To determine the utility of the Adolescent Depression Rating Scale (ADRS) for monitoring symptoms in adolescents before and during isotretinoin treatment in dermatology real-life practice.

METHODS

This was a national, multicentre prospective study that enrolled a random sample of dermatologists treating adolescents. An algorithm including ADRS score and its changes between consecutive visits was used. At each visit, dermatologists rated their satisfaction with ADRS and its ease of use, while patients rated the acceptability of the ADRS.

RESULTS

In total, 70 dermatologists used the algorithm for 1227 visits of 283 adolescents receiving isotretinoin. Of these 70 dermatologists, 80.8% were satisfied/very satisfied with the ADRS, 82.7% considered the use of the ADRS in clinical practice to be easy/very easy and 75% considered that the ADRS enabled them to discuss more easily the risk of depression with their patients. For the patients, acceptability of the ADRS was considered good by 93.8%.

CONCLUSIONS

The implementation of the ADRS could be valuable in dermatology practice, optimizing the monitoring of patients and the good use of isotretinoin.